Mindfulness-Based Group Therapy for Chronic Pain Management in Older Adults.

OBJECTIVES: There were two quality improvement goals for this project: (1) to evaluate the outcomes of an 8-week geriatric-focused mindfulness-based group therapy program for chronic pain management called "Mindfulness-based Chronic Pain Care" offered at a senior community center affiliated with a geriatric primary care clinic, and (2) to obtain feedback from participants to make relevant modifications for future groups. METHODS: The program consisted of eight 150-minute weekly sessions. Thirteen community-dwelling older adults aged 60 and older participated in the program. The study utilized a non-randomized control-group pretest-posttest design. Participants completed pre- and post-program evaluations measuring pain and related psychosocial outcomes and were also asked to evaluate the importance of the group. Intervention and control groups were compared by t-test, chi-square likelihood ratio, Fischer's exact test, and multivariate analysis of variance with repeated measures. RESULTS: There were statistically significant improvements in three areas: 1) increased activity level, 2) increased "pain willingness," and 3) decreased generalized anxiety symptoms. Qualitative analysis highlighted how this intervention was important to participants. CONCLUSIONS: The results of this pilot program indicate promising outcomes for older adults suffering from chronic pain. CLINICAL IMPLICATIONS: The Mindfulness-based Chronic Pain Care program was a practical, feasible, and acceptable approach for pain management among program participants.

The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea.

BACKGROUND AND OBJECTIVES: We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS: Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS: CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.

Conflict in Skipped Generation Households in Thailand.

A common phenomenon in rural Thailand is that adult children migrate to find work and leave their children behind in the care of their grandparents. The resulting living arrangement is referred to as a skipped generation household. This arrangement can benefit the intergenerational family but can also be associated with conflict. This study explores different types of conflict between grandparents and their adult children in skipped generation households and how they manage these conflicts. In-depth interviews were conducted with 48 grandparents in rural Thailand. Using thematic analysis, conflicts including decision to care for grandchildren, how to raise and discipline grandchildren, where the grandchildren should live, grandchildren's education, and inconsistent remittances from the migrant children to their parents were identified. The findings revealed the strategies grandparents use to cope by either trying to prevent or dealing with conflicts. Buddhist teachings play an important role in the way families react to conflict.

Assisted Living Residents' Sense of Belonging and Psychosocial Outcomes.

Little is known about the psychosocial adjustment of older adults in the assisted living environment. A sense of belonging has been linked to psychological health and a lack of belonging could lead to loneliness. We conducted a cross-sectional descriptive study to examine relationships between social engagement, sense of belonging, and psychological outcomes. Seventy female and 30 male assisted living residents participated. The mean age was 83.9 (range 65-99) years. Structural equation modeling (SEM) revealed that older age, higher physical function, and greater sense of belonging were associated with fewer negative psychosocial outcomes (depression and loneliness) and that sense of belonging functioned as a mediator between social engagement and psychosocial outcomes. Additional work is needed to fully understand how sense of belonging and other factors influence psychosocial outcomes.

A systematic review of dyadic approaches to reminiscence and life review among older adults.

Objective: This paper describes a systematic review of quantitative and qualitative studies that examine the effectiveness of dyadic approaches to life review and reminiscence. Methods: The search process began with 1,056 potentially eligible articles and, after a multi-step screening process, led to 20 full-text articles for review. Results: The resulting studies (ten quantitative, nine qualitative, and one mixed-method) comprised six different kinds of dyadic approaches. There are a combination of benefits and problems associated with dyadic life review and reminiscence approaches. Conclusions: This review provides initial understanding of the impact of life review and reminiscence when care recipients and caregivers participate in the intervention together. Future clinical studies on dyadic approaches to life review and reminiscence should provide clearer descriptions of their protocols, include more consistent measures (incorporating in-the-moment measures), and involve populations of healthy older adults and their partners as well as those with cognitive impairment. The inclusion of qualitative studies helps interpret the diverse results reported in the quantitative studies and highlights key themes related to participating in dyadic interventions.

"We are a Team": Couple Identity and Memory Loss.

Couplehood can be an important source of resilience in the face of memory loss, but couple identity has only recently been explored and has rarely been measured. This paper examines older spouses' descriptions of their couple identity and discusses salient themes. Data come from 19 couples from the Couples Life Story Project, a life review intervention where one partner has memory loss. Using baseline data, we analyzed how partners depicted their couple identity using a series of separate and overlapping circles. Almost half of the partners independently chose identical depictions of their relationships. An interpretative phenomenological approach revealed three major themes of couple identity: (1) doing things together and separately; (2) feelings, shared history, and closeness over time and; (3) essence of relationship. This study contributes to the small body of literature that focuses on couple identity and how partners mutually cope with aging-related challenges.

Health and Social-Physical Environment Profiles Among Older Adults Living Alone: Associations With Depressive Symptoms.

OBJECTIVES: We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts. METHOD: Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms. RESULTS: Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment. DISCUSSION: Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.

Cultural Adaptation of a Dyadic Intervention for Korean Couples Coping with Alzheimer's Disease.

OBJECTIVES: The Couples Life Story Approach (CLSA) was recently developed in the U.S. for older couples dealing with dementia to improve their quality of life. The purpose of this article is to describe how the CLSA was adapted to be culturally appropriate for older Korean couples and to discuss cultural themes that emerged during the implementation process. METHODS: The intervention was adapted using the Cultural Adaptation Process Model. The revised materials were implemented on 56 Korean couples. A multiple case study method was used to analyze the clinical data. RESULTS: Four cultural themes were identified: (1) dealing with negative memories in early years of marriage; (2) communication styles and patterns; (3) ways to incorporate difficult life events into the Life Story Book; and (4) complex dynamics of heirarchy in the relationship between older couples and the interventionist. With each theme, case examples are described that illustrate relevant issues. CONCLUSIONS: Cultural adaptation can be conducted systematically to improve the delivery of the CLSA for different populations. CLINICAL IMPLICATIONS: Cliniocians working with older Korean couples affected by dementia should consider cultural uniqueness in a life-story approach.

Mindfulness-based forgiveness groups for older adults.

Interventions that enable individuals to be more forgiving toward themselves and others are important for older adults. This article describes a group intervention for adults aged 60 or older that integrates forgiveness-related skills with a mindfulness approach. The Mindfulness-based Forgiveness Group was designed to meet for eight sessions. The skills taught included: recognizing one's own expectations and unenforceable rules, broadening one's perspectives about the context of the transgression, and discovering positive intentions through exercises as well as a variety of meditations to cultivate mindfulness, self-compassion and forgiveness. Data from five Mindfulness-Based Forgiveness Groups were collected. Based on pre- and post-test measures, analyses indicate that participants improved significantly in relation to forgiveness, mindfulness/self-compassion, and mental health. Using qualitative post-test data from participants, we identify elements of the intervention that appear to be helpful. Suggestions are provided for social workers seeking to replicate and build upon this promising intervention.

Care Transition Experiences of Older Veterans and Their Caregivers.

This study's main objective was to examine care transition experiences of older veterans and their caregivers. Fifty patients age 65 years and older, discharged from a Veterans Affairs Medical Center hospital, completed the Care Transitions Measure-15 survey three to four weeks postdischarge. Seven patients and six caregivers participated in semistructured interviews. Overall, the quality of care transitions was rated as good; however, some items were indicated as problematic for veterans. Themes that emerged included agreeableness, frustration with complex information, caregiver education, and the timing and methods of information delivery. These findings have implications for all clinical staff working with veterans, and particularly for social workers facilitating care transitions for veterans and their caregivers.

Qualitative Analysis of the Experience of Mental Fatigue of Family Caregivers of Patients With Cancer in Phase I Trials.

PURPOSE/OBJECTIVES: To examine family caregivers' experience of mental fatigue, identify strategies they use to manage it, and ascertain the kind of help they would like from healthcare professionals.
. RESEARCH APPROACH: Descriptive, qualitative study that was part of a larger mixed-methods study.
. SETTING: Metropolitan comprehensive cancer center in the midwestern United States.
. PARTICIPANTS: 79 family caregivers of patients with advanced cancer who were participating in phase I clinical trials.
. METHODOLOGIC APPROACH: Caregivers completed a semistructured, open-ended questionnaire and demographic and health history forms.
. FINDINGS: Caregivers were able to define mental fatigue and give many examples of it. They reported that mental fatigue did not interfere with patient care, but that it did have a negative effect on their own self-care. They identified strategies to manage mental fatigue. They wanted more information and support from professionals.
. CONCLUSIONS: The majority of caregivers experienced mental fatigue, which manifested as trouble concentrating, difficulty remembering things, and irritability. The majority worked outside of the home and had health problems of their own.
. INTERPRETATION: Healthcare professionals need to assess caregivers for mental fatigue and find ways to help them reduce mental fatigue and restore their attention. Nurses are in a prime position to mobilize resources for caregivers to effectively manage burden and reduce mental fatigue.

Creating a duet: The Couples Life Story Approach in the United States and Japan.

There is a global need for interventions that help couples who are dealing with dementia. This paper describes the way in which interventionists from the United States and Japan participated in the development of an intervention for dyads in which one person is experiencing memory loss. The 5-week intervention, the Couples Life Story Approach, helps dyads to reminisce about their life together as a couple, to work on their patterns of communication, and to develop a Life Story Book. Based on an analysis of cases conducted in the United States (n = 20 couples) and Japan (n = 9 couples), this paper highlights the cross-fertilization process that has occurred as interventionists from the two countries have shared their experiences with one another. Using case illustrations, the discussion focuses on the clinical themes that have emerged for couples in the United States and Japan.

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill.

This article discusses, from the grandmother's perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52-90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.

Receipt of care and depressive symptoms in later life: the importance of self-perceptions of aging.

OBJECTIVES: This study examines the extent to which self-perceptions of aging and perceived loss of control explain the relationship between the receipt of care and depressive symptoms among older adults. METHODS: The sample consists of individuals aged 51 and older from the 2006, 2008, and 2010 waves of the Health and Retirement Study (n = 5,938). Structural equation modeling was used to test an analytic model that focused on the mediating effects of self-perceptions of aging and perceived loss of control. The respondents' demographic and health characteristics and depressive symptoms at baseline were included as control variables. RESULTS: The results indicated that self-perceptions of aging mediated the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care perceive their aging more negatively, which, in turn, increased depressive symptoms 2 years later. However, perceived loss of control did not significantly mediate the relationship between the receipt of care and depressive symptoms. DISCUSSION: These findings suggest that the receipt of care may make frail older adults more vulnerable to negative self-perceptions of aging.

Mindfulness-based cognitive therapy with older adults: an exploratory study.

An 8-week mindfulness-based cognitive therapy (MBCT) group for older adults with depression and/or anxiety is described. This article is based on an exploratory study of this therapeutic approach and changes in participants' symptoms associated with participation. Pre-post data from 5 MBCT groups showed significant improvements in reported anxiety, ruminative thoughts, and sleep problems and a reduction in depressive symptoms. Case examples are presented to illustrate these symptom changes. Findings showed that this nonpharmacological intervention is acceptable to older adults and is associated with positive changes. Suggestions are provided for both practitioners and researchers interested in using MBCT with older adults.

Constructing Couples' Stories: Narrative Practice Insights from a Dyadic Dementia Intervention.

Memory loss and dementia can be devastating for both caregivers and care recipients. Narrative therapeutic approaches offer promise, as well as challenges, for social interventions with couples where one partner has dementia. The Couples Life Story Approach is a recently-developed method by which practitioners work with such couples to help them narrate the story of their life together. This narrative approach is augmented by mementoes (e.g., photos, cards) that are collected by the couple during the intervention. Significant memories are elicited from both partners and developed into a Life Story Book. Drawing on data from this clinical research intervention with 20 older couples, we ask: What are some of the challenges of conducting narrative-based therapeutic interventions with older couples with memory loss? Clinical themes were identified utilizing a multiple case study approach during weekly team meetings. Six of the most prominent themes are presented here. Specifically, how to: (1) construct a narrative from disparate stories, (2) tell a mutual story, (3) tell the story of a couple that has been in a shorter relationship, (4) incorporate others in the story, (5) include difficult life moments, and, (6) end the story. Within each theme, we utilize case examples to illuminate relevant issues and describe strategies that were developed to resolve these clinical challenges. Implications for practitioners and clinical researchers who are engaged in dyadic interventions are discussed.

Forgiving and feeling forgiven in late adulthood.

Enright and colleagues (1996) emphasized the beneficial effect of experiencing forgiveness across multiple domains. We build upon their conceptualization of forgiveness by adding a domain--forgiveness by God--to create global forgiveness. In the current study, we use data from a nationally representative study, the Religion, Aging and Health Survey, which utilizes the responses of 1208 Blacks and Whites. The results from a latent variable model indicated that both Blacks and women were more likely to participate in organized religion, and this participation was associated with feeling closer to God. In turn, feeling closer to God corresponded to higher levels of global forgiveness but was not directly associated with improved-well-being. Instead, it was global forgiveness that mediated the relationship between closeness to God and improved well-being.

The couples life story approach: a dyadic intervention for dementia.

This article describes an approach for working with individuals who have dementia, along with their spouses or partners. The 5-week intervention focuses on helping couples communicate, reminisce about the story of their relationship, find photographs and mementoes from their past, and develop a book that incorporates these mementoes. This clinical approach highlights the strengths and the resilience of couples and adds to the limited repertoire of dyadic interventions for dementia care which are currently available. Preliminary findings from 24 couples are presented, including the intervention's feasibility and acceptability.

Balancing eldercare and employment: the role of work interruptions and supportive employers.

This study investigates pathways by which employed caregivers' stress is related to their work performance appraisal, with particular attention to work interruptions and supportive employers. Based on a nationally representative sample from the 2004 National Long-Term Care Survey (NLTCS), the study focuses on caregivers to older adults who are currently participating in paid employment (N = 652). Results from structural equation modeling indicate that work interruptions mediate the relationship between caregivers' stress and their work performance appraisal. In addition, the support of employers moderates the relationship between employed caregivers' stress and their work interruptions as well as the relationship between their work interruptions and work performance appraisal. These results point to the need for training supervisors and helping them to understand the potential dual effects of their support on employed caregivers' work interruptions and performance.

The relationships among family, friends, and psychological well-being for Thai elderly.

OBJECTIVES: The extent to which family and friends contribute to psychological well-being (PWB) may be subject to cultural variability. This study examines the mechanisms by which relationships with family and friends contribute to PWB among Thai elders. METHOD: Interviews were conducted with 469 men and women aged 60 and older in Nan Province, Thailand. The data were analyzed using structural equation modeling, controlling for age, gender, education, income, marital status, and health status. RESULTS: Family and friendship networks have a significant direct effect on family and friendship support. However, family and friendship networks do not have a significant direct effect on PWB, but rather an indirect effect via social support. Similarly, friendship support mediates the relationship between friendship networks and family support. Both family support and friendship support are significantly related to PWB but family support is the stronger predictor. CONCLUSION: Using an adapting theoretical framework developed by Berkman, Glass, Brissette, & Seeman (2000) allows researchers to map the various pathways by which relationships with family and friends may contribute to PWB among older Thai adults.