Working with older adults impacts training preferences of counselors.

Clinicians specializing in working with older adults make up a very small portion of providers, and the majority of the service provision falls on general practitioners. Licensed Professional Counselors (LPCs) have heavily focused on Multicultural Competency in training and practice, but the profession has not specified standards of competence for work with older adults. Efforts to increase competency for generalists providing care for older adults are needed. A random sampling of LPCs was surveyed regarding demographic variables, work characteristics, perceived competence for working with older adults, and interest in aging-specific continuing education (CE). About half of the sample reported engaging in practice with older adults over the previous year. Counselors who reported practicing with older adults over the last year were more interested in aging-specific CE and reported higher perceived competence for working with older adults.

Self-reassurance and self-efficacy for controlling upsetting thoughts predict depression, anxiety, and perceived stress in help-seeking female family caregivers.

OBJECTIVES: Providing care for an older family member is a common experience for women and has been linked with increased depression, anxiety, and stress for some caregivers. This study aimed to investigate the role of self-reassurance and self-efficacy for controlling upsetting thoughts in mitigating the negative effects of caregiving stressors on mental health. DESIGN: Measures were collected during a pre-intervention assessment for a larger study in the U.S.A. evaluating online interventions for intergenerational caregivers. Hierarchical linear regressions were used to examine the contribution of self-reassurance and self-efficacy for controlling upsetting thoughts on mental health outcomes, after controlling for caregiving-related contextual variables and stressors. SETTING: Participants completed online questionnaires on a computer or tablet at their convenience. PARTICIPANTS: Participants were 150 help-seeking adult women providing health-care assistance to older relatives living in the community. MEASUREMENTS: Measures were completed for the mental health outcomes of depression, anxiety, and stress. Measures also included contextual factors of caregiving and demographics. Cognitive impairment, caregiver assistance, role overload, percentage of care provided, family conflict, self-reassurance, and self-efficacy for controlling upsetting thoughts were also measured. RESULTS: Regression models revealed that both self-reassurance and self-efficacy for controlling upsetting thoughts predicted depression, anxiety, and perceived stress after controlling for caregiving contextual factors and stressors. CONCLUSIONS: The results indicate that self-reassurance and self-efficacy for controlling upsetting thoughts are effective resources linked to mental health outcomes. Although results were obtained with cross-sectional data, these findings suggest the potential of targeting these resources in transdiagnostic interventions for family caregivers.

Intergenerational Ambivalence and Dyadic Strain: Understanding Stress in Family Care Partners of Older Adults.

OBJECTIVES: The present study used Pearlin, Mullan, Semple & Skaff's (1990) caregiving stress process model as a framework to examine the comparative influence of two stressors: (a) intergenerational ambivalence as a unified construct and (b) dyadic strain, which is one isolated component of intergenerational ambivalence. METHODS: Participants were 120 women providing healthcare and medication assistance to an earlier generation family member with physical and/or cognitive impairments. RESULTS: Hierarchical regression confirmed that intergenerational ambivalence explained perceived stress in family care partners, beyond the variance accounted for by other commonly reported stressors such as length of caregiving experience, memory/cognitive and functional impairments of the care recipient, caregiver overload, family conflict and financial strain. Further analyses revealed that examining dyadic strain apart from intergenerational ambivalence may more accurately explain the influence of ambivalence scores on care partners' perceived stress. CONCLUSIONS AND CLINICAL IMPLICATIONS: The comparative influence of dyadic strain versus ambivalence suggests that stress-reducing interventions may benefit from a focus on reducing care partners' experiences of negative strain in the dyadic relationship rather than managing ambivalence.

Medication Saving Behaviors of Older Adults: Scale Developed to Assess Family Caregiver Perspectives.

OBJECTIVES: This study developed and explored the preliminary reliability and validity of a 6-item Medication Saving Behaviors (MSB) scale when completed by family care partners of older adults. METHODS: Women (N = 119) helping an aging relative with healthcare appointments and medication management completed an online survey including items related to generalized hoarding and medication saving behaviors. RESULTS: The MSB was psychometrically sound and correlated significantly with hoarding scales and reported number of expired and leftover medications. Compared with those reporting low levels of general hoarding concerns, group means on the MSB were higher for caregivers reporting clinically significant levels of hoarding by their elderly family member. The MSB was unrelated to total prescription or over-the-counter medications for the older adult, lending support for the discriminant validity of the scale. CONCLUSIONS: This study provides initial support for the convergent and discriminant validity of the MSB when administered to intergenerational care partners of older adults. CLINICAL IMPLICATIONS: The MSB may function to identify higher risk patients via their family members and target families for interventions.

A telehealth behavioral coaching intervention for neurocognitive disorder family carers.

OBJECTIVES: This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self-efficacy. METHODS: Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via random allocation to either of the following: (1) a 14-week behavioral intervention using video instructional materials, workbook and telephone coaching in behavioral management, pleasant events scheduling, and relaxation or (2) a basic education guide and telephone support comparison condition. Telephone assessments were conducted by interviewers blind to treatment condition at pre-intervention, post-intervention, and 6 months following intervention. RESULTS: For those providing in-home care at post-treatment, depressive symptoms, upset following disruptive behaviors, and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition. Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition. Caregiving self-efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition. Effect sizes were moderate but not maintained at the 6-month follow-up. CONCLUSIONS: This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support. Carers' abilities to maintain strategy use during progressive disorders such as Alzheimer's disease likely require longer intervention contact than provided in the current study. Dementia carers, including those living in rural areas, can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost.

Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences.

The transition from "wife" to "caregiver" for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population's experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.

Validating the Medication Risk Questionnaire with Family Caregivers of Older Adults.

This study supports the validity of the 8-item version of the Medication-Risk Questionnaire (MRQ8). The MRQ8 can identify higher-risk patients via family caregivers and target them for medication review and other preventive intervention. It also enables pharmacists to collaborate with family caregivers in identifying older adults at high risk for medication-related problems.

Predicting Gay Affirmative Practice from the Theory of Planned Behavior.

This study utilized the theory of planned behavior to examine individual intentions to engage in gay affirmative practice among aging-focused professionals (N = 83) in the Midwestern United States. Participants completed self-report measures of perceived agency norms and individual attitudes related to the treatment of gay men and lesbians, intentions to provide gay affirmative care, and perceived behavioral control. Attitudes, norms and perceived behavioral control were examined as predictors of intentions; attitudes of individual aging-service professionals emerged as the strongest predictor. Results indicated that affirmative attitudes within the agency may be important in predicting intentions to provide this type of care.

Brief Aging Education Affects Continuing Education Preferences and Behaviors of Mental Health Providers.

BACKGROUND AND OBJECTIVES: This study examined the impact of receiving foundational information about aging on continuing education (CE) interests, preferences, and behaviors of mental health providers. RESEARCH DESIGN AND METHODS: Participants were practicing licensed professional counselors (N = 120) recruited from a random sampling of a state registry. The study employed a 3-group randomized controlled design with participants assigned to 1 of 3 conditions: an aging-specific reading, an opioid use disorder-specific reading, and a CE requirement-specific reading. As outcomes, participants rated their interest in aging-specific CE and selected to receive an aging-specific CE or Motivational Interviewing-specific CE program. RESULTS: Perceived competence for working with older adults, assessed before the experimental manipulation, predicted choice and degree of interest in the aging-specific CE across conditions. Participants in the Aging-Reading condition rated a higher interest in aging-specific CE and were marginally more likely to select the aging-specific CE option than those in the other 2 conditions. Those in the Aging-Reading condition were also more likely to register for and complete an actual CE program focused on any topic. DISCUSSION AND IMPLICATIONS: Foundational knowledge about aging may increase practitioners' interest and behaviors toward gaining competency for working with older adults, supporting the Positive Education about Aging and Contact Experiences model (Levy, S. R. (2018). Toward reducing ageism: PEACE (positive education about aging and contact experiences) model. Gerontologist, 58(2), 226-232. https://doi.org/10.1093/geront/gnw116) of reducing ageism.

Improving Gerontological Survey Participation With Mixed-Mode Response Options, Multiple Contacts, and Noncontingent Incentives.

BACKGROUND: Surveys are a prominent tool in gerontological research but are hindered by low response rates. This study examined methods to improve response rate among social workers, an understudied cohort in survey methodology literature. METHODS: In this brief report, we analyzed factors that influence response rate using mixed-mode survey design (mail vs. online response) and randomized monetary ($10 gift card) and in-kind (continuing education coupon) noncontingent incentives with three reminder postcards among social workers (N = 307). RESULTS: Response rate was 34.1% with more surveys returned via mail than online. Participants who received a gift card responded at a higher rate (46.33%) than those who received continuing education coupons (28.0%). The results add to the literature of survey methodology to improve response rates among social workers and support noncontingent gift cards and mixed-mode survey return procedures as best practices for reducing bias and improving the quality of gerontological research.

Depressive symptoms and use of home-based respite time in family caregivers.

This study investigated the relationship between activities during respite time and depressive symptoms in family caregivers (N = 74) of older adults receiving in-home respite services. Contrary to prior research, demographic contextual variables (caregiver gender, household income, and dyad relationship) and care recipient problems (behavioral dysfunction and functional impairment) were not associated with caregiver depressive symptoms, nor was total minutes engaged in discretionary activities during respite. Self-reported depressive symptomatology in family caregivers was significantly and inversely related to both past service usage and total minutes of chore time completed on a typical home-based respite day. Implications for research in this area and service delivery are discussed.

Reactions and Preferences for Training Among Area Agency on Aging Providers Working With Transgender and Gender Nonconforming Older Adults.

Transgender and gender nonconforming (TGNC) older adults face numerous barriers to healthy aging. These older adults may be less likely to seek out aging-focused services due to fear of discrimination and a lack of culturally competent services. There is a dearth of trainings for aging-focused professionals that would contribute to the development of affirming service environments for TGNC older adults. The current study explores providers' responses to a professional development training made available nationwide to staff and volunteers of area agencies on aging. Participants' (N = 155) reflections on what would be most helpful in their future work with TGNC older adults included requests for role-plays, instructions on creating more inclusive agency documents, increased contact with TGNC older adults, and managing discriminatory language in the workplace. Future directions include creating professional development opportunities that incorporate experiences with and exposure to both other aging-focused providers and TGNC elders.

Neurocognitive Disorder Diagnoses Matter: A Brief Report on Caregiver Appraisal of Driving Ability.

Background: Age-associated neurocognitive disorders (NCDs) are associated with progressive loss of abilities for instrumental activities of daily living, including driving. This study assesses the impact of NCD diagnosis, while controlling for reported level of cognitive impairment, on family caregiver judgment of driving safety. Method: An intervention sample of 152 intergenerational caregivers who assist an older adult with medical tasks was used. Caregiver's pre-intervention response to a single item of confidence in the older adult driving was used to determine judgment of driving ability. Cognitive impairment was assessed using caregivers' report for Clinical Dementia Rating (CDR) Sum of Boxes score. Results: Older adults with a diagnosis were rated as less capable of driving safely than those without a diagnosis, while controlling for reported level of cognitive impairment. Conclusion: Results of this study highlight the importance of NCD diagnosis on caregiver judgments. Results of this study have implications for health care and driving safety.

Development of a Transgender and Gender Nonconforming Language Self-Efficacy Scale for Social Service Providers Working With Older Adults.

There is consensus that providers who work with transgender and gender nonconforming (TGNC) older adults should use the language preferred by the older adult; however, assessment tools to document professional training efforts are lacking. This study presents data on a new TGNC Language Self-Efficacy Scale, using responses collected from employees and volunteers of area agencies on aging (AAA) across the United States (N = 155). Exploratory factor analysis supports a two-factor model: Interactions and Information subscales significantly correlated with knowledge of TGNC terminology, genderism and transphobia, gender role beliefs, beliefs about gender and gender identity, and attitudes toward lesbians and gay men. Future directions include additional measurement development work and replication of these findings outside of AAAs.

Validating the Revised Scale for Caregiving Self-Efficacy: A Cross-National Review.

BACKGROUND AND OBJECTIVES: This article reviews an instrument used in cross-national research with dementia family caregivers-the Revised Scale for Caregiving Self-Efficacy (RSCSE). Although the RSCSE has been translated into multiple languages, few studies have examined scale performance across samples. We examine congruence of psychometric, reliability, and validity data to inform research and practice. METHODS: We conducted citation searches using Scopus, Google Scholar, Web of Science, and PsycINFO. Identified dementia caregiving studies cited the original RSCSE article and described results of English and/or non-English translations of the scale. RESULTS: Peer-reviewed published studies (N = 58) of dementia family caregivers included data for Arabic, Chinese, English, French, Italian, and Spanish translations of the RSCSE; the majority (72%) reported use of non-English translations. Studies utilizing confirmatory factor analytic approaches reported findings consistent with the original development study. Internal consistency, convergent/discriminant validity, and criterion validity indices were congruent across diverse cross-national caregiving samples assessed with different translations. Data supported the RSCSE's sensitivity to change following specific psychosocial caregiving interventions. DISCUSSION: The reliability and validity of different translations of the RSCSE support continued use with cross-national samples of dementia family caregivers. Limitations of the scale point to the need for further self-efficacy measurement development within caregiving domains. Consistent with Bandura's discussion of social cognitive theory in cultural contexts, personal agency for caregiving challenges remains generalizable to cross-national populations. This review discusses the implications for cross-cultural research and practice.

Comparative outcomes of two distance-based interventions for male caregivers of family members with dementia.

Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions (N = 32) for male family dementia caregivers. Male caregivers were randomly assigned to either a basic education intervention (ie, educational booklet and biweekly check-in telephone calls) or a video intervention (ie, set of 10 videos, an accompanying workbook, and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations). Results did not support the greater efficacy of the video condition in reducing psychosocial distress (eg, negative affect, upset and annoyance following behavior problems) or increasing positive affect or caregiving self-efficacy. There was, however, a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions. Potential reasons for the lack of differential treatment effects are discussed, along with implications for recruitment of male dementia caregivers.

Predicting perceived medication-related hassles in dementia family caregivers.

Objective This study examined predictors of medication administration hassles reported by intergenerational dementia family caregivers. Methods A sample of 53 women who aided a cognitively impaired older adult with healthcare and who identified as inter-generational caregivers provided self-report medication management and psychosocial data. Results Hierarchical multiple regression analyses revealed that six independent variables hypothesized for this model, the total number of prescription medications managed by caregivers, educational attainment, care-recipient functional impairment, care-recipient cognitive impairment, caregiver depressive symptomatology, and self-reported feelings of preparedness for the caregiving role together significantly predicted caregiver medication administration hassles scores F(1, 48) = 4.90, p = .032, and accounted for approximately 25% of the variance of self-reported hassles (adjusted R2 = .247). Discussion Future interventions may reduce medication-related hassles by providing psychoeducation about healthcare, medication management, and strategies for coping with care-related stressors and depressed mood.

The Sandwich Generation Diner: Development of a Web-Based Health Intervention for Intergenerational Caregivers.

BACKGROUND: Women are disproportionately likely to assist aging family members; approximately 53 million in the United States are involved with the health care of aging parents, in-laws, or other relatives. The busy schedules of "sandwich generation" women who care for older relatives require accessible and flexible health education, including Web-based approaches. OBJECTIVE: This paper describes the development and implementation of a Web-based health education intervention, The Sandwich Generation Diner, as a tool for intergenerational caregivers of older adults with physical and cognitive impairments. METHODS: We used Bartholomew's Intervention Mapping (IM) process to develop our theory-based health education program. Bandura's (1997) self-efficacy theory provided the overarching theoretical model. RESULTS: The Sandwich Generation Diner website features four modules that address specific health care concerns. Our research involves randomly assigning caregiver participants to one of two experimental conditions that are identical in the type of information provided, but vary significantly in the presentation. In addition to structured Web-based assessments, specific website usage data are recorded. CONCLUSIONS: The Sandwich Generation Diner was developed to address some of the informational and self-efficacy needs of intergenerational female caregivers. The next step is to demonstrate that this intervention is: (1) attractive and effective with families assisting older adults, and (2) feasible to embed within routine home health services for older adults.

The revised scale for caregiving self-efficacy: reliability and validity studies.

Two samples of family caregivers (Study 1: N = 169; Study 2: N = 145) of cognitively impaired older adults were used to revise, extend, and evaluate a measure of perceived self-efficacy for caregiving tasks. The Revised Scale for Caregiving Self-Efficacy measures 3 domains of caregiving self-efficacy: Obtaining Respite, Responding to Disruptive Patient Behaviors, and Controlling Upsetting Thoughts. The 3 subscales show strong internal consistency and adequate test-retest reliability. Construct validity is supported by relationships between these 3 facets of perceived caregiving efficacy and depression, anxiety, anger, perceived social support, and criticism expressed in speech samples. The Revised Scale for Caregiving Self-Efficacy has potential uses for both research and clinical purposes.

Promoting medication adherence in older adults through early diagnosis of neurocognitive disorders.

OBJECTIVE: Community-dwelling older adults with neurocognitive disorders experience high risk of and often suffer severe consequences from medication nonadherence. Due to the important role of informal caregivers in the care of patients with neurocognitive disorders, medication management involves both patients and families. A formal diagnosis of a neurocognitive disorder may improve both provider-patient and provider-family communications and resulting regimen adherence, yet many with signs of neurocognitive disorders remain undiagnosed. The goal of this study was to examine the differences in medication management behaviors for family caregivers of mildly impaired older adults with or without a formal neurocognitive disorder diagnosis. METHOD: The study included 112 women who provided at least 2 forms of medication assistance for a mildly cognitively impaired older adult with (n = 38, 34%) or without (n = 75, 66%) a reported neurocognitive disorder diagnosis and who completed online self-assessments of medication adherence and self-efficacy for medication management from May 2012 to May 2013. Cases were selected for analyses based on analog Clinical Dementia Rating scores between 0.5 and 1, indicating mild cognitive impairment in the older adult. RESULTS: Compared to families unaware of a neurocognitive disorder diagnosis, caregivers reporting knowledge of a neurocognitive disorder diagnosis in their older family member endorsed higher medication management self-efficacy and increased levels of adherence-related behaviors. Step-wise logistic regression analyses demonstrated statistical significance in using these adherence and self-efficacy variables to differentiate between the presence or absence of a known neurocognitive disorder diagnosis (N = 112, χ (2) 6 = 22.84, P < .05). CONCLUSIONS: A formally charted and communicated neurocognitive disorder diagnosis is associated with improved medication management behaviors and medication-related self-efficacy in neurocognitive disorder family caregivers.