支持非正式照料者:发达国家老年福利制度新动向及其对中国的启示

随着人口老龄化的加剧,非正式照料(以家庭照料为主)在老年人长期照料中的作用越来越显著,一方面符合老年人的需求,另一方面可以节省公共资源。但由于老年人寿命的延长,各类冲突的加剧致使家庭成员的照料压力增大,因此非正式照料者必须有来自公共服务的支持。为了支持非正式照料者,很多国家已经有了立法保护与经济投入,以承认照料者权利并支持他们的服务,由此逐渐形成了老年福利制度的新动向。本文首先从理论上论述了国家与家庭的福利责任划分,然后概括了发达国家在支持老年人非正式照料者(主要是家庭照料者)方面的经验,最后说明他国经验对我国的启示,具体包括强调国家责任与志愿组织的作用、承认和保护照料者权利的立法、全面与灵活的照料者支持策略、稳妥的长期照料保险、以政策保障促进传统家庭价值观的传承。     

家庭社会经济地位与青少年自我效能感的关系：家庭支持的中介作用与性别因素的调节作用

为探讨家庭社会经济地位对青少年自我效能感的影响及其作用机制,该研究采用问卷法对520名青少年进行调查。结果表明：(1)家庭社会经济地位、家庭支持、自我效能感两两均显著正相关;女生的家庭支持显著高于男生,自我效能感显著低于男生;(2)家庭支持在家庭社会经济地位对自我效能感的影响中起中介作用;(3)该中介作用受到性别因素的调节,较之男生,女生的家庭支持受到家庭社会经济地位的影响作用更为显著。     

家庭照料对照料者心理健康的影响

家庭照料通过不同途径和不同因素影响照料者心理健康,包括积极影响和消极影响。早期研究多关注家庭照料带来的消极影响以及相关个体水平变量所起的作用,当前研究中逐渐增加了对照料积极方面的关注,同时更加强调背景变量和个体间关系变量的作用。该文介绍了家庭照料研究中两个重要的理论模型：压力过程模型和双因素模型;总结了不同水平上的各种变量分别对照料的积极和消极作用途径产生的影响;提出了家庭照料者研究发展呈现出的两个趋势：理论模型更为整体化、系统化,研究的关注点由个体水平变量转向反映个体与环境间相互作用的变量;并对我国目前研究中的问题和发展方向进行了讨论     

朋友支持与大学生幸福感：自我效能感的中介与社会比较倾向的调节

为探讨朋友支持与幸福感的关系,并重点关注自我效能感和社会比较倾向在其中所起的作用,该研究采用总体幸福感量表、一般自我效能感量表、社会比较观念量表和朋友支持评价量表对776位大学生进行施测。结果表明：（1）朋友支持正向预测大学生幸福感;自我效能感在两者间起中介作用;（2）社会比较倾向调节了社会支持→自我效能感→幸福感的后半段,即相对于高社会比较倾向的大学生而言,自我效能感对低社会比较倾向大学生的幸福感促进作用更强。该结果揭示了朋友支持影响大学生幸福感的内在机制：朋友支持和大学生幸福感之间是有调节的中介关系,朋友支持通过自我效能感影响幸福感,社会支持对间接效应起调节作用。     

控制感与老年人生命意义感：自我认同和政策支持的作用

通过对来自北京、香港和台北的300名老年人的问卷调查,探讨了控制感、自我认同和政策支持感等因素影响老年人生命意义感的机制。结果发现控制感和政策支持感对老年人生命意义感均有显著的积极效果;政策支持在控制感与生命意义感的关系中起调节作用——较高的政策支持增强了控制感对生命意义感的促进作用;自我认同在控制感与生命意义感的关系中起部分中介作用。这些结果对积极应对老龄化问题与增进老年人身心健康有重要的理论和现实意义。     

老年人照料孙子女对农村家庭代际矛盾的影响研究

本研究利用“安徽省老年人生活福利状况”调查数据,建立多水平Tobit模型分析老年人照料孙子女对农村家庭代际矛盾的影响。研究结果发现照料孙子女与高水平代际矛盾相关,且高强度照料的影响更为明显。由于照料角色的性别差异,照料孙子女对老年父亲的代际矛盾有显著影响,而提供低强度照料对老年母亲没有影响。女儿与老年父母的代际矛盾水平低于儿子,且向女儿提供低强度孙子女照料显著降低了老年父亲的代际矛盾。上述结果支持了“角色负担”的理论解释,且性别偏好对家庭代际矛盾有显著影响。     

未来时间洞察力与大学生职业决策自我效能感的关系:领悟社会支持与自尊的链式中介

为考察未来时间洞察力对大学生职业决策自我效能感的影响及其作用机制,本研究采用未来时间洞察力量表、领悟社会支持量表、自尊量表和职业决策自我效能感量表,对756名高校学生进行调查。结果表明:(1)未来时间洞察力、领悟社会支持、自尊、职业决策自我效能感两两之间存在显著正相关;(2)社会支持和自尊在未来时间洞察力与职业决策自我效能感之间起显著的中介作用。具体为三条中介路径:一是社会支持的单独中介作用; 二是自尊的单独中介作用; 三是社会支持和自尊的链式中介作用。研究揭示了未来时间洞察力与大学生职业决策自我效能感的关系及其作用机制,拓展了大学生职业决策自我效能感的影响因素,对大学生的职业指导具有一定的现实意义。     

员工的核心自我评价与多维生活满意度的关系：感知社会支持的中介作用

本研究以245名企业员工为被试,从感知到的不同来源社会支持的角度探索了核心自我评价对员工生活满意度不同领域的作用机制。结果表明：（1）核心自我评价对家庭、朋友、工作和自我满意度均有显著的正向预测作用。（2）家庭支持在核心自我评价与家庭满意度之间起完全中介作用,在核心自我评价与自我满意度之间起部分中介作用;朋友支持在核心自我评价与朋友满意度之间起完全中介作用。研究表明,核心自我评价能直接预测生活满意度中的非关系型领域,能通过各类社会支持分别间接预测生活满意度中的各类关系型满意度。     

组织亲家庭支持对生活满意感的影响机制:基于工作-家庭资源的视角

以工作-家庭资源理论为支撑,采用问卷法调查了509名企业员工,探讨亲家庭政策的使用和家庭支持型主管行为(FSSB)这两种组织亲家庭支持方式对员工生活满意感的影响机制。结果表明:(1)FSSB在亲家庭政策使用与工作-家庭增益之间起调节作用。(2)工作-家庭增益在亲家庭政策使用、FSSB以及两者交互作用与生活满意感之间起中介作用。研究提示:可通过干预,提升FSSB进而提高亲家庭政策的使用效果。     

家庭亲密度对高中生心理健康的影响:有调节的中介模型

基于生态系统理论探究高中生心理健康的影响因素,采用问卷法调查了四川省两所高中1020名学生。结果发现:(1)家庭亲密度显著负向预测高中生的心理健康问题;(2)生命意义感在家庭亲密度和高中生心理健康之间起中介作用;(3)社会支持调节了生命意义感中介效应的前半路径和后半路径。随着社会支持水平的提升,家庭亲密度对生命意义感的正向预测作用、生命意义感对心理健康问题的负向预测作用显著增强。     

Predictors of Appraisal and Psychological Well-Being in Alzheimer's Disease Family Caregivers

The objective of this study was to test a model of stress, appraisal, and adaptation in 114 family caregivers of patients diagnosed with dementia of the Alzheimer's type (white non-Hispanic, N = 64; Hispanic-American, N = 50). Results of structural equation analysis show that appraised caregiver burden played a central role in determining the psychological well-being of family caregivers. The findings indicate that this mediating variable, negative caregiver appraisal, was predicted by increased functional limitations and behavioral disturbances in the patient, poorer perceived physical health, and lower levels of perceived emotional support. Contrary to a priori hypotheses, functional limitations in the patient also exhibited a direct association with caregiver depression. Further, patient cognitive impairment and caregiver ethnicity were not related to caregiver appraisal. Overall, these results support the role of appraised burden in mediating the relationships between caregiving factors and the adaptational outcome of depression. The implications of these findings, limitations of the study, and future directions are discussed.     

Models of self and others and their relation to positive and negative caregiving responses

The burden of providing informal care to a family member can lead to caregiver depression and potentially harmful caregiving behavior. Given the interpersonal nature of caregiving, the relationship between caregivers and care recipients may impact caregiver responses. We applied attachment theory to understanding caregiver depression, and both potentially harmful and exemplary caregiving responses. We present data from 430 caregivers in the Family Relationships in Late Life (FRILL 2) Project, a multisite, longitudinal study of caregiving. Age, gender, and model of self were related to caregiving responses, suggesting that model of self may help identify caregivers at risk for poor responses.     

Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers

A stress and coping model was used to study predictors of individual differences in caregiver adaptation. A total of 54 family caregivers of elderly dementia patients completed interviews and questionnaires assessing the severity of patient impairment and caregiving stressors; caregiver appraisals, coping responses, and social support and activity; and caregiver outcomes, including depression, life satisfaction, and self-rated health. Correlational and regression analyses supported the utility of the stress and coping model. Appraisal, coping responses, and social support and activity were significant predictors of caregiver outcome, even when severity of caregiving stressors was statistically controlled. The importance of a multidimensional approach to assessing caregiver outcomes was supported by regression analyses indicating that each caregiver outcome was predicted by different patterns of stressors, appraisal, coping, and social support and activity. Results are discussed in terms of a stress and coping model of caregiving, and clinical implications for work with caregiving families.     

What Is a Nonresponder? A Qualitative Analysis of Nonresponse to a Behavioral Intervention

This study used qualitative methods to understand reasons for treatment nonresponse following a behavioral intervention for family caregivers of people with dementia. Caregivers and interventionists completed semistructured interviews about their experience of the treatment after completing a course of Resources for Enhancing Alzheimer’s Caregiver Health in VA (REACH VA). Treatment response from the 22 caregivers who completed the 12-session treatment was assessed using pre- to posttreatment change scores on measures of depression and caregiver burden. Interviews from the 14 nonresponder caregiver/interventionist dyads (28 total) were analyzed qualitatively to identify caregiver factors that negatively impacted improvement in depression and caregiver burden, such as emotional processing difficulties, wanting more support than structure, and limited support/difficulty asking for help. Ways nonresponders benefited from REACH VA beyond improvement on self-report symptom measures were also identified and included learning to problem solve more effectively, feeling understood and supported by another, and taking a different perspective on caregiving. The benefits of using qualitative methods to assess the experience of treatment nonresponders and identify individuals who may benefit from additional treatment or a different approach are discussed.     

Informal Caregiving to Persons with AIDS in the United States: Caregiver Burden Among Central Cities Residents Eighteen to Forty-Nine Years Old

Characteristics and caregiving experiences of friends and family members caring for people with AIDS (PWAs) were examined. Based on a probability sample of informal AIDS caregivers ages 18–49 living in central cities of the United States (n = 260), analyses were conducted to (a) identify the sociodemographic characteristics of young central city caregivers; and (b) examine the effects of caregiver characteristics (relationship to PWA, gender, race/ethnicity, income, sexual orientation, HIV status, perceived susceptibility), and level of objective caregiving demands, on subjective caregiver burden. Results indicate that the largest group of caregivers in this age category are male friends of the PWA—a group not typically found among caregivers to persons with other types of illnesses. In general, gay or bisexual caregivers, caregivers who have traditional family ties to the PWA, men relative to women, and lower income caregivers, report the greatest burden. While level of caregiving demands represents the most influential predictor of caregiver burden, white and male caregivers experience greater burden, independent of level of involvement and other caregiver characteristics. Receiving instrumental support with caregiving buffers the impact of high objective demands on subjective burden.     

Reduction of caregiver burden in Alzheimer's disease by treatment with galantamine

Alzheimer's disease is a progressive condition characterized by a loss of cognition, altered behavior, and a loss of functional ability, such as bathing, dressing, toileting, and organizing finances. Family and friends provide nearly three quarters of all care for patients with Alzheimer's disease. This informal care results in significant burden to caregivers. Caregiver burden is the set of physical, psychological or emotional, social, and financial problems that family members may experience when caring for impaired older adults. Caregivers of Alzheimer's disease patients report higher rates of physical symptoms, mortality, depression, and fatigue, as well as adverse effects on employment compared with those who are not caregivers for Alzheimer's disease patients. In many cases, the same family members are responsible for both out-of-pocket expenditures and caregiving duties. For this article, a MEDLINE search using the key words "caregiver and Alzheimer's disease" and "cost and Alzheimer's disease" was performed. The purpose of this article is to review the literature on caregiver burden, the components of caregiver burden, effects of caregiving on the health of caregivers, the cost of Alzheimer's disease on the caregiver and society, and the benefits attainable with treatment.     

Stories of family caregivers of people with dementia in Greece: Implications for counselling

A substantial body of literature has identified high rates of burden, psychological morbidity, social isolation, health and financial difficulties among dementia caregivers. The present qualitative study adopted an Interpretive Phenomenological Analysis approach in order to explore the lived experiences of dementia family caregivers within the Greek sociocultural context. The sample was purposive and consisted of 10 women dementia family caregivers from Athens and Thessaloniki. Individual in-depth interviews were conducted and analysed according to IPA. The participants’ personal accounts included themes related to ethical/existential and cultural aspects of family caregiving; changes in family relationships; impact of the caregiving experiences; sources of support and help seeking; positive and meaningful aspects of the care experience. The research findings are discussed in the context of Gilligan’s moral psychological theory, and cultural dimensions of family caregivers. Implications for counselling interventions aiming at supporting caregivers are presented.     

Caregiver burden and family functioning in different neurological diseases

Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s Disease and other dementia (AD), Parkinson’s Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out. The average scores of caregivers of patients with AD or other dementia and PD were close to the cut-off score, whereas those of caregivers of patients with MS were significantly lower than the others. Family cohesion, family satisfaction and the quality of family communication were associated with reduced levels of caregiver burden, whereas disengagement was associated with a higher burden. The data from the present study confirm that caregiver burden is a relevant issue in the context of neurological diseases, especially for those causing higher degrees of impairment. Significant correlations with family functioning emerged as well, highlighting the importance of studying and treating caregiver burden within the context of family relations.     

Caring for a Family Member With Cancer: Past Communal Behavior and Affective Reactions1

An important recent development in the caregiving literature is an increased focus on the role played by the interpersonal relationship between caregiver and care recipient. In this study, a prediction derived from communal relationship theory (Clark & Mills, 1979, 1993; Mills & Clark, 1982) was tested in a sample of patients with recurrent cancer and their family caregivers. Specifically, it was hypothesized that if a relationship had been communal in the past (i.e., characterized by mutual demonstrations of concern for and responsiveness to one another's needs), positive feelings about helping one's partner should continue even when one partner's needs far outweigh those of the other. Consistent with this hypothesis, results indicated that caregivers whose relationship with the patient before illness onset had been characterized by relatively infrequent communal behaviors evidenced more symptoms of depression that did those whose relationship had been characterized by more frequent communal behaviors. In addition, the effects of prior communal behavior on depressed affect were both mediated and moderated by feelings of burden. Caregivers who recalled relatively few communal behaviors in their past relationship felt more burdened by their caregiving role, and burden in turn predicted greater depressive symptomatology. Implications for early identification of caregivers at risk for becoming distressed are discussed.     

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.