Distress and Burden for Family Caregivers Providing care to an older adult with a dementing condition is often associated with a variety of physical and mental health conditions. Substantial empirical evidence indicates that caregivers are in poorer physical health and experience depressed immunologic functioning (Kiecolt-Glaser et al., 1987; Stone et al, 1987; Schulz et al., 1995; Tennstedt et al., 1992), use prescription drugs for depression, anxiety, and insomnia two to three times as often as the rest of the population, and report higher levels of depression, anger, and anxiety (Anthony-Bergstone et al., 1988; Gallagher et al., 1989; Haley et al., 1987). As a result of over 20 years of research, it is now widely accepted that providing care for a person with dementia is stressful and demanding. Caregiver burden, the term often used to describe the stress experienced by caregivers who provide hands-on care to impaired relatives, has received a great deal of attention from the research, practice, and policy communities. What was once a unidimensional concept reflecting a family caregiver’s general level of stress has evolved over the years into a multidimensional phenomenon that applies to both informal and formal caregivers. In describing this transformation, the present chapter will first provide a brief history of family caregiving research and burden. Next, more recent advancements in the study of burden will be presented with an emphasis on innovations in research and intervention. The chapter ends with discussion of future directions for research and intervention. Read more
A Computer Network for Alzheimer’s Caregivers and Use of Support Group Services Computer networks of informal caregivers may serve as an alternative to more traditional face-to-face support services. This investigation examines whether a computer support network for family caregivers of persons with Alzheimer, s disease affects their use of support groups for family members. Two competing hypotheses are examined: one posits that the use of a computer network will be substituted for participation in support groups, while the alternative hypothesis suggests that the computer network will supplement or increase support group use. A longitudinal analysis indicated a relationship between use of the computer network and changes in support group attendance. The relationship, however, is sometimes supplementation and sometimes substitution, depending on the caregiver's previous use of support groups. We offer an interpretation of the changing relationship that is based on the predispositions, abilities, and needs of the caregiver for support services. Read more
Institutionalization A Continuation of Family Care It is often assumed that with institutionalization comes an end to family caregiving. The goal of this study is to show that family caregiving continues even after institutionalization of the care recipient. The data come from 81 families who institutionalized their elders. The findings indicate that families remain involved in the care of the elder after institutionalization, although to a lesser degree and in different ways. Involvement in personal care tasks is reduced, not terminated; involvement in the specialized needs of the elder, such as their financial and legal concerns, continues, along with the new role of advocacy. The effects of caregiving are still felt by the primary caregiver, as are the effects of institutionalizing the care recipient. Read more
Depression and Health in Family Caregivers Adapation Over Time This study examined the predictors of caregiver depression and "adaptation" over time in a sample of 202 family caregivers of cognitively impaired adults. By examining caregiver adaptation (i.e., a caregiver's ability to adjust psychologically to the demands of providing Long Term in-home care), we were able to account for initial levels of depression, regression to the mean, and floor and ceiling effects. Results indicated that the strongest predictors of caregiver depression 1 year after baseline were initial levels of depression, worsening of caregiver subjective physical health status and burden, and short-term use of in-home respite assistance. These findings suggest that caregivers who experience deterioration in levels of physical health and burden and who use in-home respite on a short-term or sporadic basis may be especially vulnerable to the chronic stress of providing Long Term in-home care. Read more
Nursing Assistants Caring for Dementia Residents in Nursing Homes Most research on nursing home care has focused on its problems and shortcomings, with few positive reports concerning resident care. The current study investigates a neglected aspect of nursing home research. family members' positive perceptions of the care nursing assistants provide to residents with dementia. Content analysis of cross-sectional data from 133 family member interviews from five nursing homes revealed four positive themes: • Family members' appreciation for how difficult it is to care for persons with dementia and understanding constraints imposed by understaffing, heavy workloads, and low wages; • Care provided by nursing assistants that exceeds expectations; • Positive expressions between nursing assistants and residents and residents' family members; and • Identification of a kin-like relationship between residents and nursing assistants. Read more
An Intergenerational Program for Persons with Dementia Using Montessori Methods An intergenerational program bringing together older adults with dementia and preschool children in one-on-one interactions is described. Montessori activities, which have strong ties to physical and occupational therapy, as well as to theories of developmental and cognitive psychology, are used as the context for these interactions. Our experience indicates that older adults with dementia can still serve as effective mentors and teachers to children in an appropriately structured setting. Read more
The Effect of Activity Involvement and Social Relationships on Boredom Among Nursing Home Residents This study investigated the types of activities that nursing home residents participate in, and whether participation in group activities and quality of residents' social networks could explain reports of boredom. Results indicated that residents enjoyed both solitary activities (watching TV, reading) as well as group activities like parties, social programs, playing cards and other games. Further, boredom was not related to participation in group activities but rather to depression, negative interactions with social network members and, perhaps, with a lack of friendships with other residents. Findings indicate that the personal and mental health needs of residents should be given major consideration while designing group activities for residents. Read more
The Moderating Influence of Service Use on Negative Caregiving Consequences This investigation adapts the social support conceptual framework to examine the moderating influence of community service use by impaired older persons on the negative consequences of caregiving for informal helpers. The model is modified by defining services as a type of social support that can counteract the stress associated with various care recipient impairments. Results from multivariate analyses of data from 401 caregivers suggest that certain services for care recipients can reduce the adverse effects of certain impairments on informal caregivers. The use of health care service by care recipients who are more disabled is related to lower levels of caregiver depression, health deterioration, and social isolation. Personal care service use consistently offsets the negative effects of care recipients' behavioral problems. Additionally, the use of household service when care recipients exhibit behavioral problems is associated with lower levels of caregiver depression. Read more
