Self-Reported Abuse and Mistreatment among Japanese Elders Receiving Respite Care

This study examines physical and psychological mistreatment reported by Japanese elders who received care from family members. Data is based on structured face-to-face interviews with community-dwelling elders who utilized respite care services. Among the 118 elderly respondents, 12% reported being hit or almost being hit by their caregivers. Close to 54% reported at least one type of psychological mistreatment. Men who received care from their spouses were most likely to report abuse. Elders who were victimized reported increased levels of depressive symptoms. Logistic regression analyses indicated associations between physical abuse and past conflicts with the caregiver. Psychological mistreatment was associated with receiving care from a spouse, past conflicts with the primary caregiver, and depression. The findings suggest the need for increased awareness of the needs of community-dwelling Japanese elders who are at risk for abuse, mistreatment, and depression.     

Transitions in caregivers' use of paid home help: associations with stress appraisals and well-being

This study examines the associations between transitions in paid home care and stress appraisals and psychological well-being of family caregivers of dementia relatives. The sample consisted of 264 caregivers who completed up to 3 interviews during 1 year. Longitudinal analyses (i.e., generalized estimating equations) showed that the onset of paid home care was associated with increases in feelings of worry and strain and a worsening in positive affect. Ending paid home care was strongly associated with a decrease in depressive symptoms, whereas sustained use of paid home care was related to reduced overload. Several possible mechanisms for the complex relationship of paid home care and family caregivers' stress appraisals and well-being are discussed.     

Role of foster family belonging in recovery from child maltreatment

Research on foster care suggests that children who have experienced abuse are susceptible to a range of negative life outcomes. Such research also suggests that children removed into foster care can recover from abuse if given opportunities to develop healing relationships with caregivers. Drawing on qualitative data from a national research project on Australian foster carers, this paper explores how foster families enact forms of belonging that potentially work to ameliorate experiences of abuse among foster children. With a specific focus on experiences of family solidarity, rituals, identity, and culture among foster carers and the children in their care, the findings highlight the role that foster carers can play in contributing to national child protection agendas aimed at addressing experiences of maltreatment among children removed into care in Australia.     

Food meanings in HIV and AIDS caregiving trajectories: ritual, optimism and anguish among caregivers in Lesotho

The article describes the caregiving responsibility to provide food for chronically ill family members and the meanings attached to food and eating when ill created stress for family caregivers. The results come from a qualitative phenomenological study using in-depth interviews with 21 family caregivers of chronically ill HIV and AIDS patients in one district in Lesotho. Analysis of the interview data showed that the caregivers attached profound meanings to food and feeding care recipients. Their perceptions about food as part of family life and caring, the role of food and eating in curbing disease progression, the link between food and medical efficacy and the link between food and life led to ritualized behaviour around food, and moments of optimism and anguish in caregiving. Patients' behaviour in relation to food was in most instances inconsistent with the caregivers' goals, thus leading this aspect of caregiving to induce stress. Services intended to support home-based caregivers and patients could contribute to the reduction of stress associated with food through suitably tailored food assistance and professional support to caregivers to enhance their competences and understanding of the dynamics of food intake as AIDS progressed.     

Longitudinal impact of interhousehold caregiving on adult children's mental health

The wear-and-tear hypothesis of caregiving (the longer care provided, the more psychological strain on caregivers) was examined using panel survey data from 112 adult children providing interhousehold care to an impaired elderly parent. Measures included subjective caregiving stress and perceived caregiving effectiveness ("wear") and depression and affect balance ("tear"). Contrary to the hypothesis, data revealed variability in children's adaptation to caregiving, improvement rather than deterioration being the norm. In a recursive path model, both subjective stress and perceived effectiveness were significant predictors of changes in depression. Depression was not significantly related to duration of caregiving. Discussion suggests that future researchers consider other types of caregivers and care settings, factors predicting variability in caregivers' adaptation over time, and changes as well as stability in care arrangements.     

Caring for the Caregiver: Identifying the Needs of Those Called to Care Through Partnerships with Congregations

As the older adult population continues to grow, the prevalence of chronic diseases is also increasing, leading to the need for novel ways of managing this large population of patients. One solution is to focus on informal caregivers. These informal caregivers already make a substantial contribution to our nation’s healthcare finances and patient health outcomes. Caregivers also derive benefits from caring for their family member or friend; however, it is not uncommon for these individuals to experience negative health consequences, or what is often called “burden of care.” Those called to care are not without their own burdens, and they must frequently make significant lifestyle adjustments that impact their own health. Therefore, for caregivers to be effective, caring for the caregivers must be a focus of medicine in the twenty-first century.     

Narrating the negative consequences of elder care and familial obligation in Atlantic Canada

At a time when renewed emphasis is being placed on the role of the family in providing care for elderly people, shifts in family structures and the demographic profile of societies such as Atlantic Canada are impacting on community structures foundational to familial caregiving practices. Research shows that family members who attempt to provide familial care without adequate support risk negative health and interpersonal consequences. Hence many find it necessary to reflect upon their familial obligations. This article investigates the storytelling processes through which caregivers, aged between 45 and 55 years (N = 26), make sense of their efforts to provide care. We explore the ways in which participants in four focus groups and 12 interviews refer to negative consequences of caring in order to navigate dilemmas arising from their enactment of familial obligations in the absence of adequate support. Copyright © 2003 John Wiley & Sons, Ltd.     

Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.     

Adult Children’s Caregiver Burden and Depression: The Moderating Roles of Parent–Child Relationship Satisfaction and Feedback from Others

The issue of elderly care has generated great interest because today, most of us live in an aging society. It has been found that caring for one’s elderly parents is a stressful experience that is related to negative outcomes. In addition, accompanied with the decline in fertility may make adult children feel heavier caregiver’s burden. Therefore, the current study investigates moderators that may help reduce the caregiver burden. Following the conservation of resources theory (COR), we hypothesized that feedback from others and a good parent–child relationship serve as resources that may help the individual manage the stress associated with caring for his or her elderly parents. To examine our hypotheses, we collected data from 502 adult children who were primary caregivers for their elderly parents. All participants completed the Burden Assessment Scale (BAS), the Center for Epidemiological Studies Depression Scale (CES-D), the Feedback from Others Scale, and the Parent–Child Relationship Satisfaction Scale. Supporting our prediction, we found a positive correlation between the caregiver’s burden and the caregiver’s levels of depression. Furthermore, both moderation effects were significant. Consistent with our hypotheses, the relationship between caregiver burden and his or her level of depression was weaker when participants had high feedback from others or had a better parent–child relationship. Our findings highlight the view that possessing more resources may help the individual manage the stress associated with caring for elderly parents. Implications for issues related to elderly care are discussed.     

Caring for children with an intellectual disability: An exploratory qualitative study

This study explored family caregiver experiences of children with an intellectual disability in a rural South African day-care centre. The family caregivers (N = 15; mothers = 60%; age range = 35 to 68 years) completed in-depth interviews regarding their experiences providing care to children with intellectual disability. Data collection and analysis was done using phenomenological methods. The following themes emerged to characterise the family caregiver experiences: deeper understanding of intellectual disability; disability disclosure conditions; and social and economic support needs. Family support emerged as an important factor in the relationship between caregivers’ psychological stress and well-being.     

Wealthy families and their drug abusing adolescents

Abstract

Researchers have hypothesized that providing care to an elderly relative can negatively affect marital relationships of caregivers. However, no research has directly examined this issue. This study explored the impact of elderly depression and impairment, mental caregiving, caregiver/elderly person relationship closeness, spouse burden, and caregiver burden on caregiver marital happiness (and adjustment) in 90 multigenerational families. No significant relationship was found between these variables and caregiver marital adjustment. A causal model involving the six independent variables and caregiver marital happiness was developed and tested. Elderly depression and caregiver burden directly affected level of caregiver marital happiness. The other four independent variables affected caregiver marital happiness indirectly through caregiver burden. Implications for marriage and family therapists are discussed.     

Medication Administration By Family Members of Dependent Elders In Shared Care Arrangements

Twenty-three long-term care family caregivers whose care-recipients were enrolled in adult day care programs participated in face-to-face, semistructured interviews designed to learn more about their medication administration experiences. Two distinct styles of decision making were identified: self-directed and physician-directed. To help them with their medication administration responsibility, both groups used primary (physicians, pharmacists, or both) and secondary sources of information (the internet, information hotlines, nurses, more experienced caregivers, and family members with health backgrounds). Self-directed caregivers, who were significantly younger than the physician-directed caregivers, were twice as likely to report use of secondary sources of information to manage their medication administration tasks. Secondary sources of information appear to be important for the development of a caregiver's maturation and critical thinking skills over the long term and need more attention from formal providers in shared care relationships with family caregivers.     

A Closer Look at Religiosity Among Family Caregivers

This article addresses the relationships between the dimensions of religiosity and positive appraisal of caregiving among African American, Hispanic, and non-Hispanic Caucasian family caregivers for older adults. Data analysis of 69 subjects revealed a negative correlation between non-organizational religiosity and positive appraisal of care among African American caregivers and a positive correlation between organizational religiosity and positive appraisal of care among Hispanic caregivers. Findings from this analysis challenges the overall assumption that religiosity increases positive appraisal of caregiving. Rather, the nature and outcomes of family caregiving are different for various ethnic groups.     

Parents, infants, and day-care teachers: Interrelations and implications for better child care

Many young children are reared today in both family and child-care settings. The relation that exists between these two settings has important implications for child care. Bronfenbrenner's (1979) ecological model is used as a way to view the interrelations among children, families, and child-care programs. Data from a study of infants in day care provide information on the time infants spend in family and day-care contexts, how parents and caregivers view children's behavior in these two settings, and rates of otitis media (ear infections) and other illnesses for these children. Results show that infants spend about twice as many hours per day awake with parents as in day care. Regarding child behaviors, parents and caregivers seem to have similar behaviors they like and dislike, but they each see particular children quite differently with respect to these behaviors. Finally, infants in this sample were diagnosed with illnesses 60% to 70% of the time. Findings are discussed in terms of the ecological model with particular attention given to relations between parents and caregivers.     

阿尔兹海默氏症患者的家属照顾者(隐形的病患)健康状况探讨

台湾地区有超过91.5%的阿尔兹海默症照顾者为家庭成员。他们平均对轻度、中度和重度此症患者的全部照顾时间为2166、4299和5871小时。根据一项以“中国人健康问卷”所做的调查,照顾者身体健康状况平均值为2.73(标准差0.85);心理健康状况平均值为2.74(标准差0.8);社会健康状况平均值为2.98(标准差0.78);在压力的排序上以情绪上的压力和困扰为最高(3.02)。这些数据显示照顾者的身心健康已受到严重的负面影响。因此,照顾者应该首先照顾好自身,才能给予被照顾者亲属更好的必要照顾。     

Child, Family and Case Characteristics: Links with Service Utilization in Physically Abused Children

We investigated the relationships between child, familial, and case characteristics and mental health and medical health care service utilization by physically abused children. Participants included 26 parents or caregivers of 37 Medicaid-eligible children who had substantiated cases of physical abuse. Children whose female caregivers reported a greater number of stressors were more likely to receive mental health care. Furthermore, children not living with the maltreating caregiver were more likely to receive medical health care services. Results are discussed in terms of factors that may account for these links, and the similarities of these findings with those of service utilization in general and clinical child samples.     

Clinical Implications for Supporting Caregivers at the End-of-Life: Findings and from a Qualitative Study

Despite families providing considerable care at end of life, there are substantial gaps in the provision of supportive care. A qualitative interview study was conducted with 17 caregivers of people supported by an adult hospice to explore the support needs of families. Family members readily identified the ways in which the diagnosis of a life-limiting illness impacted on them and the family as a whole, not just the patient. Implications for practice demonstrate the need to intervene at a family and relational level prior to bereavement, in order to mitigate complicated grief for the surviving family members. Such an approach offers a fruitful prospective alternative to supporting caregivers post-bereavement.     

Taking care of one's own: justice and family caregiving

This paper asks whether adult children have aduty of justice to act as caregivers for theirfrail, elderly parents. I begin (Sections I.and II.) by locating the historical reasons whyrelationships within families were not thoughtto raise issues of justice. I argue that thesereasons are misguided. The paper next presentsspecific examples showing the relevance ofjustice to family relationships. I point outthat in the United States today, the burden ofcaregiving for dependent parents fallsdisproportionately on women (Sections III. andIV.). The paper goes on to use Rawls'theoretical tool of the veil of ignorance toargue that caring for parents should not belinked to a person's sex and more generally,that there is no duty of justice to assume therole of caregiver for dependent parents(Sections V.). Although justice does notprovide the moral foundations for parent care,I show that it nonetheless places importantlimits on the instinct to care. I concludethat the voice of justice should be audible,and is intrinsically present, withinfamilies.     

Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura

Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss “Recovering Together,” a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad’s experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.