Maintaining caregiving at home: a culturally sensitive grounded theory of providing care in Thailand.

Grounded theory methodology was used to generate a substantive theory that describes and explains the caregiving process of Thai caregivers for their elderly stroke relatives. Data were collected from a purposive sample of 20 family caregivers living in Chachoengsao province, Thailand, by using interviews, observations, and the primary researcher's memos. The central idea emerging from the data was maintaining caregiving at home that encompassed these seven contextual situations: (a) caregiving as an integral part of life; (b) caregiving as an unavoidable task; (c) caregiving with love, sympathy, and attachment; (d) family and kinship support; (e) community support; (f) managing treatment; and (g) managing problems and difficulties. Culture, tradition, and religion dominated throughout these situations. Application of the theory is discussed relative to providing culturally sensitive nursing education, intervention, and research.

Pathfinders: a self-care and health education program for older widows and widowers.

Recent studies suggest that the loss of a spouse can be disruptive to the survivor's self-care and health promotion practices, especially for those who lack the knowledge and skills to successfully engage in these behaviors. Pathfinders is a theoretically and research-based self-care and health education program for recently widowed persons aged 50 and older. This article describes the program's structure, content, and recruitment methods. Preliminary evaluation data suggest that the program is achieving many of the intended outcomes. Issues pertaining to replication as well as limitations are discussed.

Beyond bereavement support group meetings: exploring outside social contacts among the members.

This article examines the extent to which bereavement support group participants engage in social interaction with fellow group members outside of the meetings, demographic influences on outside contact, and the relationship between this social interaction and bereavement outcomes. Data are presented from a longitudinal study that included 144 recently bereaved spouses between the ages of 51 and 89 who participated in a support group intervention. During the course of the study the majority of the participants had contact with other group members in addition to the scheduled meetings even though the group leaders did not encourage outside contact. Although the frequency of the interaction was only moderate, the support group participants reported feeling relatively close to their fellow group members. Men were as likely as women to have outside contact but they delayed in doing so. Those who engaged in outside contact were slightly more depressed, experienced more stress, and were more lonely at the time of the contact relative to others. Those who maintained some kind of interaction by Time 3 (1 year bereaved), however, reported less loneliness by the end of the study (Time 4). Findings are discussed in terms of the frequency and duration of support group interventions, the gender composition of the groups, and the need to incorporate into future studies a more systematic examination of outside interaction among support group participants.

Exploring the Caregiver Burden Inventory (CBI): further evidence for a multidimensional view of burden.

The purpose of this study was to examine the multidimensional nature of caregiver burden by specifically analyzing the patterns of association between five dimensions of burden as measured by the Caregiver Burden Inventory [1] and selected demographic, health, functioning, and well-being indicators. Subscales measuring each dimension were internally consistent and relatively independent in a sample of 160 caregivers. Time dependence burden was most influenced by patient impairment and caregiving involvement, whereas emotional burden was largely a function of caregiving satisfaction. Most of the variance in developmental burden was explained by depression and caregiving satisfaction. Contrary to expectations, physical health measures explained little variance in physical burden, of which most was explained by depression. Less than 10 percent of the variance in social burden was explained by depression and caregiver days sick. The findings lend support to a multidimensional view of burden and with minor modifications, the CBI appears to be a promising instrument with which to measure the construct.

Video Respite: an innovative resource for family, professional caregivers, and persons with dementia.

The development of a new and promising resource for family, professional caregivers, and persons with dementia is detailed in this article. The concept, Video Respite, refers to the initial goal of creating videotapes specifically for persons with dementia to capture and maintain their attention, enabling caregivers to have respite time. Ten 20-53-minute videotapes are described along with their potential benefits and limitations. Early research findings reveal that most persons with Alzheimer's disease (AD) watch and participate with the tapes, caregivers use the time for respite, and staff of SCU's report the tapes to be calming for the residents.

Intrapersonal resources and the effectiveness of self-help groups for bereaved older adults.

The relative impact of three intrapersonal resources (self-esteem, competencies and life satisfaction) and the duration of a self-help group intervention on levels of depression and grief were examined over time among a sample of 295 recently bereaved older adults. In general, the resources examined had a greater direct influence on outcomes than the intervention. Also, those with lower competencies reported reduced depression and grief with greater meeting attendance, whereas the opposite was at first true for those with high competencies. Depression eventually decreased, however, among those with high competencies who continued to attend self-help group meetings for more than 8 weeks. Although bereavement self-help groups can aid those who may be deficient in selected skills, it is equally important to emphasize ways the bereaved can more effectively use those strengths that they may already possess in order to facilitate adaptation.

Bereaved older adults who seek early professional help.

The purpose of this exploratory study was to determine the characteristics of older bereaved spouses who sought early professional help related to their grief. Among a sample of 339 bereaved older adults, aged 50 years or older, 39 (11.5%) reported that they had obtained some form of professional help. The most commonly reported source of help sought was from clergy followed by that provided by the health-care system and community groups. Those who sought help reported higher depression, lower coping ability, and poorer perceived health as well as slightly lower self-esteem and instrumental and resource-identification skills. With a few exceptions, the particular source of help sought was not statistically related to many of the indicators examined.

Wives, husbands, and daughters caring for institutionalized and noninstitutionalized dementia patients: toward a model of caregiver burden.

The primary purposes of this article are to clarify some of the inconsistencies in the previous research studies done on factors associated with caregiver burden; to identify specific sets of variables that best explain the differential burden levels among caregivers; and to provide a substantial foundation for developing a model of caregiver burden useful for both research and clinical interventions. The caregiver's gender, relationship to the patient, and the residential location of the patient (same house, community, or institution) are major considerations in our analyses. This study is also unique, because it uses a relatively large national sample of caregivers, which is necessary to accomplish the study's objectives. Mailed questionnaires were completed by 409 caregivers identified by fifty local support groups in sixteen different states in the United States. Generally, the primary correlates of burden were factors related to the levels and types of impairment in patient functioning, caregiver life satisfaction, and social support. Each category of caregiver circumstances had a unique set of three to five correlates with the total amount of variance explained in burden ranging from 25 percent (husbands living with the patients) to 68 percent (husbands with spouses in nursing homes). Implications for future research and interventions are discussed.

Intergenerational conflict: middle-aged women caring for demented older relatives.

This study examined the experiences of 181 middle-aged women who, while raising a family, were also primary care providers for an older demented relative. Results indicated that the caregiver burden depended on the context of the caregiving experience, particularly the relative's place of residence. Employment did not alter responsibilities but did affect coping strategies and perceived health of the caregiver.

Assessing interviewer effects in a longitudinal study of bereaved elderly adults.

In a 2-year study, bereaved elders who were personally interviewed were compared with those who completed a mailed questionnaire on measures of depression, life satisfaction, and five global measures constructed from a series of bereavement-related feelings and behaviors. Data were gathered at six separate measurement periods. Multiple analyses of variance with repeated measures revealed no effect due to group assignment. Although significant changes over time were observed on most measures, these changes were statistically independent of whether the respondents were interviewed or not. The presence of interviewers was, however, associated with higher and more consistent completion rates at each measurement period.