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Haley, William, and Joanne Elayoubi. "Individual Differences in Caregiving: Application of a Stress Process Model." Innovation in Aging 4, Supplement_1 (December 1, 2020): 659. http://dx.doi.org/10.1093/geroni/igaa057.2276.
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Abstract Stress process models propose individual differences in caregiver outcomes depending on background characteristics and primary caregiving stressors, and resilience factors including stress appraisals, and internal and external resources. This paper will examine individual differences in the effects of the transition to caregiving on indicators of well-being and biomarkers of inflammation. Completed analyses show that, contrary to previous findings from cross-sectional studies, changes in well-being after caregiving generally do not differ by caregiver race, gender, age, or relationship category (spouse, adult child, others). Additional analyses examine the relationship of primary caregiving stressors (e.g. ADL and behavioral problems), stress appraisals (e.g., perceived stressfulness of ADL and IADL problems, perceived benefits of caregiving), and personality with changes in well-being and inflammation after the transition to caregiving. The lack of differences on most biomarker measures suggests that caregivers show substantial resilience in the face of significant, chronic caregiving stress.
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Badana, Adrian, and William E. Haley. "USING A STRESS PROCESS MODEL TO EXAMINE RACIAL DIFFERENCES IN CAREGIVER WELL-BEING AND HEALTH." Innovation in Aging 3, Supplement_1 (November 2019): S487. http://dx.doi.org/10.1093/geroni/igz038.1807.
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Abstract Current research must utilize nationally-representative samples of older adults and their family caregivers to accurately reflect the growing diversity of the United States. This study aims to use a stress process model to examine potential racial differences in caregiving in a population-based sample of 844 White and 389 Black family caregivers in the United States. We conducted 3 x 2 x 2 (relationship type x race x dementia care status) factorial ANOVAs to examine potential differences in caregiving stressors, appraisals, resources, and mental and physical health outcomes among primary family caregivers. Results indicated significant racial differences in caregiving on several stress process measures. Although Black caregivers reported more caregiving stressors, compared to White caregivers, they tended to report more positive appraisals of caregiving and more caregiving resources. Dementia caregivers tended to report greater caregiving stressors and worse measures of appraisal compared to non-dementia caregivers. There was a significant two-way interaction among relationship type and dementia care status for the caregiving stressor, hours of care. A stress process model can allow researchers to investigate various factors associated with racial differences in caregiving.
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Cimarolli, Verena R., Amy Horowitz, Danielle Jimenez, Xiaomei Shi, Francesca Falzarano, and Jillian Minahan. "THE SOCIOCULTURAL STRESS PROCESS MODEL APPLIED TO LONG-DISTANCE CAREGIVING." Innovation in Aging 3, Supplement_1 (November 2019): S557. http://dx.doi.org/10.1093/geroni/igz038.2057.
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Abstract This study investigated the impact of LDC on mental health utilizing the Sociocultural Stress Process Model as a conceptual framework. A path analytic model tested the impact of caregiving stressors (i.e. distance, frequencies of visits, hours spent helping, burden) and sociocultural values (i.e. familialism) on LDCs’ mental health outcomes (i.e. depression, anxiety), and resources (i.e. coping strategies, social support) which can mediate the association between stressors and mental health outcomes while controlling for socio-demographics. Results show that resources did not mediate the effects of stressors on the mental health outcomes. However, both higher depression and anxiety were associated with living closer to the care recipient (CR), less frequent visits, higher burden, being younger, being female, and less optimal income adequacy. In addition, higher depression was associated with lower use of coping strategies and higher education. Higher anxiety was also associated with lower levels of social support and higher familialism.
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Falzarano, Francesca, and Karen Siedlecki. "Dementia Caregiving and Cognition: An Extension of the Stress Process Model." Innovation in Aging 4, Supplement_1 (December 1, 2020): 476–77. http://dx.doi.org/10.1093/geroni/igaa057.1542.
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Abstract As cases of Alzheimer’s disease and related dementias (ADRD) continue to rise, informal caregivers are critical resources in providing dementia care, yet caregiving is associated with high levels of burden, stress, anxiety and depression. Caregiving can be a prolonged and stressful experience, and impaired cognitive functioning in caregivers could impact their own health and quality of life and compromise the quality of care provided to their care-recipient. Thus, the purpose of the current study is to use the Stress Process Model as a guiding theoretical framework to identify whether primary stressors (e.g., care recipient functional status, cognitive problems) or secondary stressors (e.g., loss of self, economic conflict) predict performance across seven domains of cognition in 50 primary ADRD caregivers. Hierarchical regression analyses were used to examine which primary and secondary stressors emerge as predictors of cognitive performance. Results indicated that primary stressors (e.g., problematic dementia behaviors and relational deprivation) significantly predicted working memory performance and secondary stressors (e.g., economic strain, loss of self) significantly predicted implicit memory performance. Additionally, higher levels of caregiver burden predicted worse performance on executive functioning and implicit memory measures. Overall, the findings of this study indicate that the stress associated with caregiving may have adverse effects beyond psychosocial outcomes, and findings can be used to inform policies and practices with regard to caregiver health and well-being.
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Roth, David L., William Haley, Orla Sheehan, Jeremy Walston, David Rhodes, and Virginia Howard. "DESIGNING FAMILY CAREGIVER STUDIES THAT BALANCE STRESS PROCESS AND HELPING RELATIONSHIP PERSPECTIVES." Innovation in Aging 3, Supplement_1 (November 2019): S235. http://dx.doi.org/10.1093/geroni/igz038.873.
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Abstract Family caregiving is often characterized as a chronically stressful situation, and stress process models have been the dominant conceptual foundation underlying caregiving studies for decades. Recently, this perspective has been augmented with more positive views that emphasize potentially healthy and prosocial aspects of caregiving. Replicated findings from population-based studies show that caregivers have lower mortality rates than noncaregivers, consistent with the more balanced conceptual approach. The Caregiving Transitions Study is investigating 251 participants who transitioned into a caregiving role at some point between two blood samples taken 10 years apart in a national epidemiological study and 251 matched controls. Preliminary analyses confirm that caregiving leads to increased psychological distress. Ongoing analyses are examining changes in inflammatory biomarkers, health status, and positive aspects of caregiving. Findings will be examined alongside our recent meta-analysis of convenience samples that found caregiving to have small and inconsistent relationships with biomarkers of inflammation and immunity.
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DePasquale, Nicole, Courtney A. Polenick, Kelly D. Davis, Phyllis Moen, Leslie B. Hammer, and David M. Almeida. "The Psychosocial Implications of Managing Work and Family Caregiving Roles: Gender Differences Among Information Technology Professionals." Journal of Family Issues 38, no. 11 (May 5, 2015): 1495–519. http://dx.doi.org/10.1177/0192513x15584680.
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An increasing number of adults, both men and women, are simultaneously managing work and family caregiving roles. Guided by the stress process model, we investigate whether 823 employees occupying diverse family caregiving roles (child caregiving only, elder caregiving only, and both child caregiving and elder caregiving, or “sandwiched” caregiving) and their noncaregiving counterparts in the information technology division of a white-collar organization differ on several indicators of psychosocial stress along with gender differences in stress exposure. Compared with noncaregivers, child caregivers reported more perceived stress and partner strain whereas elder caregivers reported greater perceived stress and psychological distress. With the exception of work-to-family conflict, sandwiched caregivers reported poorer overall psychosocial functioning. Additionally, sandwiched women reported more family-to-work conflict and less partner support than their male counterparts. Further research on the implications of combining a white-collar employment role with different family caregiving roles is warranted.
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Chronister, Julie, and Fong Chan. "A stress process model of caregiving for individuals with traumatic brain injury." Rehabilitation Psychology 51, no. 3 (August 2006): 190–201. http://dx.doi.org/10.1037/0090-5550.51.3.190.
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Ice, Gillian H., Aalyia F. A. Sadruddin, Amy Vagedes, Jaja Yogo, and Elizabeth Juma. "Stress associated with caregiving: An examination of the stress process model among Kenyan Luo elders." Social Science & Medicine 74, no. 12 (June 2012): 2020–27. http://dx.doi.org/10.1016/j.socscimed.2012.02.018.
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DePasquale, Nicole, Steven H. Zarit, Jacqueline Mogle, Phyllis Moen, Leslie B. Hammer, and David M. Almeida. "Double- and Triple-Duty Caregiving Men: An Examination of Subjective Stress and Perceived Schedule Control." Journal of Applied Gerontology 37, no. 4 (April 1, 2016): 464–92. http://dx.doi.org/10.1177/0733464816641391.
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Based on the stress process model of family caregiving, this study examined subjective stress appraisals and perceived schedule control among men employed in the long-term care industry (workplace-only caregivers) who concurrently occupied unpaid family caregiving roles for children (double-duty child caregivers), older adults (double-duty elder caregivers), and both children and older adults (triple-duty caregivers). Survey responses from 123 men working in nursing home facilities in the United States were analyzed using multiple linear regression models. Results indicated that workplace-only and double- and triple-duty caregivers’ appraised primary stress similarly. However, several differences emerged with respect to secondary role strains, specifically work–family conflict, emotional exhaustion, and turnover intentions. Schedule control also constituted a stress buffer for double- and triple-duty caregivers, particularly among double-duty elder caregivers. These findings contribute to the scarce literature on double- and triple-duty caregiving men and have practical implications for recruitment and retention strategies in the health care industry.
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Koumoutzis, Athena, and Nader Mehri. "The Impact of Caregiving Intensity and Religiosity on Spouse Caregivers’ Health and Mortality in the United States (2004–2014)." Innovation in Aging 4, Supplement_1 (December 1, 2020): 514. http://dx.doi.org/10.1093/geroni/igaa057.1658.
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Abstract Prior research has indicated that religiosity may buffer against the deleterious effects of caregiving. However, research is lacking in examining the role of religiosity and caregiving intensity in the context of caregiver wellbeing and mortality. Data come from the Health and Retirement Study (2004-2014 waves) and consisted of spousal caregivers and noncaregivers (n= 49,638 person-spells). Pearlin’s Stress Process Model (1990) informed this study to analyze how religiosity impacts caregiver self-rated health and mortality by comparing the intensity of provided care among spousal caregivers and spousal noncaregivers. This study used two indicators to measure religiosity: 1) the importance of religion in life and 2) frequency of attending religious services. Bivariate probit model was used to model the impact of caregiving intensity and religiosity on self-rated health and all-cause mortality. After controlling for sociodemographic and health covariates, results showed that only the importance of religion in life predicted a better self-rated health among high intense spouse caregivers defined by providing >=14 hours of care per week. Findings suggest religiosity may buffer the adverse effect of caregiving stress on health for high intense spousal caregivers. Development and maintenance of religiosity may enhance positive aspects of caregiving and decrease caregiver burden.
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Oyebode, Jan. "Assessment of carers' psychological needs." Advances in Psychiatric Treatment 9, no. 1 (January 2003): 45–53. http://dx.doi.org/10.1192/apt.9.1.45.
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Carers play a vital role in supporting family members who need help. Facts and figures on caregiving are set in the context of current UK policy. Research into the impact of caregiving shows that one-third to one-half of carers suffer significant psychological distress. Factors associated with carer stress are reviewed, including those related to the care-recipient, the caregiver, their relationship, and wider family and social support. The most well-known frameworks for understanding caregiving stress, including stress-process models, are introduced. Measures that may help in assessing psychological needs of carers are reviewed, emphasising the distinction between objective and subjective stress. The range of possible interventions leads to promising evidence of the effectiveness of individual psychosocial interventions, but further research is needed.
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Park, Myonghwa, Sora Choi, Song Ja Lee, Seon Hwa Kim, Jinha Kim, Younghye Go, and Dong Young Lee. "The roles of unmet needs and formal support in the caregiving satisfaction and caregiving burden of family caregivers for persons with dementia." International Psychogeriatrics 30, no. 4 (September 28, 2017): 557–67. http://dx.doi.org/10.1017/s104161021700196x.
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ABSTRACTBackground:A growing number of studies are emphasizing the importance of positive and negative appraisals of caregiving and the utilization of social resources to buffer the negative effects of caring for persons with dementia. By assessing the roles of unmet needs and formal support, this study tested a hypothesized model for Korean family caregivers’ satisfaction and burden in providing care for persons with dementia.Methods:The stress process model and a two-factor model were used as the conceptual framework for this study. Data for 320 family caregivers from a large cross-sectional survey, the Seoul Dementia Management study, were analyzed using structural equation modeling. In the hypothesized model, the exogenous variables were patient symptoms, including cognitive impairment, behavioral problems, and dependency on others to help with activities of daily living and with instrumental activities of daily living. The endogenous variables were the caregiver's perception of the unmet needs of the patient, formal support, caregiving satisfaction, and caregiving burden.Results:The adjusted model explained the mediating effect of unmet needs on the relationship between patient symptoms or formal support and caregiving satisfaction. Formal support also had a mediating effect on the relationship between patient symptoms and unmet needs. Patient symptoms and caregiving satisfaction had a significant direct effect on caregiving burden.Conclusion:The level of unmet needs of persons with dementia and their family caregivers must be considered in the development of support programs focused on improving caregiving satisfaction.
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Koumoutzis, Athena, and Kelly Cichy. "Perceptions of Caregiving: Racial Examinations of Resiliency and Stress." Innovation in Aging 4, Supplement_1 (December 1, 2020): 352. http://dx.doi.org/10.1093/geroni/igaa057.1133.
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Abstract Adult children are at risk of emotional strain when parental caregiving needs emerge. Pearlin’s Stress Process Model (1990) and caregiver studies suggest minority caregivers report lower subjective caregiving burden, however, few studies simultaneously consider both the stresses and rewards of caregiving. Using data from Wave II of the Family Exchange Study (N = 243), we examine racial differences in midlife adults’ perceptions (i.e., stress and rewards) of assisting their parents with activities of daily living (ADLs) and the associations between perceptions of ADL assistance and emotional well-being among adults who help their parents with ADLs. Compared to non-minority caregivers (M = 4.18, SD = 0.91), minority caregivers (M = 4.45, SD = 0.84) found it more rewarding to help their mother (t(314) = -2.54, p < .05), whereas non-minority caregivers (M = 2.25, SD = .1.27) found it more stressful to help their father than did minority caregivers (M = 1.64, SD = 0.99), t(162) = 3.01, p < .01). After controlling for demographics and ADL needs, linear regression analyses revealed that the stress of helping parents predicted depression (F(6, 189) = 5.30, p < .001) and race moderated the association (p < .01); the association was only significant for minority caregivers (p < .05). Implications will be discussed.
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Mcdonald, Thomas P., Thomas K. Gregoire, John Poertner, and Theresa J. Early. "Building a Model of Family Caregiving for Children with Emotional Disorders." Journal of Emotional and Behavioral Disorders 5, no. 3 (September 1997): 138–48. http://dx.doi.org/10.1177/106342669700500302.
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In this article we describe the results of an ongoing effort to better understand the caregiving process in families of children with severe emotional problems. We make two assumptions. First, we assume that these families are essentially like other families but are faced with a special challenge in raising and caring for their special children while at the same time performing the multiple tasks and demands faced by all families. Second, we assume that public policy and programs must be supportive of the care of these children in their own homes and communities whenever possible. The purpose of this article is to present a model of family caregiving that draws broadly from available theory and empirical literature in multiple fields and to subject this model to empirical testing. We use structural equation modeling with latent variables to estimate an empirical model based on the theoretical model. Results of the model testing point to the importance of the child's external problem behaviors and the family's socioeconomic status and coping strategies as determinants of caregiver stress. Other findings highlight difficulties in measuring and modeling the complex mediating process, which includes formal and informal supports, perceptions, and coping behaviors. The use of structural equation modeling can benefit our efforts to support families by making explicit our theories about the important dimensions of this process and the relationship between these dimensions, which can then be subjected to measurement and validation.
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Robison, Julie, Noreen Shugrue, Chanee Fabius, Richard Fortinsky, Martha Porter, and Kristin Baker. "Money Follows the Person and Informal Caregivers: Insights Into a New Stage of the Caregiving Career." Innovation in Aging 4, Supplement_1 (December 1, 2020): 103. http://dx.doi.org/10.1093/geroni/igaa057.340.
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Abstract The Money Follows the Person (MFP) program transitions people to the community after extended institutional stays. This study examines effects of this transition on informal caregivers in this new caregiving career stage. Analyses explore whether and how MFP affects caregivers according to caregiver race/ethnicity, and care recipient age and disability type. Data come from surveys with 686 caregivers of persons in Connecticut’s MFP from November 2014-November 2018. Using Pearlin’s Caregiver Stress Process Model, bivariate and multivariate analyses examine predictors of multiple caregiver well-being indicators. Care recipients: older adults (50%), and younger persons with physical (35%), mental health (8%) or developmental (7%) disabilities. Caregivers: non-Hispanic White (62%), non-Hispanic Black (24%), and Hispanic (14%). Caregivers’ average assistance is 5 days/week, 6 hours/day, with 3 activities of daily living and 5 instrumental activities; 11% are paid for caregiving. Compared to other community-based samples, they report low mean levels of burden (4.7 of 16), anxiety (2.2 of 18) and depressive symptoms (31%), and high positive feelings about caregiving (9.5 of 12). A majority feel less stressed (60%) or no change in stress (20%) compared to before and during the institutional stay. Caregivers across the four care recipient groups don’t differ on most outcomes, although more caregivers of people with developmental disabilities (82% vs. 55-61%) report less stress once the person transitions. Black and Hispanic caregivers report more intensive caregiving, but White caregivers report more burden and subjective stress. Findings illustrate the benefits of programmatic support during a newly defined post-institutionalization caregiving career stage.
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Blandin, Kesstan, and Renee Pepin. "Dementia grief: A theoretical model of a unique grief experience." Dementia 16, no. 1 (July 27, 2016): 67–78. http://dx.doi.org/10.1177/1471301215581081.
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Previous literature reveals a high prevalence of grief in dementia caregivers before physical death of the person with dementia that is associated with stress, burden, and depression. To date, theoretical models and therapeutic interventions with grief in caregivers have not adequately considered the grief process, but instead have focused on grief as a symptom that manifests within the process of caregiving. The Dementia Grief Model explicates the unique process of pre-death grief in dementia caregivers. In this paper we introduce the Dementia Grief Model, describe the unique characteristics of dementia grief, and present the psychological states associated with the process of dementia grief. The model explicates an iterative grief process involving three states— separation, liminality, and re-emergence—each with a dynamic mechanism that facilitates or hinders movement through the dementia grief process. Finally, we offer potential applied research questions informed by the model.
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Burton, Allison M., William E. Haley, Brent J. Small, Margaret R. Finley, Marie Dillinger-Vasille, and Ronald Schonwetter. "Predictors of well-being in bereaved former hospice caregivers: The role of caregiving stressors, appraisals, and social resources." Palliative and Supportive Care 6, no. 2 (May 23, 2008): 149–58. http://dx.doi.org/10.1017/s1478951508000230.
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ABSTRACTObjective:The current literature on caregiving and bereavement indicates that the relationship between these two common life events is complex and needs to be further studied in order to gain a more comprehensive understanding of their interaction.Methods:In the current project, 50 spouses of hospice patients with end-stage lung cancer or dementia were assessed while caregiving and at an average of 4 months after the death on a variety of measures, including caregiving stressors, appraisals, social resources, and well-being. A stress process model was utilized in order to examine which preloss factors were associated with postloss depression, life satisfaction, and grief.Results:Our results indicated that patient diagnosis (cancer or dementia) and caregiver appraisals (stressfulness of functional impairment and positive aspects of caregiving) were not predictors on any of our well-being outcomes. However, fewer months caregiving was a significant predictor of both higher depression and grief postloss. Additionally, lower levels of social activities, smaller social networks, and lower satisfaction with social support were significantly associated with higher postloss depression.Significance of results:Results support both the resource depletion and anticipatory grief hypotheses and suggest that short-term bereavement outcomes are different than factors that predict well-being while caregiving. Future studies should address whether long-term bereavement outcomes differ by baseline caregiving characteristics to guide intervention research.
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Kim, Go-en, and Soondool Chung. "Elderly Mothers of Adult Children with Intellectual Disability: An Exploration of a Stress Process Model for Caregiving Satisfaction." Journal of Applied Research in Intellectual Disabilities 29, no. 2 (March 1, 2015): 160–71. http://dx.doi.org/10.1111/jar.12166.
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Fabius, Chanee D., Jennifer L. Wolff, and Judith D. Kasper. "Race Differences in Characteristics and Experiences of Black and White Caregivers of Older Americans." Gerontologist 60, no. 7 (May 13, 2020): 1244–53. http://dx.doi.org/10.1093/geront/gnaa042.
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Abstract Background and Objectives Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects. Research Design and Methods Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin’s Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources. Results Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race. Discussion and Implications Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers.
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Liu, Jinyu, and Mercedes Bern-Klug. "“I should be doing more for my parent:” Chinese adult children's worry about performance in providing care for their oldest-old parents." International Psychogeriatrics 28, no. 2 (October 22, 2015): 303–15. http://dx.doi.org/10.1017/s1041610215001726.
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ABSTRACTBackground:In China, as is the case in most of the world, family is the largest source of support for frail older adults. Confucian filial piety expectations hold children-in particular sons-responsible for the care of aging parents in China. During the course of caregiving, in addition to positive feelings, the caregiver may feel overwhelmed, entrapped, and worried about their performance, which can have negative health consequences. The purpose of this exploratory study is to examine one dimension of caregiver burden “worry about performance” (WaP) and investigate whether variables inspired by Pearlin's Stress Process Model help to explain the variation of WaP, so that at-risk caregivers can be identified and supported.Methods:Multiple regression was used to analyze CLHLS data from 895 Chinese adult children providing care for their oldest old parent in eight coastal provinces in China. WaP was measured by two items from the Zarit Burden Inventory. Independent variables representing concepts from Pearlin's Stress Process Model and control variables were included in the models.Results:Compared to a model of control variables only, using independent variables inspired by Pearlin's Stress Process Model increased the ability to explain the variation in WaP by three fold to 14%. The following variables increased WaP: parent's IADL level, the amount of time spent caregiving, being a daughter, reporting an emotionally close relationship with the parent, sharing a residence with the parent.Conclusion:Despite not being able to fully operationalize Pearlin's Model with this dataset, analyzing variables that represent concepts from the model was useful in increasing the ability to explain the variation in WaP. Results suggest that caregiver support directed at daughters may be particularly beneficial.
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Brown, Lauren L., Uchechi A. Mitchell, and Jennifer A. Ailshire. "Disentangling the Stress Process: Race/Ethnic Differences in the Exposure and Appraisal of Chronic Stressors Among Older Adults." Journals of Gerontology: Series B 75, no. 3 (June 6, 2018): 650–60. http://dx.doi.org/10.1093/geronb/gby072.
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Abstract Objectives Exposure to stressors is differentially distributed by race/ethnicity with minority groups reporting a higher stress burden than their white counterparts. However, to really understand the extent to which some groups bear a disproportionate stress burden, we need to consider race/ethnic differences in stress appraisal, specifically how upsetting stressors may be, in addition to stress exposure. We examine racial/ethnic differences in both the number of reported chronic stressors across five domains (health, financial, residential, relationship, and caregiving) and their appraised stressfulness among a diverse sample of older adults. Method Data come from 6,567 adults ages 52+ from the 2006 Health and Retirement Study. Results Results show older blacks, U.S. and foreign-born Hispanics report more chronic stress exposure than whites and are two to three times as likely to experience financial strain and housing-related stress. Socioeconomic factors fully explain the Hispanic–white difference in stress exposure, but black–white differences remain. Despite experiencing a greater number of stressors, blacks and U.S.-born Hispanics are less likely to be upset by exposure to stressors than whites. U.S.-born Hispanics are less upset by relationship-based stressors specifically, while blacks are less upset across all stress domains in fully-adjusted models. Foreign-born Hispanics are only less upset by caregiving strain. Discussion The distinction between exposure and appraisal-based measures of stress may shed light on important pathways that differentially contribute to race/ethnic physical and mental health disparities.
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Cairo Notari, Sarah, Nicolas Favez, Luca Notari, Linda Charvoz, and Jean-François Delaloye. "The caregiver burden in male romantic partners of women with non-metastatic breast cancer: The protective role of couple satisfaction." Journal of Health Psychology 22, no. 13 (March 3, 2016): 1668–77. http://dx.doi.org/10.1177/1359105316633285.
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We examined the evolution of the subjective burden of romantic partners caring for women with non-metastatic breast cancer and investigated the moderating role of couple satisfaction on caring stress. Forty-seven partners filled out questionnaires 3 and 12 months after surgery. Using a stress process model, we examined caring stressors and moderating factors (couple satisfaction, coping and social support) as predictors of subjective burden. Results showed that subjective burden decreases over time and that the couple satisfaction largely explains it above and beyond other influential variables. Partners dissatisfied with their couple relationship are especially vulnerable to the stress of caregiving.
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Moss, Sara, Lauren Gebhardt-Kram, Holly Dabelko-Schoeny, and Jennifer Cheavens. "Identifying Care-Related Needs of Family Caregivers of People With Dementia: Beyond the Stress Process Model." Innovation in Aging 4, Supplement_1 (December 1, 2020): 74. http://dx.doi.org/10.1093/geroni/igaa057.241.
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Abstract The psychosocial stress process model (Pearlin et al., 1990) remains a dominant theoretical framework characterizing the transactions between factors affecting outcomes of informal caregivers of people with dementia (PWD). Despite widespread agreement that the model provides an important framework for understanding caregiver experiences and predicting caregiver outcomes, it is not sufficient to clarify the needs of caregivers. Needs are conceptualized as the skills and resources that could be used to ameliorate the negative impacts of caregiving and promote quality of life (Gitlin & Hodgson, 2015). Determining caregiver needs requires appreciation of the complex background, contextual, and stress-related variables described in the stress process model and requires empirically- and theoretically-driven understanding of the diverse resources, materials, and skills that individuals require for global health and functioning. In this study, we conducted a content analysis of existing measures of dementia caregiver needs (N = 54), content analysis of materials related to evidence-based dementia caregiver interventions and government reports and documents (N = 28), and semi-structured in-depth interviews with current caregivers of PWD (N = 12) to identify the personal and care-related needs of family caregivers of PWD. We propose a framework of five inter-related need categories (Health-related needs, environmental needs, psychological needs, social needs, and needs related to the care and functioning of the PWD) that transact with the factors described in the stress process model, ultimately influencing functioning. In the future, we plan to test this model empirically with a nationally representative sample of caregivers.
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Yefimova, Maria, Carolyn Pickering, Christopher Maxwell, Frank Puga, and Tami Sullivan. "RISK AND PROTECTIVE FACTORS FOR ABUSE AND NEGLECT IN DAILY CAREGIVING." Innovation in Aging 3, Supplement_1 (November 2019): S544. http://dx.doi.org/10.1093/geroni/igz038.2003.
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Abstract The stress-process model suggests a variety of factors related to the stress-experience as important in the formation of outcomes including elder abuse and neglect (EAN). Multi-level modeling with days (n=831) nested within caregivers (N=50) was used to evaluate relationships between theoretically-based risk and protective factors and odds of EAN. Disruptions in the daily routine are a significant risk factor for abuse and neglect. Participating in a meaningful activity at least twice a day with the care recipient is a significant protective factor for neglect (OR=0.19; CI=0.06-0.64; p=0.01), but not abuse. Hypotheses that spending the full day together would increase the risk of EAN, and receipt of instrumental support and caregiver participation in self-care would decrease risk, were not supported. Findings demonstrate that the risk of EAN varies from day-to-day in the presence and absence of contextual factors. Moreover, abuse and neglect may have different etiologic pathways.
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Roth, David, and Steven Zarit. "Longitudinal Effects of Becoming a Family Caregiver: The Caregiving Transitions Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 658. http://dx.doi.org/10.1093/geroni/igaa057.2271.
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Abstract Taking on caregiving responsibilities for older adult family members with disabilities is often considered to be a highly stressful experience that may adversely affect the health of caregivers. However, the vast majority of studies in this area compare existing samples of caregivers with questionably matched non-caregiving controls. In this symposium, we will present findings for a population-based sample of persons who became family caregivers while participating in a longitudinal epidemiological study. Changes in health and well-being are compared between these caregivers and non-caregiving control participants who were matched on multiple demographic and pre-caregiving health history variables. All persons enrolled as caregivers were providing sustained and substantial caregiving assistance. Presentations will include 1) a descriptive overview of the screening, eligibility, and enrollment methods used to construct these unique, population-based samples; 2) comparisons of within-person changes on measures of self-reported health and well-being for dementia and non-dementia caregivers; 3) changes in the caregivers’ social networks, social engagement, and leisure time activities; 4) comparisons of longitudinal changes on circulating inflammatory biomarkers (e.g., IL-6, CRP, TNF alpha receptor 1) and cellular aging (telomere length); and 5) examinations of individual differences in caregiver outcomes using a stress process model. Becoming a family caregiver can be stressful, but the opportunity to help a loved one and the related feelings of purpose and deepening family connections may also promote resilience and enhance health. These questions are far from resolved, and rigorous, prospective, population-based studies like the Caregiving Transitions Study promise to provide compelling new insights.
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Kung, Winnie W. "Consideration of Cultural Factors in Working with Chinese American Families with a Mentally Ill Patient." Families in Society: The Journal of Contemporary Social Services 82, no. 1 (February 2001): 97–107. http://dx.doi.org/10.1606/1044-3894.221.
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Cultural beliefs of Chinese American families are discussed in relation to their caregiving experience of a mentally ill relative. Implications of such beliefs to mental health professionals are highlighted. Somatic factors and psychosocial stresses as causes of mental disorders are found compatible to the belief systems of these families. The stress-vulnerability dialysis is recommended as the explanatory model to be adopted by clinicians when they communicate the causes of mental illness to these families. In view of the pressure experienced by these families in the caregiving process and their relative social isolation as a result of their immigrant status, ways to harness the support from extended families and community resources are suggested. Also examined is a viable working alliance between these families and clinicians in terms of a therapeutic bond, consensual treatment goals, and relevant tasks. Finally, elements of a family intervention model compatible with cultural beliefs of these families are proposed.
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Lu, Nan, Nan Jiang, Qian Sun, and Vivian W. Q. Lou. "Community Social Capital and Positive Caregiving Experiences Among Adult-Children Caregivers of Older Adults With Disabilities in Urban China." Research on Aging 42, no. 1 (September 22, 2019): 3–12. http://dx.doi.org/10.1177/0164027519876095.
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The present study aimed to examine the association between community social capital and positive caregiving experiences among adult-children caregivers of disabled older adults in urban China. Data for this study were derived from the 2016 wave of the Longitudinal Study on Family Caregivers for Frail Older Adults Aged 75 or Above in Shanghai. The final analysis featured 440 disabled older adult and adult-children caregiver dyads. Multiple indicators and multiple causes modeling was used to test the proposed model from a structural equation modeling perspective. Provision of support to others was significantly associated with self-affirmation. Citizenship activity was significantly associated with life enrichment. Support of units (i.e., employers) was significantly associated with self-affirmation and life enrichment. The findings support the integration of the stress process model and social capital theory and highlight the important role of community social capital in enhancing the subdimensions of positive caregiving experiences. Policy and intervention implications are discussed.
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Leggett, Amanda, Cathleen Connell, Laura Gitlin, and Helen Kales. "The Influence of Dementia Caregiving Styles on Caregiver Distress and the Person With Dementia’s Quality of Life." Innovation in Aging 4, Supplement_1 (December 1, 2020): 360–61. http://dx.doi.org/10.1093/geroni/igaa057.1160.
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Abstract Building vertically upon the Stress Process Model, dementia caregivers’ cognitive-behavioral management styles are an understudied area with implications for dyadic care outcomes and tailoring of care interventions. We consider whether membership in five previously classified caregiving styles (Externalizers, Individualists, Learners, Adapters, Nurturers- which vary in their adaptability, dementia understanding, and behavioral management practices) impacts caregivers’ experiences of care-related stress and the quality of life of the person with dementia (PWD). Participants included 100 primary family caregivers for PWDs who were 74% female, 18% non-White, and on average 64 years old. Utilizing linear regressions, each caregiving style was considered as a key predictor (reference: Externalizers- poor understanding, non-adaptable approach, and punitive behavioral strategies) of the Caregiver Assessment of Function and Upset (CAFU) upset score, Neuropsychiatric Inventory (NPI-C) distress scale, Zarit Burden Interview (ZBI), and PWD quality of life (QOL-AD) scale controlling for demographics, care duration, co-residency, and dementia severity. Relative to Externalizers, Nurturers (understanding, adaptability, positive engagements) had less CAFU upset (β=-0.4, p<.01), less NPI-C distress (β=-0.3, p<.05), and greater QOL-AD for the PWD (β=0.4, p<.01). Learners (recognize need to change care approach, attempting adaptability, trial-and-error behavioral care) also showed significantly lower NPI-C distress than Externalizers (β=-0.5, p<.01). Thus caregiving styles with more dementia understanding, adaptability and positive behavioral strategies showed less distress and better PWD QOL. Corresponding with recent dementia care summits calling for identification of caregivers at greatest risk for poor outcomes, targeting and tailoring interventions based on caregiving styles may lead to great public health impact.
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Blieszner, Rosemary, Tina Savla, Karen Roberto, Brandy Renee McCann, Aubrey Knight, and Emily Hoyt. "Do Competing Demands Elevate Caregiver Challenges?" Innovation in Aging 4, Supplement_1 (December 1, 2020): 639. http://dx.doi.org/10.1093/geroni/igaa057.2193.
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Abstract Family members caring for relatives with dementia simultaneously hold other roles and face other everyday challenges related to employment, finances, interactions with others, and the like. Using the Pearlin stress process model as a foundation, we evaluated contributions of secondary role and intrapsychic stressors such as health, relationship, and financial worries, and role captivity and overload, to 157 rural caregivers’ morale and well-being. Whereas family conflict and role overload contributed significantly to higher agitation, money worries, poor health, and role captivity interfered with positive mental health (p<.05). Nevertheless, some caregivers characterized employment and volunteering as respite from caregiving and appreciated informal help even when family ties were complicated. Findings highlight complex responses to dementia-related caregiving and point to the need for a range of resources and support deployed creatively to assist caregivers in places such as rural Appalachia where geography, underfunding, and low income limit access to services.
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PATTERSON, T. L., S. J. SEMPLE, W. S. SHAW, E. YU, Y. HE, M. Y. ZHANG, W. WU, and I. GRANT. "The cultural context of caregiving: a comparison of Alzheimer's caregivers in Shanghai, China and San Diego, California." Psychological Medicine 28, no. 5 (September 1998): 1071–84. http://dx.doi.org/10.1017/s0033291798007053.
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Background. Systematic comparisons of the psychological and physical responses of caregivers of Alzheimer's disease (AD) patients in the US and China have not been previously reported.Methods. Informal caregivers of community dwelling AD patients in Shanghai, China and demographically-matched non-caregiving Chinese controls were compared with a sample of American caregivers residing in San Diego, California and demographically-matched American controls.Results. Despite some demographic discrepancies, caregivers from both China and the US were similar. Caregivers from both cultures reported more depressive symptoms and more physical symptoms when compared with non-caregivers. Both groups of caregivers reported that patients required similar amounts of care and help with activities of daily living (ADLs). However, Shanghai caregivers reported less access to emotional support when compared with the San Diego sample. A conceptual model, guided by the stress process model of Pearlin et al. (1990), was used to explore multivariate relationships between caregiver characteristics and the physical and psychological health of our sample of AD caregivers in Shanghai, China. Results from a path analytical procedure revealed that the relationships among these variables and health outcome did not differ significantly from those observed in the US sample.Conclusions. Although elderly family members are venerated in the stereotypical Chinese family unit, and informal caregiving of disabled family members is socially mandated, the negative health consequences of caregiving appear to be similar to those observed among caregivers in the US.
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Valadez, Albert A., Christine Lumadue, Bibiana Gutierrez, and Sabina de Vries-Kell. "Family Caregivers of Impoverished Mexican American Elderly Women: The Perceived Impact of Adult Day Care Centers." Families in Society: The Journal of Contemporary Social Services 86, no. 3 (July 2005): 384–92. http://dx.doi.org/10.1606/1044-3894.3436.
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Using an interview format, this exploratory study examined the narratives of 15 Mexican American primary caretakers and the perceived effects of adult day care centers (ADCs) on the lives of their elderly impoverished parents. Emergent themes and categories included (a) caretaking and gender differences, (b) resistance to nursing homes, (c) negative perceptions of White caregivers, (d) perceived positive effect of ADCs on the elderly parent's physical and emotional (depression) states and the elderly parent-caregiver relationship, and (d) the negative effects of stress associated with caregiving. The data also provide insight into complicated dynamics regarding the differential treatment of daughters and sons in Mexican American families. Pearlin's stress process model provides explanations for the buffering effects of ADCs reported by caregivers.
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Cimarolli, Verena R., Amy Horowitz, and Rachel Pruchno. "LONG-DISTANCE CAREGIVING: MENTAL HEALTH CONSEQUENCES AND USE OF RESOURCES." Innovation in Aging 3, Supplement_1 (November 2019): S556—S557. http://dx.doi.org/10.1093/geroni/igz038.2055.
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Abstract Long-distance caregiving (LDC) is a growing phenomenon and common experience for caregivers of frail older adults. In fact, 11% of family caregivers in the US live more than two hours distance from the care recipient (CR). Unfortunately, there is a paucity of research on unique experiences of LDCs and the impact of LDC on the mental health of LDCs. This symposium presents findings from the NIA funded Fordham Long-Distance Caregiving Study (R21AG050018) analyzing data of 304 long-distance caregivers (LDCs). The overall study goal was to better understand how LDCs deal with the structural constraint of distance, and to examine LDC consequences and resources. First, Horowitz presents the study background, characteristics of the sample, and provides a description of the unique experiences of LDCs. Next, Cimarolli concentrates on the Sociocultural Stress Process Model applied to LDC. Her study tested the impact of LDC on mental health and investigated resources (e.g., coping skills) which could mediate the association between caregiving stressors and mental health outcomes. The third paper (Falzarano) presents data related to satisfaction with formal service providers for four subgroups of LDCs based on CR residence and dementia status. Finally, Jimenez focuses on the characteristics of LDCs’ network of other informal caregivers (IC) providing assistance to the CR and factors are associated with more help received from other ICs. Dr. Pruchno, an expert in caregiving research, will discuss study findings. The symposium provides insights into unique experiences of LDCs, the impact of LDC on mental health, and resource use among LDCs.
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Trapp, Stephen K., Melissa M. Ertl, Susana Gonzalez-Arredondo, Yaneth Rodriguez-Agudelo, and Juan Carlos Arango-Lasprilla. "Family cohesion, burden, and health-related quality of life among Parkinson’s disease caregivers in Mexico." International Psychogeriatrics 31, no. 07 (October 15, 2018): 1039–45. http://dx.doi.org/10.1017/s1041610218001515.
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ABSTRACTBackground:Informal caregivers of individuals with Parkinson’s disease face a range of responsibilities that increase as the disease progresses. As a result of these stressors, caregivers are vulnerable to decreased health-related quality of life (HRQOL). Guided by the stress process model of caregiving, the present study examined the relations between family cohesion, perceived burden, and mental and physical HRQOL among Parkinson’s disease caregivers in Mexico. It was hypothesized that perceived burden would mediate the relations of family cohesion and mental and physical HRQOL.Methods:Ninety-five family caregivers of individuals with Parkinson’s disease in Mexico City, Mexico, participated in the study. Multiple regression was utilized to conduct mediation analyses.Results:Results indicated that burden fully mediated the relation between family cohesion and mental HRQOL, and family cohesion was not associated with physical HRQOL.Conclusions:Findings extend the stress process model cross-culturally and lend support for the importance of family cohesion and perceived burden in determining caregiver mental HRQOL. Clinical health promotion interventions should target perceived burden and family cohesion together to improve mental HRQOL among familial caregivers in Mexico.
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Sherrell, Kathleen, Kathleen C. Buckwalter, and Darby Morhardt. "Negotiating Family Relationships: Dementia Care as a Midlife Developmental Task." Families in Society: The Journal of Contemporary Social Services 82, no. 4 (August 2001): 383–92. http://dx.doi.org/10.1606/1044-3894.188.
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This article is based on interviews with a 44-year-old woman who exemplified the concepts of filial anxiety and filial maturity. These two concepts were initially defined by Blenkner in 1965, but more recently they were developed into a conceptual framework for understanding adult child caregiving responsibilities. The process of becoming “filially mature” is one of grieving, mourning, and letting go of previously secure rules and regulations about relationships with parents. This adds to a previously mandated imperative of developmental tasks that one must face at midlife (e.g. dealing with mortality). Augmenting these midlife tasks, parent care can be defined as a positive, growth-enhancing experience, versus the burden-stress model that has previously characterized this experience.
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Beach, Scott R., Richard Schulz, Heidi Donovan, and Ann-Marie Rosland. "Family Caregiving During the COVID-19 Pandemic." Gerontologist 61, no. 5 (April 13, 2021): 650–60. http://dx.doi.org/10.1093/geront/gnab049.
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Abstract Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic has negatively affected persons with existing chronic health conditions. The pandemic also has the potential to exacerbate the stresses of family caregiving. We compare family caregivers with noncaregivers on physical, psychosocial, and financial well-being outcomes during the pandemic and determine family caregivers most at risk for adverse outcomes. Research Design and Methods We conducted a cross-sectional online survey of 576 family caregivers and 2,933 noncaregivers from April to May 2020 in Pittsburgh, PA region with a national supplement. Outcome measures included concurrent anxiety, depression, fatigue, sleep disturbance, social participation, and financial well-being and perceived changes due to COVID-19 (loneliness, financial well-being, food security). We also measured sociodemographic, caregiving contextual variables, and COVID-19-related caregiver stressors (COVID Caregiver Risk Index). Results Controlling for sociodemographics, family caregivers reported higher anxiety, depression, fatigue, sleep disturbance, lower social participation, lower financial well-being, increased food insecurity (all p < .01), and increased financial worries (p = .01). Caregivers who reported more COVID-19-related caregiver stressors and disruptions reported more adverse outcomes (all p < .01). In addition, caregivers who were female, younger, lower income, providing both personal/medical care, and providing care for cognitive/behavioral/emotional problems reported more adverse outcomes. Discussion and Implications Challenges of caregiving are exacerbated by the COVID-19 pandemic. Family caregivers reported increased duties, burdens, and resulting adverse health, psychosocial, and financial outcomes. Results were generally consistent with caregiver stress–health process models. Family caregivers should receive increased support during this serious public health crisis.
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Roberto, Karen A., and J. Tina Savla. "EXPANDING RELATIONAL BOUNDARIES OF DEMENTIA CARE." Innovation in Aging 3, Supplement_1 (November 2019): S187—S188. http://dx.doi.org/10.1093/geroni/igz038.671.
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Abstract Rapid changes in family structures have expanded caregiving boundaries beyond the level of lineal kin to include extended and fictive kin. Guided by stress process and health behavior models, we analyzed semi-structured interviews with 120 family caregivers of persons with dementia (PWD) in rural Appalachia to explore personal/family circumstances that influence the responsibilities nonlineal kin assumed to meet the needs of PwD. Compared to spouse and adult children caregivers, nonlineal caregivers reported that PWD had similar behavioral problems, but greater ADL limitations. They also expressed greater burden, overload and role captivity; yet, they reported higher personal mastery, and perseverance. Although sisters and nieces did not report using any paid services to care for PwD, grandchildren and fictive kin used paid services such as meal delivery, personal care, and respite services. Findings provide new insights into a more elaborated conception of caregiving that considers the transformations occurring in family life today.
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Cho, Jinmyoung, and Alan Stevens. "The Relationship Between Functional Decline of Care Recipients and Health of Caregivers." Innovation in Aging 4, Supplement_1 (December 1, 2020): 361. http://dx.doi.org/10.1093/geroni/igaa057.1161.
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Abstract Pearlin’s stress-process model (2010) depicts that functional decline in care-recipient would shape caregiving burden and impact on caregiver’s health. With this background, we explored how the changes in care-recipients’ physical and cognitive functioning are related to the caregivers’ physical health. A total of 853 care-recipients from the Rounds 1 and 5 of the National Health and Aging Trend Study (NHATS) and their 1,303 caregivers from Round 5 of National Study of Caregiving (NSOC) were included. Multiple regression analyses were conducted to identify correlates of self-rated health and the number of chronic conditions with the change in physical and cognitive functioning from Round 1 to 5 and multidimensional caregiver burden. Physical functioning measured by the NHATS short physical performance battery included balance stands, walking chair stands, grip strength, and peak airflow. Memory, orientation, and executive functioning measured cognitive functioning. Multidimensional caregiver burden includes four domains (emotional, psychological, relationship, and resilience) identified with factor analysis. Background factors (recipient’s age, assisting recipients for 5 years, race/ethnicity, and number of chronic conditions of recipient) were included as covariates. After controlling covariates, the data showed that 5-year change of physical functioning and caregiver’s emotional burden were negatively significant for self-rated health; and assisting care-recipients for 5 years or more was significant for more numbers of chronic conditions among caregivers. Findings highlight that caregivers’ physical health is closely associated with care-recipient’s functional decline for long-term caregiving experiences. Further investigation on caregiver’s physical health using multiple health outcomes is needed to promote physical health in long-term caregivers.
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Walsh, Edel, and Aileen Murphy. "Examining the effects of activities of daily living on informal caregiver strain." Journal of Health Services Research & Policy 25, no. 2 (August 7, 2019): 104–14. http://dx.doi.org/10.1177/1355819619848025.
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Objectives This study examines the factors associated with caregiver strain experienced by informal caregivers of older people, using data from Ireland. Methods The analysis is based on a sample of 1394 informal caregivers obtained from Ireland’s Quarterly National Household Survey (2009). The Caregiver Strain Index is used to measure caregiver strain on a scale from 0 to 13. The analysis focuses on estimating the association between caregiving activities (measured using Activities of Daily Living) and caregiver strain, using multivariate regression analysis. Results Overall, 60% of informal caregivers report feeling strained. The results suggest that different types of caregiving assistance are associated with increasing caregiver strain, in line with Pearlin’s conceptual model of Stress Process theory and Process Utility theory of informal care. Female caregivers have significantly higher levels of strain. Moreover, caregiver strain amongst co-residential caregivers is 0.8 points higher compared to those who are non-resident. Conversely, caregivers over 65 years are less prone to strain than younger caregivers. The condition of the dependent is also a statistically significant factor: caring for someone with a physical condition, a mental condition or both a physical and mental condition, increases caregiver strain. Conclusions As Ireland and Europe’s populations are ‘greying’, sustainable systems and supports need to be designed to meet demand for care that limit strain for caregivers. In doing so, policymakers and their advisors need to better understand the impact of informal caring on caregivers.
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Carr, Deborah. "UNDERSTANDING THE ROLE OF STRESS PROCESSES IN CUMULATIVE DIS/ADVANTAGE PROCESSES." Innovation in Aging 3, Supplement_1 (November 2019): S418. http://dx.doi.org/10.1093/geroni/igz038.1562.
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Abstract In my book Golden Years (2019), I argue that the psychosocial consequences of normal biological processes of aging are intensified for those who have had lives of disadvantage, just as the harmful consequences of life-course disadvantages are particularly acute for those experiencing age-related physical health declines. In this paper, I discuss the role of stress processes, including stress proliferation and amplification, as possible mechanisms contributing to cumulative dis/advantage. I evaluate these ideas empirically by focusing on the linkages between functional limitations (an indicator of normal biological aging) and psychological well-being in later life, and explore the extent to which these linkages are amplified diverse indicators of life course disadvantage including low education; poor-quality employment; avoidant coping strategies; and family-related strains including intensive caregiving. Analyses are based on data from the Midlife in the United States (MIDUS) study. I discuss the implications of incorporating stress process models in cumulative dis/advantage research.
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Hoyt, Emily, Jyoti Savla, Karen Roberto, Aubrey L. Knight, Rosemary Blieszner, and Brandy R. McCann. "Dual Caregivers of Relatives with Dementia in Rural Virginia: The Added Stress of COVID-19." Innovation in Aging 4, Supplement_1 (December 1, 2020): 943. http://dx.doi.org/10.1093/geroni/igaa057.3453.
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Abstract Family caregivers often find themselves “sandwiched” between caring for an older relative with dementia (PWD) and another person. Serving in a dual caregiving role presents unique challenges and has consequences for caregivers’ physical and mental health. Seven daily diary interviews with 46 dual dementia caregivers assessed their daily stressors and informal and formal supports. Results showed that dementia caregivers who also cared for another older relative reported poorer physical health and used more community-based services to care for the PwD. Conversely, dementia caregivers who also cared for younger relatives reported greater secondary stressors, lower family support, and use of fewer community-based services to care for the PwD. Since the COVID-19 pandemic began, two telephone interviews were conducted with 15 dual dementia caregivers. Caregivers were asked in-depth questions about how the pandemic had impacted their caregiving responsibilities, mental health, and use of community-based services. Guided by stress process and behavior models, a thematic analysis of dual caregivers’ interviews revealed that caregivers had less time for themselves, engaged in self-care activities less often, and felt their social life had suffered. Many of the caregivers reported feeling exhausted, stressed, and had more things to do than they could handle. Of the eight caregivers that used services before COVID-19, six experienced a change in services including loss of services, different workers, or self-selected cancellation of services. Discussion focuses on challenges dual dementia caregivers face and the added stressors they experienced during the COVID-19 pandemic.
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Nah, Suyoung, and Lynn Martire. "Role Overload, Perceived Gratitude, and Health Among Spousal Caregivers: A Longitudinal Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 353–54. http://dx.doi.org/10.1093/geroni/igaa057.1137.
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Abstract Spouses are likely the most vulnerable caregivers due to their advanced age and more intense caregiving than other family members. Thus, it is crucial to identify risk and protective factors for spousal caregivers’ health. According to Pearlin’s stress process model, caregivers’ subjective stressors and resources may impact their health. We focused on spousal caregivers’ role overload, a critical indicator of subjective stressors, and their perception that the partner is grateful for their help, which may be beneficial for their health but has rarely received attention. This study tested the hypotheses that spousal caregivers’ higher role overload and lower perceived gratitude are associated with poorer physical and mental health over time. We also examined whether greater perceived gratitude buffers the negative relationships between role overload and health. We focused on 223 spousal caregivers of older adults without dementia from the 2015 and 2017 National Study of Caregiving. Autoregressive models revealed that spousal caregivers’ higher role overload at baseline was associated with poorer self-rated health at follow-up (b = -0.23, p < .05), but not with depressive symptoms or anxiety. Spousal caregivers’ greater perceived gratitude at baseline was associated with lower anxiety at follow-up (b = -0.32, p < .01). There were no moderating effects of perceived gratitude on the relationships between role overload and health. These findings suggest that spousal caregivers’ role overload is a risk factor for their physical health, while their perception that the partner is grateful for their help serves as a protective factor for their mental health.
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Colomer-Pérez, Natura, Elena Chover-Sierra, Vicente Gea-Caballero, and Joan J. Paredes-Carbonell. "Health Assets, Vocation and Zest for Healthcare Work. A Salutogenic Approach to Active Coping among Certified Nursing Assistant Students." International Journal of Environmental Research and Public Health 17, no. 10 (May 20, 2020): 3586. http://dx.doi.org/10.3390/ijerph17103586.
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People’s health assets (HA) mapping process and design dynamization strategies for it are paramount issues for health promotion. These strategies improve the health heritage of individuals and communities as both the salutogenic model of health (SMH) and health assets model (HAM) defend. Connecting and mobilizing HA and strengthens the ‘sense of coherence’ (SOC) are both related to enhancing stress active and effective coping strategies. This study aims to describe the HA present in a population of certified nursing assistant students (n = 921) in Spain and then to explore their relationships with the SOC, the motivation to choose healthcare studies and their academic performance. A great variety of HA were identified and mapped. Findings showed that individuals with greater motivation towards self-care and ‘caring for others’ as internal HA, possessed higher SOC levels and a strong vocation for healthcare work. Differences in HA were identified according to gender, age and employment situation. Consistent connections between the care–relation factor and vocational factor with interpersonal and extrapersonal HA were reported. Evidence and results substantiated the salutogenic and asset-based approach as a proper strategy to strengthen SOC, dynamize their HA map, reinforce the sense of calling and enable Certified Nurse Assistant (CNA) students to buffer against caregiving-related stress and thrive in their profession.
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Degeneffe, Charles Edmund. "The Rehabilitation Needs of Adult Siblings of Persons With Traumatic Brain Injury: A Quantitative Investigation." Australian Journal of Rehabilitation Counselling 15, no. 1 (March 1, 2009): 12–27. http://dx.doi.org/10.1375/jrc.15.1.12.
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AbstractThis study examined the post-injury rehabilitation needs of 158 adult siblings of persons with traumatic brain injury (TBI) in the United States. The mean age of participants was 37.0 years (SD= 10.0 years), and their ages ranged from 19 to 72 years. A total of 120 (75.9%) of the participants were female. Participants completed the Family Needs Questionnaire (FNQ) (Kreutzer, 1988), which measures the unique needs of families following TBI. The FNQ counts the types of needs rated as important and the frequency in which those needs have been met. Data were analysed via hierarchical multiple regression analysis with the number of met needs set as the outcome variable. A total of 15 predictor variables assessed direct and indirect markers of caregiving related stresses corresponding to position in the Pearlin stress process model. Participants indicated that health information was the most important need while needs for involvement with care were the most often met. Results also indicated that participant feelings of more restrictions in valued family activities and perceptions of greater cognitive-behavioural impairments with their injured siblings were associated with lower number of met rehabilitation needs. Participants reported that the use of effective coping behaviours and access to social support were associated with higher numbers of met rehabilitation needs. Findings suggest adult siblings share similar needs to parents and spouses (i.e., the most common primary caregivers) and require professional attention and support following TBI.
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Ng, Ting Kin, and Daniel Fu Keung Wong. "The efficacy of cognitive behavioral therapy for Chinese people: A meta-analysis." Australian & New Zealand Journal of Psychiatry 52, no. 7 (November 16, 2017): 620–37. http://dx.doi.org/10.1177/0004867417741555.
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Objective: Over the past decade, cognitive behavioral therapy has been applied to an increasingly wider range of disorders and problems in Chinese societies. However, no meta-analysis has been conducted to synthesize the studies on cognitive behavioral therapy for Chinese clients. The purpose of this meta-analytic study was to examine the overall efficacy of cognitive behavioral therapy for Chinese people. Method: A literature search was conducted using electronic databases, including Web of Science, PsycINFO and PubMed. Pooled mean effect sizes were calculated using the random-effects model. Results: The literature search identified 55 studies with 6763 Chinese participants. The overall short-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Effect sizes were medium for anxiety, depression/well-being and caregiving stress and small for psychotic symptoms and addictive behaviors. The effects of cognitive behavioral therapy on process variables, dysfunctional thoughts and coping, were in the small range. The overall longer-term effect of cognitive behavioral therapy on the primary outcome was medium in size. Moderator analyses showed that the short-term effect was stronger for culturally adapted cognitive behavioral therapy than for unadapted cognitive behavioral therapy. Type of primary outcome, type of control group, recruitment method, study design, the format of delivery and region were found to moderate the efficacy of cognitive behavioral therapy. Conclusion: The findings of this study provide evidence for the overall efficacy of cognitive behavioral therapy for Chinese people and the benefit of cultural adaptation of cognitive behavioral therapy to Chinese culture.
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Scicolone, Monica, and Patricia A. Parmelee. "DEPRESSION IN CAREGIVERS OF VETERANS: THE INTERACTION OF PERCEIVED SOCIAL SUPPORT AND AGE." Innovation in Aging 3, Supplement_1 (November 2019): S487. http://dx.doi.org/10.1093/geroni/igz038.1808.
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Abstract Caregiving is a risk factor for increased psychological stress and depression (Pinquart & Sörensen, 2003). Perceived social support (PSS) is strongly associated with emotional well-being and, for informal family caregivers, may be an important predictor of caregiver psychological outcomes. Although much is known about the effects of global PSS, there is a gap in research regarding numerous identified functional dimensions of support, particularly among family caregivers. Thus, this secondary data analysis examined how dimensions of PSS predict depression, and the moderating effects of age on this relationship, utilizing data from 240 family caregivers of elderly veterans receiving outpatient care at the Atlanta VA. The analysis utilizes a multidimensional measure of PSS (Sherbourne & Stewart, 1991) with four sub scales: emotional/informational, tangible, affectionate, and positive social interaction. Preliminary OLS regression analyses, regressing depression on relevant demographic variables and PSS domains, revealed a significant overall model (p < .001). All domains besides tangible support significantly predicted depression. Because age was the only demographic variable associated with depression, we tested hypotheses of an interaction of PSS and age with PROCESS macro (Hayes, 2017). Moderation analyses revealed a significant interaction of support and age on caregiver depression (p = .0145). Of unique social support dimensions, only emotional/informational social support interacted with age (p = .0075), demonstrating decreased depression at high levels of emotional/informational support, but a weaker effect for those of increased age. The original study was supported by the U.S. Department of Veterans Affairs Rehabilitation R&D Service.
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Mahmoud, Kafayat, and Candidus Nwakasi. "Cycle of Disadvantages: An Exploration of Young and Older Female Dementia Caregivers’ Experiences." Innovation in Aging 4, Supplement_1 (December 1, 2020): 351. http://dx.doi.org/10.1093/geroni/igaa057.1128.
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Abstract Families play an essential role in providing care for older persons in Nigeria, a responsibility that is culturally assigned to women. Caregiving is made even more difficult given the increasing rates of older persons with dementia and the limited capacity of caregivers to provide adequate care. We explored the experiences of two female dementia caregivers and how they cope with other competing responsibilities. The research method employed a case study approach, which followed the lived experiences of two Nigerian women – a 75-year-old woman (Ada) who cares for her husband, and a 35-year old woman (Chika) who cared for her father. The research adopted the life course concept of ‘linked lives’ and the Family Stress Process model to explore and identify the continued embeddedness of persons within their family networks and relationships, which may have deleterious effects on the wellbeing of caregivers. This study revealed that married women providing care to older parents are exposed to domestic violence from their spouses who deem them uncommitted to their (husbands’) families. These women continue to remain in such abusive relationships due to financial dependence and unwillingness to leave their children. Older women caregivers, on the other hand, over time, begin to develop physical limitations, which limit their ability to provide care for their spouses and subsequently must depend on unemployed children who live close by. This study highlights the complicated cycle of exposure to socio-economic and health disadvantages which women experience as caregivers across two generations.
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Stratton, Lauren, David Bass, Rachel Schaffer, Sara Powers, Ocean Le, and Jenna McDavid. "COMPARISON OF CAREGIVERS FROM DIVERSE COMMUNITIES WHO IMMIGRATED TO OR WERE BORN IN THE US." Innovation in Aging 3, Supplement_1 (November 2019): S955. http://dx.doi.org/10.1093/geroni/igz038.3465.
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Abstract The Diverse Elders Coalition, in partnership with its six member organizations and the Benjamin Rose Institute on Aging, completed a national survey of 840 family and friend caregivers from diverse racial, ethnic, and sexual orientation communities to understand their unique caregiving issues and challenges. Data from a subsample of 369 caregivers identifying as Hispanic/Latino, Asian, Southeast Asian or multiple ethnicities were analyzed to understand similarities and differences between caregivers born in the US and who immigrated to the US. The Stress Process Conceptual Model guided selection of characteristics used for comparative analysis. Results of logistic regression revealed that caregivers born in the US were younger (B=-.08, p<.001), had higher educational degrees (B=.42, p<.001), and higher incomes (B=.34, p=.002). They assisted care receivers with more health-related tasks (B=.27, p=.013), but fewer culture-related tasks (B=-.51, p=.002); reported higher levels of strain in their relationship with care receivers (B=.66, p=.038); and were less satisfied with the quality of care receivers’ healthcare (B=-.62, p=.042). In terms of reasons for being a caregiver, there were no significant differences in cultural commitment to caring for older family members, however those born in the US were more likely to report providing care because it was more convenient for them than for other family and friends (B=.99, p=.002). Understanding the needs of diverse caregivers has implications for healthcare and service providers, such as providing training on diverse needs. Additionally, the differences between US born and immigrant caregivers highlights implications on the dynamic between caregivers and their care receiver.
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Bidwell, Julie T., Emilio Ferrer, Christopher S. Lee, Martin Cadeiras, Karen S. Lyons, Heather M. Young, and Ladson Hinton. "92438 Symptom Dynamics and Biomarkers of Disease Progression in Older Adult Patient-Caregiver Dyads During Care Transitions after Heart Failure Hospitalization: Study Design and Anticipated Results." Journal of Clinical and Translational Science 5, s1 (March 2021): 130. http://dx.doi.org/10.1017/cts.2021.732.
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ABSTRACT IMPACT: This study is designed to address a critical gap in our understanding of how aging patients and caregivers recognize and respond to clinically important changes in heart failure symptoms during vulnerable transitions. OBJECTIVES/GOALS: Research on family involvement in heart failure (HF) symptom response is limited. Our objective is to examine HF symptom monitoring processes in couples after HF hospitalization, and quantify how coupled symptom assessments predict symptom response, patient clinical events, care strain, and dyad health during the high-risk post-discharge period. METHODS/STUDY POPULATION: This is an ongoing T2 translational study that employs an intensive longitudinal design. Adults aged ≥65 years hospitalized for HF and their caregiving spouse/partner are enrolled. The target n is 48 dyads. Over 5 weeks of follow-up, dyads complete daily diaries assessing patient HF symptoms. Clinical biomarkers of HF severity (NTproBNP, ST2) are also collected. Primary study endpoints are dyads’ HF symptom response behaviors and caregiver strain; secondary endpoints are dyads’ health status and patient clinical events. Dyadic dynamics of symptom assessment will first be characterized using dyadic autoregressive time series models. Subsequently, we will extract cross-partner effect parameters from the time series models and test whether dyadic effects predict the trajectories of each of our endpoints. RESULTS/ANTICIPATED RESULTS: This study is currently underway. In line with our study hypotheses, we anticipate that couples who assess patient symptoms similarly (dyadic agreement), and whose symptom assessments accurately reflect clinical severity, will be more likely to respond to symptoms appropriately with lower stress to the caregiving partner, and have better trajectories of health (self-reported and clinical). Characterizing dyadic symptom dynamics will provide important insight into the day-to-day process of symptom recognition in couples. Further, quantifying dyadic symptom dynamics in relation to our endpoints will provide information on the clinical value of dyadic symptom agreement, and whether it might be a target for future interventions to support better symptom response and health outcomes for both dyad members. DISCUSSION/SIGNIFICANCE OF FINDINGS: This project innovates on existing paradigms by applying family-level theory and techniques to better understand and support interventions for couples during post-discharge HF transitions - a vulnerable period for older adults that has traditionally been studied almost exclusively at the patient-level, with marginal success.
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Pioli, Mark F. "Global and caregiving mastery as moderators in the caregiving stress process." Aging & Mental Health 14, no. 5 (May 17, 2010): 603–12. http://dx.doi.org/10.1080/13607860903586193.
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Whitlatch, Carol J., Dorothy Schur, Linda S. Noelker, Farida K. Ejaz, and Wendy J. Looman. "The Stress Process of Family Caregiving in Institutional Settings." Gerontologist 41, no. 4 (August 1, 2001): 462–73. http://dx.doi.org/10.1093/geront/41.4.462.
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