Longitudinal impact of interhousehold caregiving on adult children's mental health.

The wear-and-tear hypothesis of caregiving (the longer care provided, the more psychological strain on caregivers) was examined using panel survey data from 112 adult children providing interhousehold care to an impaired elderly parent. Measures included subjective caregiving stress and perceived caregiving effectiveness ("wear") and depression and affect balance ("tear"). Contrary to the hypothesis, data revealed variability in children's adaptation to caregiving, improvement rather than deterioration being the norm. In a recursive path model, both subjective stress and perceived effectiveness were significant predictors of changes in depression. Depression was not significantly related to duration of caregiving. Discussion suggests that future researchers consider other types of caregivers and care settings, factors predicting variability in caregivers' adaptation over time, and changes as well as stability in care arrangements.

Care-related decision-making satisfaction and caregiver well-being in families caring for older members.

Families provide care and make decisions regarding care within the context of specific structural characteristics and the broader family environment. This research analyzes data from 244 adult child and spouse caregiver interviews. It examines the impact of structural variables (e.g., caregiver type, elder impairment) and family environment (adaptability, conflict, cohesion) on satisfaction with care-related decision making and caregiver well-being. Regression analysis results indicate that aspects of family environment such as adaptability and conflict are the best predictors of decision-making satisfaction are the best predictors of caregiver depression.

The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer.

On the basis of Mishel's uncertainty in illness theory, Lazarus and Folkman's stress on appraisal and coping, and Herth's perspective of hope, this cross-sectional, correlational study was designed to examine the influence of uncertainty, stress appraisal, and hope on coping in 71 survivors of breast cancer. Uncertainty was measured by the Mishel Uncertainty in Illness: Community Scale, stress appraisal by the Stress Appraisal Index, hope by the Herth Hope Index, and coping by the Ways of Coping Questionnaires (WCQ).

Health care professionals and family involvement in care-related decisions concerning older patients.

This article examines care-related decision making within the context of in-home family care. It also uses the Andersen-Newman model to identify the correlates of physician involvement and centrality in decision making and the impact that it has on family members' caregiving satisfaction. Analysis of data from 244 family caregivers shows that elders (40%) and nuclear kin (53%) are key decision makers, indicating that families prefer to control care-related decisions. However, physicians are part of the decision-making process for nearly one fourth of the families in this study. The patient's impairment and the caregiver's education correlate with physician involvement in decision making. Shared residence and caregiver's overall satisfaction with the caregiving process correlate with physician centrality on the network. Discussion centers on implications for physician interactions with caregiving families around decision making. Included are indications for improved communication in decision-making contexts.

The impact of family environment and decision-making satisfaction on caregiver depression: a path analytic model.

OBJECTIVES: This research examines caregiver depression in the context of traditional care-related primary stressors, such as the caregiving context and care-recipient impairment, and secondary stressors, such as family environment and decision-making satisfaction. METHODS: The authors examine a causal (path) model of depression among 244 caregivers. Ordinary least squares regression results are used to determine the direct and indirect effects of stressors on caregiver depression. RESULTS: The path coefficients obtained show that adaptability and conflict have the most powerful net effects. With the caregiving context variables, they explain approximately 30% of the variance in decision-making satisfaction. Family adaptability and decision-making satisfaction also have significant paths. The caregiving context, network, family environment, and decision-making variables explain approximately 25% of the variance in caregiver depression. DISCUSSION: These findings suggest that practitioners working with caregivers to ameliorate depression need to examine the broader aspects of family environment and caregiver perceptions related to decision making.

Care-related stress. A comparison of spouse and adult-child caregivers in shared and separate households.

This research examines the role that relationship and household arrangement have in explaining the levels of care-related stress effects experienced by spouse and adult-child caregivers in shared and separate residences. Data from 180 spouse and adult-child caregivers were analyzed to identify differences in caregiver health decline, relationship strain, and activity restriction across these settings when the effects of elder impairment, caregiver age, and use of social supports are controlled. Results show that spouse and adult children in shared households experience similar levels of care-related strain. However, comparison of adult children in shared and separate households show considerable cross-setting differences in strain, with those in shared households having significantly greater activity restriction but less relationship strain. These findings have implications for the delivery of social services, specifically for targeting health monitoring, respite, and family counseling services.

Social resources and mental health: an empirical refinement.

A factor analysis of the social resources measures included in the Older Americans Resources and Services instrument (Blazer, 1978) yielded four factors. These factors were labeled attachments, social interaction, social support, and adequacy of social resources. Of these, attachments and social interaction measures were found to have a very limited degree of association with mental health measures (self- and interviewer-rated mental health and the Minnesota Multiphasic Personality Inventory). The overall rating of social resources and the perceived adequacy of social resources, however, had a higher degree of association with the mental health measures.

Families caring for elders in residence: issues in the measurement of burden.

This paper examines the concept of caregiving burden and urges a multidimensional perspective in which burden is viewed as a mediating force between the elders' impairments and the impact that caregiving has on the lives of caregivers and their families. The analysis underscores the need to apply the concept of burden to subjective interpretations by caregivers of the elders' different kinds of impairments including impairment of activities of daily living, cognitive incapacity, disruptive behavior, and lack of sociability. The analysis also demonstrates that a variety of less subjective effects of caregiving are important and measureable. These issues are elaborated and illustrated using data and findings from the Benjamin Rose Institute's survey of 614 families in which impaired elders resided with and were provided care by family members.

Racial differences in social integration and life satisfaction among aged public housing residents.

The effects of social activity, social resources, health, and functional status on the life satisfaction of black and white aged were examined, based on interviews with 330 residents of age-integrated and age-segregated public housing estates in Cleveland, Ohio. The results of multivariate analysis call into question previous conclusions that age-segregation is conducive to greater life satisfaction. However, the findings do lend support to previous research indicating that social integration has a greater degree of importance in determining the life satisfaction of black than of white aged.

Symptoms of mental impairment among elderly adults and their effects on family caregivers.

Research that has examined the relationship between caregiving stress and elders' symptoms of mental impairment has focused primarily on cognitive incapacity. This research expands the symptoms of mental impairment to include caregivers' reports of problems in elders' social functioning and the presence of disruptive behavior, in addition to the traditional measure of cognitive incapacity. Results from a study of 614 families living with and caring for an impaired elder show cognitive incapacity to have a less important direct effect on caregiving stress than disruptive behavior and impaired social functioning. Cognitive incapacity does have an important indirect effect through its influence on disruptive behavior and social functioning.

The influence of a diagnosed mental impairment on family caregiver strain.

This study examines whether a diagnosis of mental impairment of a care recipient influences the strain of family caregiving. Two competing hypotheses, derived from labeling theory, provide alternative views. One posits that a diagnosis reduces strain by linking problematic characteristics of care recipients' impairment to an illness. The competing hypothesis suggests that a diagnosis increases strain by reifying the existence of a progressive chronic condition. LISREL analysis with data from a sample of 576 primary caregivers shows that the diagnosis has an important effect, but this influence varies for different types of strain. Relationship strain and restrictions in social activities are increased for caregivers of diagnosed care recipients. Functional impairment also causes a greater restriction of social activities when a diagnosis has been made. A different pattern emerges for depression, with caregivers in the diagnosed group being less depressed and less negatively affected by care recipients' impaired ability for social interaction, but more depressed by disruptive behavior and functional impairment.