Correlates of family involvement before and during medical visits among older adults with high-risk diabetes.

AIMS: To examine the characteristics of patients with diabetes who regularly receive help from a supporter in preparing for and attending medical visits, and the association between this help and clinical risk factors for diabetes complications. METHODS: We linked survey data about family involvement for patients in the Veterans Health Administration system with poorly controlled Type 2 diabetes (n = 588; mean 67 years; 97% male) with health record data on blood pressure, glycaemic control and prescription-fill gaps. We used multivariable regression to assess whether supporter presence and, among patients with supporters, supporter role (visit preparation, accompaniment to medical visit or no involvement) were associated with concurrent trends in clinical risk factors over 2 years, adjusting for sociodemographic and health characteristics. RESULTS: Most patients (78%) had a main health supporter; of these, more had regular support for preparing for appointments (69%) than were regularly accompanied to them (45%). Patients with preparation help only were younger and more educated than accompanied patients. Support presence and type was not significantly associated with clinical risk factors. CONCLUSIONS: Family help preparing for appointments was common among these patients with high-risk diabetes. In its current form, family support for medical visits may not affect clinical factors in the short term. Supporters helping patients engage in medical visits may need training and assistance to have an impact on the clinical trajectory of patients with diabetes.

Racial, ethnic, and cultural differences in the dementia caregiving experience: recent findings.

PURPOSE: This research reviewed studies that compare two or more racial, ethnic, national, or cultural groups on aspects of the dementia caregiving experience. DESIGN AND METHODS: Electronic databases were searched to find studies published between 1996 and 2000 in peer-reviewed journals that met the above criteria. RESULTS: Twenty-one studies based on 18 samples were identified. These articles included comparisons involving the following groups of caregivers: African Americans, Chinese, Chinese Americans, Koreans, Korean Americans, Latinos, Whites, and residents of 14 European Union countries. Consistent with previous research, White caregivers were more likely to be spouses when compared to other groups. White caregivers tended to report greater depression and appraised caregiving as more stressful than African American caregivers. Findings were mixed regarding differences in coping and social support, but suggested that minority groups may not have more available support than Whites. Common methodological limitations were a lack of noncaregiving control groups and failure to test specific pathways by which the grouping variable (e.g., race) exerts its impact on outcome variables. IMPLICATIONS: Future studies in this area should use both quantitative and qualitative research methods to specify the pathways by which race, ethnicity, and culture affect the caregiving experience, and should expand their focus beyond the primary caregiver to include the effects of caregiving on families and networks.

Factors influencing quality of life in older women with heart disease.

BACKGROUND: Better understanding of factors influencing the quality of life (QOL) of cardiac patients can guide treatment decisions. OBJECTIVES: To describe the impact of clinical and psychosocial factors on the QOL of older women with heart disease. RESEARCH DESIGN: Baseline and 12-month data from women participating in an intervention study. SUBJECTS: Eligible participants, identified from medical records, were female, > or = 60 years of age, and diagnosed with cardiac disease. A volunteer sample of 570 women (87% white) completed baseline interviews, with 485 women completing the 12-month assessment. MEASURES: Utilizing Wilson and Cleary's conceptual framework (1995), measures of clinical, psychosocial, and functional status were examined for their associations with QOL. RESULTS: At baseline, General Health Perceptions and Symptom Status accounted for 38% and 26%, respectively, of the variation in the QOL rating. Using logistic regression models, seven measures were significant predictors (P < 0.05) of maintenance/improvement versus decline in QOL over 12 months: baseline QOL rating; baseline value and change in satisfaction with social activities over 12 months; change in satisfaction with physical activities; change in satisfaction with mental activities; and baseline value and change in perceived stress. For women who maintained or improved their satisfaction with social activities, the odds for also maintaining or improving QOL were 4.5 times the odds for women whose satisfaction with social activities deteriorated. CONCLUSIONS: Satisfaction with social activities and perceived stress are important predictors of subsequent QOL. Consideration of the impact of treatments on these factors may help to prevent deterioration of QOL among older female cardiac patients.

Social networks among blacks and whites: the interaction between race and age.

OBJECTIVES: This study examined the main and interactive effects of age and race on the core characteristics of social networks including size, frequency of contact, geographical proximity, and composition of network. METHODS: Respondents were drawn from a stratified probability sample of people aged 20-93 in the greater Detroit metropolitan area. Approximately 30% of the sample were African American, and people aged 60 and older were over-sampled (n = 1.382). The authors used hierarchical regression analysis to estimate the influence of race and age on each component of social network, controlling for marital status, gender, and education. An interaction term (Race x Age) was added to explore the extent to which age moderates any detected race differences. RESULTS: Older age was associated with smaller, less frequently seen, and less proximal networks that had a higher proportion of kin. Blacks and Whites were similar with regard to proximity, but Blacks had smaller networks, more contact with network members, and more family members in their networks. Race differences in frequency of contact and proportion of kin were moderated by age, such that the differences in these variables diminished with increasing age. DISCUSSION: A systematic analysis of how age, race, and their interaction influence the characteristics of social networks furnishes important empirical knowledge about social networks among diverse groups. Such data may provide a context for how, and some explanation for why, support exchanges occur.

The costs of caring: impact of dementia on family caregivers.

With the aging of the population, an increasing number of older adults are diagnosed with Alzheimer's disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experience a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dementing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role.

The social relations-physical health connection: a comparison of elderly samples from the United States and Japan.

Cross-national comparison of the social relations-physical health association in the elderly can broaden our understanding of the implications of social relationships in this age group. Using representative cross-sectional samples of adults aged 60-93 years from metropolitan areas in the United States and Japan (n = 1005), we used analysis of variance to examine between-country differences in the association of illness with measures of network structure, social support, and negative relations. One significant between-country difference in this association was found: in Japan only, ill women reported more available financial help from their child than did non-ill women (p < .05). Ill women in both countries reported less sick care available from their spouse than did ill men (p < .05) and more negative relations with their child than did non-ill women (p < .05). These results suggest the primacy of gender, rather than cultural context, in shaping the association between social relations and health.