RESUMO
BACKGROUND AND OBJECTIVES: We explored whether relationship quality, as measured by mutual communal behavior, would serve as a buffer against caregiver resentment and, consequently, depressive symptoms when care recipients (CRs) engage in problem behavior (i.e., controlling and manipulative behavior [CMB]). Using the common core model of caregiver distress, we hypothesized that caregiver resentment would explain why caregivers were depressed when their CRs engage in CMB. We predicted that the indirect effect of CRCMB on depressive symptoms via resentment would depend on the strength of the communal bond between the caregiver and CR. Resentment was expected to play a significant role in explaining the association between CRCMB and depressive symptoms for caregivers in less communal relationships, but a small or nonexistent role for those in highly communal relationships. We also investigated whether these effects were different for Black and White caregivers. RESEARCH DESIGN AND METHODS: Data were obtained from 187 Black and 247 White caregivers from the second Family Relationships in Late Life Project. Before testing our model, we confirmed the measurement equivalence/invariance of the four scales used in this study. RESULTS: Resentment mediated the association between CRCMB and depressive symptoms. However, the indirect effect was larger among highly communal caregivers. Caregiver race did not moderate the moderated mediation. DISCUSSION AND IMPLICATIONS: The communal bond between the caregiver and CR does not entirely protect the caregiver from depressive symptoms, particularly among highly communal caregivers. Interventions aimed at improving caregiver outcomes should acknowledge the unique vulnerabilities of caregivers in close relationships.
Assuntos
Cuidadores , Depressão , Hostilidade , Humanos , NegociaçãoRESUMO
Spielberger's state and trait anxiety and anger scales are widely used and documented, but there is little or no direct evidence that they actually measure their respective state and trait aspects as was intended. We conducted latent state-trait analyses on data collected from 310 community-dwelling caregivers of older adult care recipients and found that (a) both state and trait scales reflected a mixture of state and trait aspects of their latent constructs, (b) state scales reflected more state-like variance than did corresponding trait scales, but (c) both state and trait scales were dominated by stable trait-like variance. Follow-up bivariate latent state-trait analyses indicated that correlations between trait components of anger and anxiety correlated more strongly with trait components of caregiver-care recipient mutually communal behavior and care recipient problem behavior than did state-state component correlations. Implications for the measurement of state and trait components of psychological constructs are discussed.
Assuntos
Cuidadores , Vida Independente , Idoso , Ira , Ansiedade , Transtornos de Ansiedade , HumanosRESUMO
PURPOSE: To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are routinely satisfied. We investigated the extent to which potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are empirically distinct dimensions of quality of care. DESIGN: 237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of their own depression, life events, cognitive status, and perceptions of pre-illness relationship quality. RESULTS: Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing additional evidence for the distinction between these measures of quality of care. CONCLUSIONS: ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care.
Assuntos
Atividades Cotidianas/psicologia , Negro ou Afro-Americano/psicologia , Cuidadores/psicologia , Efeitos Psicossociais da Doença , Demência/psicologia , Demência/reabilitação , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Assistência Domiciliar/psicologia , Assistência Domiciliar/normas , Indicadores de Qualidade em Assistência à Saúde , População Branca/psicologia , Idoso , Idoso de 80 Anos ou mais , Demência/etnologia , Depressão/diagnóstico , Depressão/etnologia , Depressão/psicologia , Avaliação da Deficiência , Abuso de Idosos/etnologia , Abuso de Idosos/prevenção & controle , Abuso de Idosos/psicologia , Relações Familiares/etnologia , Feminino , Humanos , Acontecimentos que Mudam a Vida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Proibitinas , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
This research tested the proposition that the oft-reported relation between caregiver mental health outcomes (i.e., resentment, depression) and potentially harmful caregiver behavior (PHB) would be mediated or moderated by caregiver endorsement of proactively aggressive caregiving strategies (PA). Caregiver resentment was the strongest predictor of PHB in the sample of 417 informal caregivers who resided with their care recipients; in fact, resentment mediated the impact of caregiver depression, thus suggesting that depressed affect was associated with PHB only if depressed caregivers resented their caregiving burdens. As predicted, caregiver endorsement of PA moderated the relation between resentment and PHB, such that links between these two constructs were strongest when caregivers were high in both resentment and PA. Endorsement of PA also mediated the relations between demographic or contextual variables (i.e., income, care recipient dementia) and PHB. Implications of these results for research and intervention are discussed.
Assuntos
Atitude , Cuidadores/psicologia , Coerção , Efeitos Psicossociais da Doença , Transtorno Depressivo/psicologia , Dominação-Subordinação , Abuso de Idosos/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Conflito Psicológico , Coleta de Dados , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Resolução de Problemas , Proibitinas , Fatores de Risco , Estatística como Assunto , Estados UnidosRESUMO
OBJECTIVES: Caring for a sick or disabled relative has been linked to compromised caregiver health, and risk factors for negative caregiver outcomes have been studied extensively, but little attention has been given to care recipient and caregiver health as risk factors for potentially harmful behavior by informal caregivers. This article explores such risk factors. DESIGN: Structured interviews from baseline assessment of the Family Relationships in Late Life Study. SETTING: Three U.S. communities. PARTICIPANTS: Referred, volunteer sample of 265 caregiver/care recipient dyads. Caregivers were primarily responsible for care of an impaired, community-residing family member aged 60 and older and providing help with at least one activity of daily living (ADL) or two instrumental activities of daily living (IADLs). MEASUREMENTS: Self-reported care recipient demographics, cognitive status, need for care, and self-rated health; self-reported caregiver demographics, cognitive status, amount of care provided, self-rated health, physical symptoms, and depression. Care recipient reports of potentially harmful caregiver behavior, including screaming and yelling, insulting or swearing, threatening to send to a nursing home, and withholding food, were the main outcome variable. RESULTS: The following were significant risk factors for potentially harmful caregiver behavior: greater care recipient ADL/IADL needs (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.03-1.22), spouse caregivers (vs others; OR=8.00, 95% CI=1.71-37.47), greater caregiver cognitive impairment (OR=1.20, 95% CI=1.04-1.38), more caregiver physical symptoms (OR=1.07, 95% CI=1.01-1.13), and caregivers at risk for clinical depression (OR=3.47, 95% CI=1.58-7.62). CONCLUSION: Potentially harmful caregiver behavior is more likely in spouse caregiving situations and when care recipients have greater needs for care and caregivers are more cognitively impaired, have more physical symptoms, and are at risk for clinical depression. This risk profile is similar to that for negative caregiver outcomes.
Assuntos
Atividades Cotidianas , Cuidadores/psicologia , Nível de Saúde , Saúde Mental , Qualidade da Assistência à Saúde , Violência , Idoso , Idoso de 80 Anos ou mais , Feminino , Necessidades e Demandas de Serviços de Saúde , Assistência Domiciliar/psicologia , Humanos , Masculino , Fatores de RiscoRESUMO
A five-item scale was developed that asked respondents to indicate how often they were non-adherent to immunosuppressant therapy (IST) given a particular circumstance. Two hundred and twenty-two recipients completed the instrument. Validity of the scale was assessed by correlating composite item scores with refill record adherence rates (RRARs), serum immunosuppressant (IS) concentrations, graft rejection, and increased serum creatinine (SCr) levels. One scale item was deleted due to lack of response variability. Cronbach's alpha coefficient for the four-item scale was 0.81, demonstrating that the scale has acceptable reliability. All items loaded on a single principal component, suggesting that the scale measures a single adherence construct, which accounted for 64% of the scale items' variance. The four-item scale, adherence measured by IS RRARs, and "target" IS serum concentrations had positive correlations (p < 0.01). Item scores were shown to be negatively related to rejection occurrence and increased SCr (p < 0.05). The immunosuppressant therapy adherence scale is the first published, valid and reliable instrument that measures recipients IST adherence.
Assuntos
Imunossupressores/administração & dosagem , Transplante de Órgãos , Cooperação do Paciente , Inquéritos e Questionários , Atitude Frente a Saúde , Creatinina/sangue , Interpretação Estatística de Dados , Esquema de Medicação , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Digital imaging has several advantages that include a reduction in radiation exposure, convenient image acquisition, display, and storage, as well as elimination of the darkroom, chemical solutions and the environmental concerns of their disposal, and processing errors. As many digital systems are available for both intraoral and extraoral imaging, it is most important to select a system that meets the needs of the dental practice, accommodates the patient population, and is user friendly.
Assuntos
Odontopediatria , Radiografia Dentária Digital , Apresentação de Dados , Desenho de Equipamento , Humanos , Processamento de Imagem Assistida por Computador/métodos , Armazenamento e Recuperação da Informação , Doses de Radiação , Radiografia Dentária Digital/instrumentação , Radiografia Dentária Digital/métodosRESUMO
In a sample of 59 chronically ill pediatric patients and their maternal caregivers, both child-reported pain and caregiver-reported depression predicted child-reported depression. Results further suggested that the association between pain and depression in children is ameliorated by caregiver coping strategies and that how caregivers cope is a function of their attachment-related representations of the self and others. Caregivers with a negative model of the self were more depressed. and those with a negative model of others were more prone to use avoidant coping strategies, and, in turn, to be more depressed. However, the extent to which caregivers with negative models of self used more avoidant and less approach coping appeared to depend on whether they perceived that others were likely to respond to their needs.
Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Transtorno Depressivo/psicologia , Comportamento Imitativo , Dor/psicologia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Efeitos Psicossociais da Doença , Transtorno Depressivo/diagnóstico , Feminino , Humanos , Masculino , Relações Mãe-Filho , Mães/psicologia , Apego ao Objeto , Determinação da PersonalidadeRESUMO
Since the discovery of X-rays in 1895, film has been the primary medium for capturing, displaying, and storing radiographic images. It is a technology that dental practitioners are the most familiar and comfortable with in terms of technique and interpretation. Digital radiography is the latest advancement in dental imaging and is slowly being adopted by the dental profession. Digital imaging incorporates computer technology in the capture, display, enhancement, and storage of direct radiographic images. Digital imaging offers some distinct advantages over film, but like any emerging technology, it presents new and different challenges for the practitioner to overcome. This article presents an overview of digital imaging including basic terminology and comparisons with film-based imaging. The principles of direct and indirect digital imaging modalities, intraoral and extraoral applications, image processing, and diagnostic efficacy will be discussed. In addition, the article will provide a list of questions dentists should consider prior to purchasing digital imaging systems for their practice.
Assuntos
Radiografia Dentária Digital , Perda do Osso Alveolar/diagnóstico por imagem , Cárie Dentária/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Fósforo , Doses de Radiação , Intensificação de Imagem Radiográfica , Radiografia Dentária Digital/métodos , Radiografia Dentária Digital/normas , Técnica de Subtração , Terminologia como Assunto , Filme para Raios XRESUMO
We compared the extent to which subjective report of activities of daily living (ADLs) by caregivers and older adults were associated with objective measures of older adults' cognition. In independent studies (Study 1 N = 238; Study 2 N = 295), bivariate correlations and multiple regression analyses examined the association of caregiver and self-rated reports of older adult basic, instrumental, and total ADLs and older adult cognition. We examined the magnitude of the caregiver/self-report discrepancy and older adult cognition. In both studies, caregiver reports more accurately accounted for older adult cognitive differences. Older adult visuospatial/constructional deficits were uniquely related to caregiver basic ADL reports. Results indicate that caregiver reports of older adult ADLs are more reliable indicators of older adult cognition than self-reports, and this difference grows as older adult cognition decreases. Thus, older adult ADL assessment may be useful in providing information on potential cognitive decline.
Assuntos
Atividades Cotidianas , Envelhecimento/psicologia , Cuidadores/psicologia , Cognição/fisiologia , Avaliação Geriátrica/métodos , Autorrelato , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The burden of providing informal care to a family member can lead to caregiver depression and potentially harmful caregiving behavior. Given the interpersonal nature of caregiving, the relationship between caregivers and care recipients may impact caregiver responses. We applied attachment theory to understanding caregiver depression, and both potentially harmful and exemplary caregiving responses. We present data from 430 caregivers in the Family Relationships in Late Life (FRILL 2) Project, a multisite, longitudinal study of caregiving. Age, gender, and model of self were related to caregiving responses, suggesting that model of self may help identify caregivers at risk for poor responses.
Assuntos
Cuidadores/psicologia , Depressão/epidemiologia , Relações Familiares , Teoria Psicológica , Autoimagem , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Cuidadores/estatística & dados numéricos , Depressão/psicologia , Feminino , Humanos , Relações Interpessoais , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Apego ao Objeto , Análise de Regressão , Violência/estatística & dados numéricos , População Branca/psicologia , População Branca/estatística & dados numéricosRESUMO
This research examined longitudinal associations between caregiving stressors, caregiver depression, and quality of care. Informal caregivers of elderly care recipients were interviewed at baseline (N = 310) and again one year later (N = 213). Hierarchical regression analyses indicated that increases in caregiving stressors (i.e., caregiver physical health symptoms, caregiver activity restriction, and care recipient controlling and manipulative behavior) were related to increased caregiver depression. In turn, increased caregiver depression and decreased caregiver respectful behavior predicted increases in potentially harmful behavior. These results extend previous cross-sectional findings and indicate that changes in caregiving stressors, caregiver depression, and caregiver respect over time may signal that intervention is warranted in order to forestall or prevent poor quality of care.
Assuntos
Cuidadores/psicologia , Depressão/psicologia , Assistência Domiciliar/normas , Estresse Psicológico/etiologia , Idoso , Abuso de Idosos/psicologia , Feminino , Assistência Domiciliar/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Qualidade da Assistência à Saúde , Análise de Regressão , Estresse Psicológico/psicologiaRESUMO
PURPOSE: Caregivers feeling stress and experiencing mental health problems can be at risk for engaging in abusive acts against elderly care recipients. Potentially harmful behavior (PHB) was used as a measure of caregivers' engagement in, or fear of engagement in, behavior that places dependent care recipients at risk of physical and/or psychological maltreatment and may be seen as an antecedent of, or a proxy for, identifiably abusive behavior. The study examined the ability of anger to mediate and moderate the relations of depression, resentment, and anxiety with PBH. DESIGN AND METHODS: Data are from the first wave of the second Family Relationships in Late Life study of caregivers of community-dwelling elderly care recipients with whom they coreside. Caregivers (N = 417) completed face-to-face interviews. RESULTS: Anger was found to mediate the relation between anxiety and PHB. Anger both mediates and moderates the relations of both depression and resentment with PHB in a dynamic way such that the mediating effect of anger increases substantially with increased scores on both depression and resentment. IMPLICATIONS: Identifying anger levels among caregivers who report symptoms of depression is warranted. Reducing depression in caregivers who report high levels of anger may result in reductions of PHB. Screening for resentment is warranted, as the relation between resentment and anger is similar to that between depression and anger.
Assuntos
Ira/ética , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Abuso de Idosos/psicologia , Saúde Mental , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/ética , Coerção , Conflito Psicológico , Dominação-Subordinação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proibitinas , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: The objective of this study was to increase the ability to predict renal transplant patients (RTPs) who are most likely to be non-adherent to their immunosuppressant therapy (IST). METHODS: One hundred and fifty-eight RTPs completed questionnaires assessing Theory of Planned Behaviour (TPB) variables (attitudes, subjective norms and perceived behavioural control) relevant to intentions to adhere to their IST, with the addition of a general measure of past adherence to medical advice. In the full sample, intentions to adhere to IST was the outcome variable. In a subsample of 70 RTPs, the primary outcome was IST adherence. RESULTS: TPB variables (attitudes, beta = 0.32, P < 0.01; perceived behavioural control, beta = 0.37, P < 0.01; but not subjective norms, beta = -0.001, ns) explained 41% of the variance in intentions to adhere to IST (P < 0.001). Past behaviour predicted perceived behavioural control (beta = 0.67, P < 0.001). Subsample analyses explained 33% (P < 0.001) of the variance in adherence, with intentions and past behaviour being the primary factors (P < 0.05). CONCLUSIONS: RTPs particularly at risk may be those who have a history of non-adherence to medical advice, especially when they have negative attitudes about IST adherence and feel they have little control over their medication-taking behaviour. Interventions to improve attitudes about IST adherence and control of adherence behaviour are needed.
Assuntos
Imunossupressores/uso terapêutico , Transplante de Rim/métodos , Adulto , Idoso , Comportamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Cooperação do Paciente , Percepção , Estudos Prospectivos , Risco , Inquéritos e QuestionáriosRESUMO
BACKGROUND: To decrease allograft rejection as a result of non-adherence to immunosuppressant therapy (IST), a valid and reliable instrument that measures solid organ transplant patients' adherence barriers is needed. METHODS: An immunosuppressant therapy barrier scale (ITBS) was developed to assess transplant patients' perceived barriers to IST adherence and was completed by 222 transplant patients who lived in Georgia, USA. A renal transplant population subset was used to test the ITBS reliability and validity. Scale reliability was estimated using Cronbach's alpha coefficient of internal consistency; scale dimensionality was assessed using principal components analysis. The criterion-related validity of the scale was assessed by relating subscale scores to adherence measures and graft rejection. Nomological validity was assessed by relating barrier subscales to specific patient factors. RESULTS: Two subscales that represented 'controllable' and 'uncontrollable' barriers were found. Cronbach's alpha coefficients demonstrated acceptable reliabilities of 0.93, 0.86 and 0.91 for the 'uncontrollable' and 'controllable' subscales, and for the entire ITBS, respectively. The ITBS subscales correlated negatively with a self-reported measure of IST adherence, IST serum concentrations and IST pharmacy refill adherence rate (P<0.01). The 'uncontrollable barrier' subscale was positively correlated to kidney graft rejection (P<0.01), thus demonstrating the ITBS's validity. Males and older patients reported more adherence barriers (P<0.05). CONCLUSIONS: The ITBS is a reliable and valid instrument that can be used to measure patients' perceived barriers to IST adherence.