Caregiver Burden, Care Recipient Depressive Symptomology, and Social Exchange: Does Race Matter?

Informal caregivers play a vital role in supporting seriously ill patients. However, informal caregiving is burdensome and can lead to negative health outcomes for the caregiver and the care recipient. The study's aim was to evaluate relationships among caregiver burden, care recipient depressive symptomology, and race. Guided by the social exchange perspective, we examined cross-sectional dyadic data from the National Long-Term Care Survey (N = 1279). Using ordinal logistic regression, we found that higher caregiver-reported objective burden was associated with higher care recipient depressive symptoms ( P < .05), an association that was stronger for blacks. Interestingly, despite significant levels of objective burden, there was an association between lower depressive symptoms in black care recipients when there was an exchange of the social good "helpful company" with a caregiver. These findings illustrate the importance of supporting reciprocal exchange as a promising component of maintaining balanced caregiver-care recipient relationships among black older adults and their informal caregivers.

Lay Patient Navigators' Perspectives of Barriers, Facilitators and Training Needs in Initiating Advance Care Planning Conversations With Older Patients With Cancer.

CONTEXT: Respecting Choices is an evidence-based model of facilitating advance care planning (ACP) conversations between health-care professionals and patients. However, the effectiveness of whether lay patient navigators can successfully initiate Respecting Choices ACP conversations is unknown. As part of a large demonstration project (Patient Care Connect [PCC]), a cohort of lay patient navigators underwent Respecting Choices training and were tasked to initiate ACP conversations with Medicare beneficiaries diagnosed with cancer. OBJECTIVES: This article explores PCC lay navigators' perceived barriers and facilitators in initiating Respecting Choices ACP conversations with older patients with cancer in order to inform implementation enhancements to lay navigator-facilitated ACP. METHODS: Twenty-six lay navigators from 11 PCC cancer centers in 4 states (Alabama, George, Tennessee, and Florida) completed in-depth, one-on-one semistructured interviews between June 2015 and August 2015. Data were analyzed using a thematic analysis approach. RESULTS: This evaluation identifies 3 levels-patient, lay navigator, and organizational factors in addition to training needs that influence ACP implementation. Key facilitators included physician buy-in, patient readiness, and navigators' prior experience with end-of-life decision-making. Lay navigators' perceived challenges to initiating ACP conversations included timing of the conversation and social and personal taboos about discussing dying. CONCLUSION: Our results suggest that further training and health system support are needed for lay navigators playing a vital role in improving the implementation of ACP among older patients with cancer. The lived expertise of lay navigators along with flexible longitudinal relationships with patients and caregivers may uniquely position this workforce to promote ACP.

"He's on his dying bed": Next-of-kin's experiences of the dying body.

For family members of dying patients who have grown accustomed to providing daily body care, the transition from home to hospital is stressful. The authors used the experiences surrounding death for 78 U.S. veterans who died in a Veterans Affairs hospital. The research is based on interviews conducted with the decedent's next-of-kin. Secondary qualitative analysis of previously-coded transcribed interviews was used. Themes of social disorganization and a loss of control over the body emerged. Next-of-kin experienced the physical and functional breakdown of their loved one's body. Understanding the nature of the loss of control may help alleviate the loss of control may help alleviate the strain on families.

Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer?

BACKGROUND: Current literature suggests that racial/ethnic minority survivors may be more likely than whites to experience economic hardship after a cancer diagnosis; however, little is known about such hardship. METHODS: Patients with lung cancer (LC) and colorectal cancer (CRC) participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium were surveyed approximately 4 months (baseline) and 12 months (follow-up) after diagnosis. Economic hardship at follow-up was present if participants 1) indicated difficulty living on household income; and/or 2) for the following 2 months, anticipated experiencing hardships (inadequate housing, food, or medical attention) or reducing living standards to the bare necessities of life. The authors tested whether African Americans (AAs) and Hispanics were more likely than whites to experience economic hardship controlling for sex, age, education, marital status, cancer stage, treatment, and economic status at baseline (income, prescription drug coverage). RESULTS: Of 3432 survivors (39.7% with LC, 60.3% with CRC), 14% were AA, 7% were Hispanic, and 79% were white. AAs and Hispanics had lower education and income than whites. Approximately 68% of AAs, 58% of Hispanics, and 44.5% of whites reported economic hardship. In LC survivors, the Hispanic-white disparity was not significant in unadjusted or adjusted analyses, and the AA-white disparity was explained by baseline economic status. In CRC survivors, the Hispanic-white disparity was explained by baseline economic status, and the AA-white disparity was not explained by the variables that were included in the model. CONCLUSIONS: Economic hardship was evident in almost 1 in 2 cancer survivors 1 year after diagnosis, especially AAs. Research should evaluate and address risk factors and their impact on survival and survivorship outcomes.

The effects of caregiver emotional stress on the depressive symptomatology of the care recipient.

OBJECTIVES: Depression is a leading mental health issue affecting elderly individuals worldwide. Previous research widely neglects caregiver emotional stress as a probable contributing factor of depression in the elderly. This study investigated caregiver emotional stress as a chronic life stressor of an elderly care recipient using the life stress paradigm as the theoretical foundation. METHODS: The relationships between caregiver emotional stress and care receiver depressive symptoms, as well as other social and psychological mediation factors, were investigated using the 2004 wave of the National Long-Term Care Study (NLTCS). The NLTCS is a nationally representative longitudinal study used to identify frail and disabled elderly Medicare recipients living in the United States. The analytic sample of this study included 1340 caregiver-care receiver dyads who were asked a series of questions concerning their mental health (i.e. emotional stress and depressive symptoms), as well as the availability of social and psychological resources. RESULTS: Overall, the results showed that high levels of emotional stress reported by the caregiver were associated with a higher likelihood of the disabled care receiver reporting depressive symptoms. CONCLUSION: The findings of this investigation point to the importance of studying caregivers and care receivers as dyads as the stress associated with the caregiving role affects each member.

Grandparenting and Physical Activity.

Objective: The aim of this study was to examine a continuum of grandparenting intensity and its association with physical activity using three perspectives: grandparents are active, the more constraints perspective, and the selection bias perspective. Method: We use 2014 data from the Health and Retirement Study (HRS), a nationally-representative panel study of the US population over the age of 50 and their spouses (n = 17,851). Results: We found that greater grandparenting intensity was inversely associated with physical activity, providing support for both the more constraints perspective and the selection bias perspective. Discussion: We discuss the implications of inequality in which the most advantaged with physical activity are those who were either not grandparents, or grandparents who provided less care.

How Does Successful Aging Apply To Black Women?: A Latent Class Analysis.

BACKGROUND AND OBJECTIVES: Although prior research has identified racial/ethnic and gender differences in successful aging (SA), heterogeneity within groups has been little examined. We consequently explore the variety of aging experiences among older Black women. RESEARCH DESIGN AND METHODS: We used the 2010/2012 U.S. Health and Retirement Study, limiting analyses to Black women who completed the Psychosocial Leave-Behind Questionnaire (N = 1,186). We conducted latent class analysis (LCA) using indicators of physical health, psychological well-being, social support/strain, and social engagement. RESULTS: Six SA latent classes were identified and labeled according to their distinctive characteristics: infirm, isolated, taxed, independent, vivacious, and robust. The infirm class had uniformly poor health, while the isolated class was in poor physical health but also lacked social relations. Although both had average physical health and psychological well-being, the taxed class experienced high levels of social support and social strain compared to the high support (and unpartnered) independent class. The vivacious and robust classes exhibited high physical health and psychological well-being, high social support/low social strain, and high social engagement, but vivacious women (23% of respondents) were unpartnered and robust women (16% of respondents) were partnered. The robust class had the highest physical and psychological well-being, and best social relations across all classes. DISCUSSION AND IMPLICATIONS: Using nationally representative data, we reveal significant heterogeneity in Black women's aging experiences. Although many face difficult aging experiences, 39% of older Black women fit the SA framework well. Future work should recognize that Black women's aging experiences are not homogenous.

The intersection of gender and place in online health activities.

This study examines how rurality and gender are related to online health activities. Rural women face greater health risks and yet have access to a weaker health system infrastructure, which has resulted in a health disadvantage. New health information technologies may ameliorate some of these disparities; thus, the authors examine the relevance of gender and place in going online to search for health information, buy medicines, participate in health-related support groups, communicate with physicians, or maintain a personal health record. Analyzing data from the National Cancer Institute's 2007 Health Information National Trends Survey, the authors found that the relations between rurality and gender vary, depending on the specific type of online health activity, and that gender may be a more salient factor than rurality in determining whether individuals engage in particular types of online health activities. This study contributes to the literature by examining how gender and place are related to online health activities, a combined area neglected in past research, and advancing research on gender and technology. This research highlights the importance of expanding high-speed access in rural locations, increasing technological and health literacy, and tailoring the Internet to specific populations.

Secondary emotional labor: How female nurses respond to the contradictions of caring.

Prior research suggests that caring is in tension with a financially incentivized, technologically-driven healthcare system. Nevertheless, employers, the public, and nurses expect nurses to be caring when providing care to patients and families. This article focuses on nurses' emotional labor strategies when managing emotions related to organizationally imposed interference with caring. We analyzed 27 semi-structured interviews with nurses and found that the unsuccessful performance of emotional labor spills over into the women's relationships at and outside of work. We apply Di-Cicco-Bloom and DiCicco-Bloom's concept of secondary emotional labor to examine our findings and how secondary emotional labor further develops the alienation and exploitation concepts of Hochschild's emotional labor theory. We suggest a structural change in nurses' job design that remedies contradictory caring expectations and supports their emotional labor to prioritize a climate of caring for patients.

Masculine Ideals and Health in Older Men: Findings From the Wisconsin Longitudinal Study.

How do older men's masculine ideals affect their health? Are masculine activities involved in this relationship? Masculine identity upholds beliefs about masculine enactment. These beliefs can be detrimental to men and can lead to behaviors that can put undue stress on them. We examine how masculine ideals are associated with health and depressive symptomatology in older men. We used 2011 data from the Wisconsin Longitudinal Study (n = 2,594) to investigate how masculine ideals inform older men's health and how participation in masculine activities might shape these outcomes. Findings from this study illustrate that traditional masculine ideals are associated with worse self-rated health (SRH), greater chronic illness, and depressive symptomatology. For masculine activities, doing repairs and car maintenance was associated with less chronic illness and depression. Belonging to a senior men's group was associated with worse SRH, greater chronic illness, and greater depression. Therefore, older men's greater endorsement of traditional masculine ideals was generally associated with worse health, though certain masculine activities affected this relationship. We posit that more gender-equitable beliefs may be useful for improving the "men's health gap."

Ethical capital: 'what's a poor man got to leave?'.

For those of little or no means, leaving one's mark through financial assets, social connections, and human investment is difficult. Using secondary analysis of transcripts from face-to-face interviews with 33 terminally-ill patients from an outpatient clinic at a public hospital serving the disadvantaged in the southern United States, we examine the legacy participants wish to leave behind. As part of this process, participants assess life circumstances to try and generate a legacy allowing them to remain personally relevant to loved ones after death. For the low-SES terminally ill persons in this study, the desire to leave a material legacy and the means to do so are not congruous. In the absence of economic resources to bequeath loved ones, participants describe their desire to leave loved ones some form of ethical currency to facilitate interactions with others and protect them against social marginalisation. We call this concept ethical capital. We then argue ethical capital is a way for disadvantaged people to find dignity and to affirm their lives.

Substance Use Stigma and Antiretroviral Therapy Adherence Among a Drug-Using Population Living with HIV.

Among people living with HIV (PLWH), HIV-related stigma predicts nonadherence to antiretroviral therapy (ART); however, the role of stigma associated with drug use is largely unknown. We examined the association between substance use (SU) stigma and optimal ART adherence in a sample of 172 self-reported HIV-infected drug users. Participants completed surveys on SU, stigma, and ART adherence. The three substance classes with the greatest number of participants exhibiting moderate/high-risk scores were for cocaine/crack cocaine (66.28%), cannabis (64.53%), and hazardous alcohol consumption (65.70%). Multivariable logistic regression was conducted to investigate associations between levels of SU stigma and optimal ART adherence, adjusting for sociodemographic characteristics, severity of illicit drug use (alcohol, smoking and substance involvement screening test) and alcohol use severity (Alcohol Use Disorders Identification Test-C), HIV-related stigma, and social support. The odds of optimal adherence among participants experiencing moderate [Adjusted Odds Ratio (AOR) = 0.36, p = 0.039] and very high (AOR = 0.25, p = 0.010) levels of anticipated SU stigma were significantly lower than participants experiencing low levels of anticipated SU stigma. No other stigma subscales were significant predictors of ART adherence. Interventions aiming to improve ART adherence among drug-using PLWH need to address anticipated SU stigma.

Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer's disease.

Those who provide care at home for a spouse with Alzheimer's disease (AD) endure considerable challenges, including social isolation and increasing caregiving responsibilities. We examine the extent to which an intervention that helps spouse-caregivers mobilize their social support network, helps them better adapt to the caregiving role. We used detailed social support information collected from 200 spouse-caregivers participating in a randomized, controlled trial of enhanced social support services in the USA. Using random effects regression models, we found that individuals in the intervention group reported higher levels of satisfaction with their social support network over the first 5 years of the intervention than those in the support group. Higher levels of emotional support, more visits, and having more network members to whom they felt close were all individually predictive of longitudinal changes in social support network satisfaction. We conclude with a discussion of the importance of having psychological respite when caregivers spend their days in the home and are isolated.

Uncovering the mystery: factors of African American suicide.

Traditionally, African Americans have registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African Americans. To date, the research conducted regarding this phenomenon has been limited for a variety of reasons and previous research has been inconclusive in determining risk factors of African American suicide. The purpose of this paper is to identify risk and protective factors specific to African American suicide. To determine the factors, the 1993 National Mortality Follow-back Survey was analyzed. The risk factors identified include being under age 35, southern and northeastern residence, cocaine use, firearm presence in home, and threatening others with violence. Some of the protective factors associated with African American suicide include rural residence and educational attainment. These results provide valuable information about completed African American suicides in relation to Whites. Several of these factors are unique to African Americans.

Retirement and mental health.

OBJECTIVES: This research examines whether retirement is associated with mental health and how one's daily pursuits mediate this association. It tests two perspectives from the sociology of work and the sociology of mental health. METHODS: Using data from two surveys, the 1995 Aging, Status, and Sense of Control and the 1987-1988 National Survey of Families and Households, regression analysis was used to examine retirement, activities, and well-being. RESULTS: In support of the view that work is alienating and retirement liberating, retirees experienced less anxiety and distress and higher positive affect. Retirees' lower anxiety and distress were explained by activity characteristics. In support of the view that work is empowering and retirement demoralizing, retirement is associated with lower sense of control in both data sets, in part because of the daily pursuits. Retirement was not associated with depressive symptomatology. DISCUSSION: Suggestions for creating opportunities that enhance well-being are discussed.

Physical impairment is associated with nursing home admission for older adults in disadvantaged but not other neighborhoods: results from the UAB study of aging.

OBJECTIVES: Aging adults face an increased risk of adverse health events as well as risk for a decrease in personal competencies across multiple domains. These factors may inhibit the ability of an older adult to age in place and may result in a nursing home admission (NHA). This study combines insights from Lawton's environmental press theory with the neighborhood disadvantage (ND) literature to examine the interaction of the neighborhood environment and individual characteristics on NHA. METHODS: Characteristics associated with the likelihood of NHA for community-dwelling older adults were examined using data collected for 8.5 years from the UAB Study of Aging. Logistic regression models were used to test direct effects of ND on NHA for all participants. The sample was then stratified into 3 tiers of ND to examine differences in individual-level factors by level of ND. RESULTS: There was no direct link between living in a disadvantaged neighborhood environment and likelihood of NHA, but physical impairment was associated with NHA for older adults living highly disadvantaged neighborhood environments in contrast to older adults living in less disadvantaged neighborhood environments, where no association was observed. DISCUSSION: These outcomes highlight (a) the usefulness of linking Lawton's theories of the environment with the ND literature to assess health-related outcomes and (b) the importance of neighborhood environment for older adults' ability to age in place.

Neither a borrower nor a lender be: the relative importance of debt and SES for mental health among older adults.

OBJECTIVE: This study examines the impact of indebtedness on depressive symptomatology, anxiety, and anger. METHOD: We use data from a two-wave panel study of adults in Miami-Dade County. The analytic sample consists of 1,463 mostly older respondents with valid data on all study measures, including education, income, occupational status, wealth, and debt. RESULTS: We find that indebtedness is common and is associated with more symptoms of depression, anxiety, and anger. It is weakly associated with other aspects of socioeconomic status (SES), and thus not redundant with them. In fact, in this sample, debtor status is more consistently associated with mental health than any other single traditional indicator of SES, its effect does not vary across income or other aspects of SES, and fears of never paying off debt account for its negative impact on mental health. DISCUSSION: These findings affirm health scholars' calls for more complete measures of SES.

The importance of type, amount, and timing of internet use for understanding psychological distress.

Objective. Few social scientists have examined how Internet usage, including using the Internet for health purposes, may affect mental health. This study assesses whether the type or amount of online health activities and the timing of Internet use are associated with psychological distress.Methods. We use data from the National Cancer Institute's 2005 Health Information National Trends Survey.Results. When we compare Internet users to non-Internet users, using the Internet and using the Internet for health purposes are negatively associated with distress. However, among Internet users, the number of online health activities is positively associated with distress. Greater distress is also associated with using the Internet on weekdays and looking online for information on sun protection.Conclusions. Internet usage is not necessarily positively associated with psychological distress. The effects depend on the type, amount, and timing of Internet usage.

Caregiving outside of the home: the effects of race on depression.

OBJECTIVE: This research examines the conditions that determine whether Blacks experience lower or higher levels of depression while caregiving outside of the home, as compared to Whites. Some prior literature has found that African Americans report a lesser caregiver burden despite an increased likelihood that they will acquire this role, and decreased resources to do so. Others have found that African Americans experience the same caregiver burden and distress as Whites. Given these mixed findings, we use the stress process model to examine whether African American caregivers experience lower or higher levels of depression when they provide care outside of the home. DESIGN: A sample of care workers who provide care to others outside of the home was drawn from the 1992-4 National Survey of Families and Households. The final sample included 275 (11%) Blacks, and 2,218 (89%) Whites (not of Hispanic origin). The primary statistical method for predicting differences in caregivers' depressive symptomatology was OLS regression analysis with progressive adjustment. RESULTS: We examined sociodemographics, family structure, resources, and stressors and found that African Americans, those with lower socioeconomic status, the unmarried, spending more weeks caregiving, having a physical impairment, and surprisingly receiving more help from parents are associated with higher depressive symptomatology. Stronger religious beliefs decreased depressive symptomatology for Blacks. The race effect was, in part, explained by family structure, amount of caregiving, and impairment of care worker. CONCLUSION: Contrary to prior literature, we found that Blacks are more depressed than White caregivers in large part because of lower socioeconomic status and greater stressors, and higher levels of physical impairment. Yet, strength in religious belief has a stress-buffering effect for African Americans. We suggest that policies that attempt to eliminate racial disparities in socioeconomic status and health could benefit these caregivers.