Informal Caregiver Burden, Benefits, and Older Adult Mortality: A Survival Analysis.

OBJECTIVE: Informal caregivers are crucial to maintaining older adults' health, but few studies examine how caregiving receipt is associated with older person longevity. In a nationally representative sample, we prospectively explore whether and how having an informal caregiver is associated with older adult overall mortality, and how caregivers' burden and benefits perceptions relate to care recipient mortality. METHODS: We match six National Health and Aging Trends Study waves (2011-2016) with 2011 National Study of Caregiving data, conducting survival analysis on 7,369 older adults and 1,327 older adult-informal caregiver dyads. RESULTS: Having an informal caregiver is associated with 36% (p < .001) higher mortality risk over 6-year follow-up, adjusting for demographic, economic, and health factors. Older adults whose caregivers perceive only burden have 38% higher (p < .05) mortality risk than those with caregivers reporting neither burden nor benefits. This risk is reduced from 38% higher to 5% higher (p < .001) for older adults with caregivers reporting benefits alongside burden, compared to those with caregivers reporting neither perception. DISCUSSION: Having a caregiver may signal impending decline beyond known mortality factors. However, interventions to increase caregivers' benefit perceptions and reduce their burden may decrease mortality risk for older adults with declining health and functional ability.

Do Caregiver Experiences Shape End-of-Life Care Perceptions? Burden, Benefits, and Care Quality Assessment.

CONTEXT: Researchers, hospices, and government agencies administer standardized questionnaires to caregivers for assessing end-of-life care quality. Caregiving experiences may influence end-of-life care quality reports, which have implications for caregiver outcomes, and are a clinical and policy priority. OBJECTIVES: This study aims to determine whether and how caregivers' end-of-life care assessments depend on their burden and benefit perceptions. METHODS: This study analyzes data from 391 caregivers in the 2011 National Study of Caregiving and their Medicare beneficiary care recipients from the 2011-2016 National Health and Aging Trends Study. Caregivers assessed five end-of-life care aspects for decedents. Logistic regression was used and predicted probabilities of caregivers positively or negatively assessing end-of-life care based on their burden and benefit experiences calculated. Analyses adjusted for caregiver and care recipient demographic and health characteristics. RESULTS: No or minimal caregiving burden is associated with ≥0.70 probability of caregivers reporting they were always informed about the recipient's condition and that the dying person's care needs were always met, regardless of perceived benefits. High perceived caregiving benefit is associated with ≥0.80 probability of giving such reports, even when perceiving high burden. CONCLUSION: Caregiver burden and benefit operate alongside one another regarding two end-of-life care evaluations, even when years elapse between caregiver experience reports and care recipient death. This suggests that caregiver interventions reducing burden and bolstering benefits may have a positive and lasting impact on end-of-life care assessments.

Exploring Indicators of Engagement in Online Learning as Applied to Adolescent Health Prevention: A Pilot Study of REAL media.

Engagement is central to the effectiveness of online health messages and the related educational programs that aim to deliver these messages to the intended audience (Li, Won, Yang et al. 2019: Lin, Hung, Kinshuk et al. 2019). Drawing from health communication and social learning theories, the Theory of Active Involvement (TAI) (Greene, 2013) posits that an online prevention program's impact depends on how engaged participants are. In practice, measuring engagement in this context has relied primarily on self-report measures (e.g., Hamutoglu, Gemikonakli, Duman et al. 2019). However, the emergence and growth of online learning platforms to deliver health-specific information offers other options for assessing engagement. This includes program analytics that capture interaction with content and facilitate examination of patterns via multiple indicators such as responses to interactive questions and time spent in the program (Herodotou, Rienties, Boroowa, et al. 2019; Li, Wong, Yang et al. 2019; van Leeuwen, 2019). However, little is known about the relationships between these different indicators of engagement as it applies to health curricula. This study uses self-report, observational, and program analytic data collected on a small (N = 38) sample using REAL media, an online substance use prevention program, to examine relationships among various indicators of engagement. Findings suggest a cluster of indicators across the three modalities that provide a useful way of measuring engagement. A cluster centered around complexity suggests a separate factor to be considered when designing engaging interventions.

The caregiving dyad: Do caregivers' appraisals of caregiving matter for care recipients' health?

Caregiving experiences matter for caregivers' own wellbeing, but few studies link caregivers' burden and benefit perceptions with recipient outcomes. Following the stress process model, I prospectively explore how caregivers' experiences shape recipients' mental health. I match US National Health and Aging Trends Study and National Study of Caregivers, employing logistic regression on 781 older adult-informal caregiver dyads. I examine how caregivers' appraisals shape recipients' subsequent depression and anxiety, with caregiver mental health and recipient unmet care need as key covariates. Recipients receiving care from caregivers reporting predominantly benefits are less likely to become depressed than counterparts receiving care from persons reporting predominantly burden. Recipients receiving care from persons reporting benefits even alongside low or moderate burden are also less likely to become anxious. Recipient unmet care need, but not caregiver mental health, is associated with recipient mental health. Improving caregiver conditions may have benefits for both dyad members.

The Burden and Benefits of Caregiving: A Latent Class Analysis.

BACKGROUND AND OBJECTIVES: Informal caregiving to older adults is a key part of the U.S. long-term care system. Caregivers' experiences consist of burden and benefits, but traditional analytic approaches typically consider dimensions independently, or cannot account for burden and benefit levels and combinations that co-occur. This study explores how benefits and burden simultaneously shape experiences of caregiving to older adults, and factors associated with experience types. RESEARCH DESIGN AND METHODS: 2015 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) data were linked to obtain reports from caregivers and recipients. Latent class and regression analysis were conducted on a nationally representative sample of U.S. informal caregivers to older persons. RESULTS: Five distinguishable caregiving experiences types and their population prevalence were identified. Subjective burden and benefits level and combination uniquely characterize each group. Primary stressors (recipient depression, medical diagnoses), primary appraisal (activities of daily living, instrumental activities of daily living, medical task assistance, hours caregiving), and background/contextual factors (caregiver age, race, relationship to recipient, mental health, coresidence, long-term caregiving) are associated with experience types. DISCUSSION AND IMPLICATIONS: Findings highlight caregivers' experience multiplicity and ambivalence, and identify groups that may benefit most from support services. In cases where it is not possible to reduce burden, assistance programs may focus on increasing the benefits perceptions.

Social Participation in Later Years: The Role of Driving Mobility.

Objectives: I investigate the role of driving mobility for older adults' formal and informal social participation. I expand the common driving status dichotomy using gradated driving frequency, driving change, and ride receipt to account for the complexity of driving behaviors in later years. Method: I estimate logistic regression models using the 2011 and 2013 waves of the National Health and Aging Trends Study on a nationally representative sample of 4,359 community-dwelling older adults. I adjust models for demographic, socioeconomic, health, and social activity factors. Results: Frequent drivers are most likely to visit friends and family, go out for enjoyment, attend religious services, and participate in organized activities compared with occasional drivers, those who ceased driving, and those who never drove. Driving frequency decrease lowers social participation. Participation does not differ between those who ceased driving and those who never drove. Persons with consistent ride access participate more than those never receiving rides. Models using a measure of driving mobility fit data better than models using dichotomous driving status. Discussion: Both driving frequency and ride receipt matter for older adults' formal and informal involvement. Facilitating ride-giving and developing flexible transportation options may enhance social participation among older adults who cease or begin ceasing to drive.