Negative reactions to received spousal care: predictors and consequences of miscarried support.

This study focused on the negative reactions of older women with osteoarthritis to the receipt of instrumental support (i.e., physical assistance) from their husbands and the effects of such negative reactions on the women's psychological well-being and self-care. Applying a person-environment fit model, the authors predicted that women's negative reactions to spousal support would be determined by the fit between this support and the personal centrality (importance) of being functionally independent. Consistent with this prediction, women who received high levels of support from the husband and for whom being functionally independent was not highly central reacted less negatively to this support. More negative reactions to spousal support were related to greater concurrent depressive symptomatology and fewer self-care behaviors. In addition, negative reactions were predictive of the women's increased depressive symptomatology and decreased life satisfaction. Findings illustrate a useful theoretical approach to the examination of support from family caregivers.     

Dementia caregiving: recent research on negative health effects and the efficacy of caregiver interventions

Provision of care to an older adult with dementia is an important societal resource. This resource may also come at a high cost to informal caregivers, most of whom are family members. In this paper we provide an overview of recent research on dementia caregiving and caregiver interventions. First, we provide background information on the prevalence and costs of Alzheimer's disease and related disorders. Second, we describe the specific stressors and broader mental and physical health outcomes of dementia caregiving. Third, recent evidence of the efficacy of caregiver interventions for both caregiver and patient outcomes is reviewed. Throughout the paper, we describe promising new directions for future research in this area, including assessment and intervention with family caregivers of older patients with comorbid dementia and depression, and the focus on sleep disturbance as a critical health consequence of dementia caregiving.     

Caregiver Attributions for Late‐Life Depression and Their Associations with Caregiver Burden

Late‐life depression (LLD) has detrimental effects on family caregivers that may be compounded when caregivers believe that depressive behaviors are volitional or within the patient's capacity to control. In this study we examined three person‐centered caregiver attributions that place responsibility for LLD on the patient (i.e., character, controllability, and intention), and the impact of such attributions on levels of general caregiver burden and burden specific to patient depressive symptoms. Participants were 212 spouses and adult children of older adults enrolled in a depression treatment study. Over one third of caregivers endorsed character attributions, which significantly predicted greater levels of both general and depression‐specific burden. Intention attributions were significantly associated with general burden, but not depression‐specific burden. Contrary to our expectation, controllability attributions did not predict either type of burden. Our findings suggest that the assessment of family caregiver attributions for LLD may be useful in identifying caregivers at risk for burden and subsequent health effects, as well as those who may need education and support to provide effective care to a vulnerable population of older adults.     

Stress, Rewards, and Change in the Centrality of Women’s Family and Work Roles: Mastery as a Mediator

Although research suggests that stress and rewards experienced in a social role are associated with changes in the centrality (or personal importance) of that role over time, little attention has been given to the mechanisms that account for this relationship. This study was conducted to examine change in role mastery as a mediator in the relationship between changes in role experiences (stress and rewards) and changes in centrality among 195 women who simultaneously occupied the roles of parent care provider, mother, wife, and employee. Regression analyses indicated that increases in parent care, mother, and employee stress eroded mastery in those roles. In addition, increases in rewards were associated with a bolstered sense of mastery in each of the four roles. Mastery was found to be a mediating mechanism in the relationship between stress/rewards and centrality in one of the four roles examined, the employee role. However, changes in womens perceptions of mastery were unrelated to the extent to which women changed the importance of their three family roles. These findings extend prior research by demonstrating that mastery is a mechanism through which stress and rewards are associated with centrality in the employee role.     

Helping a child with multiple disabilities endure a demanding physical posture through self-managed access to preferred stimuli

This study assessed whether a child with multiple disabilities would endure a difficult (standing) position more easily if allowed to access preferred stimuli while in that position. The study included an ABAB sequence with 2- and 3-mo. postintervention checks. Data showed that self-managed access to preferred stimuli during the B phases of the study and the postintervention checks reduced the child's indices of unhappiness, frowning and crying, while increasing his object contact and smiles as indices of happiness.     

Impact of close family members on older adults' early response to depression treatment

This study of 130 depressed older adults and their spouses or adult children examined the impact of caregiver burden specific to patients' depressive symptoms on patients' response to antidepressant treatment. Primary care patients completed medical, psychiatric, and neuropsychological assessments prior to treatment, and interviews were conducted with their identified family member. As hypothesized, caregivers' depression-specific burden predicted greater depression severity for the patient at the 6th week of treatment after accounting for patients' pretreatment characteristics, caregivers' depressive symptoms, and caregivers' relationship satisfaction. Future research may identify family attitudes and behaviors that stem from burden and compromise older adults' ability to recover from depression.     

Perceptions and implications of received spousal care: evidence from the Caregiver Health Effects Study

The experiences of older care recipients have received far less theoretical and empirical attention than those of their family caregivers. In this study of 91 care recipients, the authors assessed perceptions of the amount, timing, and manner of spousal assistance; the amount of strain experienced from receiving care; and psychological well-being. Although female care recipients were more likely to report dissatisfaction with the manner in which assistance was provided, there were few gender differences in perceptions of care overall. In a stringent test of the hypothesis that perceived quality of spousal care affects recipient well-being, the authors found that poorer quality of care was related to increased depressive symptoms and a decreased sense of mastery 1 year later. These longitudinal effects were independent of the recipient's physical disability, marital quality, and care-receiving strain as well as the caregiver's well-being. These findings argue for a comprehensive assessment of the care-receiving experience that includes both care-recipient and caregiver perspectives.     

Involving Family in Psychosocial Interventions for Chronic Illness

ABSTRACT— Interactions with close family members have consequences for the emotional and physical well-being of individuals who are dealing with a chronic physical illness. Therefore, inclusion of a close family member in psychosocial interventions for chronic illnesses is a logical treatment approach that has the potential to boost the effects of intervention on the patient and also benefit the family member. However, randomized, controlled studies indicate that such family-oriented interventions generally have small effects. The efficacy of these treatment approaches might be enhanced by targeting specific interactions that emerging research identifies as promoting or derailing healthy behaviors and by better incorporating strategies from family caregiver interventions. In addition, family-oriented interventions should be more fully evaluated, by assessing the benefits for both patients and family members. Future research in this area can tell us much about how and when to involve family in treatment of specific chronic illnesses and, in turn, may inform conceptual models of the impact of family interactions on health.     

Depression and Mortality in the Elderly

It is well known that depression can be a consequence of medical illness and disability, but a growing literature suggests also that depression can cause biological changes linked to morbidity and mortality. Depression is strongly implicated as a contributor to cardiovascular disease and mortality. Using the cascade-to-death model as a conceptual framework, we explore the complex relations among behavior, affect, motivation, and pathophysiology that might account for the association between depression and premature death. Our model suggests that some individuals become entrapped in a downward spiral in which behavior, medical illness, and depressive affect feed on each other to undermine the biological integrity of the organism. In addition to specifying behavioral and biological mechanisms linking depression to mortality, future research needs to more closely examine phenomenological aspects of depression in order to determine what aspects of depression and related constructs such ashopelessness, vital exhaustion, and motivational depletion account for the link between depression and mortality.