Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey.

OBJECTIVE: To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70 years old enrolled in the US 2010 health and retirement survey. METHODS: Multivariable logistic regression models estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2 years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5+ events. HCU included hospitalization (any vs. none) and physician visits (< 20 vs. ≥ 20) over 2 years. FINDINGS: Hospitalization odds declined by 25 % (OR 0.75, 95 %CI 0.64-0.86), odds of ≥ 20 physician visits declined by 47 % (OR 0.53, 95 % CI 0.45-0.63) and the odds of SRH improvement increased by 49 % (OR 1.49, 95 % CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 % elevated for participants that reported 1-2, 3-4 and 5+ versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. CONCLUSION: In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.

Population-level impact of loss on survivor mortality risk.

INTRODUCTION: The loss of a loved one adversely affects the bereaved. MATERIALS AND METHODS: Using data from the 2010 and 2012 waves of Health and Retirement Study (HRS), we estimate the risk for death in a 2-year span after the loss of a parent, spouse, or child for adults aged 50 to 70 years. CONCLUSION: A respondent with a loss was twice as likely to die when compared similarly aged persons with no loss (OR 2.32; 95 % CI 1.14, 5.30). Loss of either a parent (OR 1.93; 95 % CI 1.01, 4.07), or a child (OR 1.77; 95 % CI 1.08, 2.96) also increased respondent mortality. This elevated risk persists after adjustment for gender and other high-risk health conditions. Any physical activity reduces survivor death rates during this critical period by more than 85 %.

The impact of mid- and late-life loss on insomnia: findings from the health and retirement study, 2010 cohort.

Bereavement and insomnia are both well-documented risk factors for illness. We use cohort data to estimate risk of insomnia after death of a family member among adults aged 50 to 70 years. Each day, 6700 persons die in the United States. During the next 20 years, this number will increase. In this cohort, any loss increases the likelihood of insomnia. The highest rates of insomnia occur among women aged 50 to 59 years; men aged 65 to 70 years, and persons reporting death of a spouse/partner or child. Physical activity reduces this risk by one-third. Bereavement is a public health issue requiring a targeted response.

Dementia behavioural and psychiatric symptoms: effect on caregiver's sleep.

AIMS AND OBJECTIVES: To examine caregiver sleep quality, especially in relation to the daytime and night-time behaviours and psychological symptoms exhibited by persons with dementias. BACKGROUND: Caregivers of persons with dementias experience poorer sleep in comparison with noncaregivers, and poor sleep is related to negative health outcomes. The reasons for caregivers' poor sleep are complex, and it is known that the night-time behaviours of the persons with dementia contribute to caregiver sleep disruption. However, the frequency of behavioural and psychological symptoms of dementia has hitherto not been sufficiently explored as a contributing factor to poor caregiver sleep. DESIGN: A nonexperimental cross-sectional design. METHODS: Eighty caregivers completed questionnaires on the frequency of behavioural and psychological symptoms of the persons with dementia, the Dementia Severity Rating Scale, the Pittsburgh Sleep Quality Index and the Center for Epidemiologic Studies Depression Scale. RESULTS: Poor sleep was reported with awakenings by the persons with dementia occurring for more than half of the caregivers. The frequency of behaviours and symptoms did not make a unique contribution to the variance of caregivers' global sleep. The frequency of behaviours, and specifically of agitation and apathy, contributed to the variance in subjective sleep quality, as defined by the caregivers' appraisal of their sleep. CONCLUSIONS: The findings demonstrate the relationship between (1) daytime and night-time behaviours of persons with dementias and (2) their caregivers' sleep quality and emphasise the complexity of the factors that contribute to caregiver sleep quality. RELEVANCE TO CLINICAL PRACTICE: These findings suggest that nurses should be cognizant of the relationship between daytime behaviours of the persons with dementia and the caregivers' appraisal of their sleep, realising that appraising one's sleep as poor can be a contributing factor to perpetuating sleep problems. Interventions aimed at helping the caregiver manage the persons with dementia's agitation or the caregiver's emotional response to persons with dementia apathy may improve caregivers' perception of their sleep.

Short-term changes in sleep, mastery & stress: impacts on depression and health in dementia caregivers.

Dementia caregiving is stressful and can result in negative health outcomes. Understanding the intermediate dynamic changes in caregiving may help nurses target interventions. The purposes of this study were to measure short-term changes in sleep, mastery, and stress in dementia caregivers and to explore their impacts on caregiver depression and health. Seventy-four caregivers were measured at baseline, 4, and 8 weeks for changes in global mastery, caregiver mastery, sleep quality, perceived stress, depression, and health. Over the 8 weeks, changes were observed in sleep, mastery, stress, and health measures, indicating support for the dynamic and complex nature of dementia caregiving. Sleep and perceived stress made unique contributions to depression, but the contributions to health varied. Clinical implications for nurses are to assess caregivers frequently and reinforce successful interventions periodically as caregiving evolves.

Emotion work in family caregiving for persons with dementia.

Emotion work enhances emotional well-being and emotional support in relationships between two people. Emotion work is a part of family work but has not been described in the context of caring for a family member with dementia. Content analysis applied to 11 interviews of informal caregivers describing their interactions with a person with dementia resulted in four categories of emotion work: (1) managing feelings, (2) weighing options, (3) being parental, and (4) ensuring emotional well-being. Caregivers performed emotion work to meet the feeling rules of being a good caregiver, but often with emotional dissonance between the caregivers' true feelings.

Decision-making capacity and informed consent to participate in research by cognitively impaired individuals.

Obtaining informed consent is a fundamental part of conducting research that balances the need for participant autonomy and calls on the principal investigator to exercise beneficence. This is especially true in research involving persons with dementia and mild cognitive impairment where the ability to understand and reason may be compromised. Performing an assessment of decision-making capacity to consent to research should be the first step in helping the researcher decide who signs the consent. This article reviews the current literature available on instrumentation and procedures for capacity assessment, and in the absence of universal guidelines offers implications and suggestions for practice.

A feasibility study of a two-session home-based cognitive behavioral therapy-insomnia intervention for bereaved family caregivers.

OBJECTIVE: In 2008 over two million family caregivers will become bereaved. The vast majority of these caregivers have provided 'round-the-clock care for a period ranging from months to years. Bereaved family caregivers report insomnia symptoms that persist beyond 1 year, longer than what is seen in bereaved noncaregivers, placing them at increased risk of depression and complicated grief. Despite some rewarding elements, caregiving is a stressful and exhausting role that often requires the caregiver to restructure his or her life around the needs of the patient. Once the patient dies, the structure is lost. Cognitive behavioral therapy interventions are effective in providing structure. This pilot study explored the feasibility of a two-session home-based cognitive behavioral therapy-insomnia (CBT-I) intervention for bereaved family caregivers. METHOD: A 5-week longitudinal descriptive study design was used with 11 adult primary family caregivers of patients who died from cancer. A master's prepared nurse delivered two CBT-I intervention sessions in participant homes. Data collection sessions occurred at baseline, 3, and 5 weeks. A debriefing session was held at Week 6. RESULTS: Participant evaluations of the intervention indicated that it was feasible and acceptable (e.g., 100% would recommend it to others); objective data further supported its feasibility (e.g., 100% completed the trial). In addition, when comparing baseline with Weeks 3 and 5, participants demonstrated improvement in insomnia and depressive symptoms. SIGNIFICANCE OF RESULTS: The results of this pilot study suggest that the intervention is feasible and acceptable and produces promising effects on insomnia and depressive symptoms in bereaved family caregivers.

In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years.

In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87%). A report of any loss increases risk of health care utilization by 20% to 30%. For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.

The Impact of Living Arrangements on Dementia Caregivers' Sleep Quality.

In the United States half of the 15 million informal caregivers of persons with Alzheimer's disease or a related dementia (PWDs) do not live with the PWD. This paper compares the sleep quality and health of 59 community-dwelling caregivers living with the PWD and 21 living apart from the PWD. Variables of interest were caregiving experience (hours caregiving, problematic behaviors of the PWD, caregivers' perception of dementia severity), sleep quality, and health (perceived health, stress, and depressive symptoms). Parametric unpaired t tests were used to calculate the differences between key variables. Multiple regression models were constructed, controlling for age, gender, behavior index, and dementia severity to examine the variance explained by living arrangements on sleep quality and health. Caregivers living apart from the PWD experienced the same level of poor sleep quality as did caregivers living with the PWD. The living arrangements of the caregiver did not make a unique contribution to sleep quality or health variables except for reports of unhealthy days. Given the importance of good quality sleep for health, the findings highlight the importance of evaluating caregivers living apart from the PWD for sleep problems with the same level of concern as one would have for those living with the PWD.

Concurrent therapies that protect against doxorubicin-induced cardiomyopathy.

Doxorubicin is a chemotherapeutic agent successfully used in the treatment of a wide range of cancers. However, with cumulative doses, doxorubicin also is known to have cardiotoxic effects, including cardiomyopathy and heart failure. Research is targeted at maximizing the antitumor effects of doxorubicin while attenuating the potential cardiotoxicity. Concurrent therapies under study are combinations of doxorubicin with drugs such as probucol, carvedilol (Coreg, GlaxoSmithKline, Research Triangle Park, NC), dexrazoxane (Zinecard, Pfizer, New York, NY), and antioxidant nutrients. As patient advocates, nurses must be aware of current research, treatment options, and evidence-based patient resources and be diligent in assessing and educating patients before, during, and after treatment with doxorubicin.

Dementia caregivers' lived experience of sleep.

PURPOSE: Poor sleep quality leads to sleep deficiency, an unmet public health problem that is especially acute in caregivers. The purpose of this study was to investigate the dementia caregiver's lived experience of sleep. The specific objectives were to (1) explore causes for poor sleep as identified by the caregiver, (2) gain knowledge about how the caregiver manages the sleep experience, and (3) gain an understanding of how caregivers perceive health promotion suggestions to improve sleep quality. METHODS: This was a qualitative study using a phenomenological framework. In 3 focus groups, data were collected from 15 informal/family member caregivers of a person with dementia (PWD). RESULTS: Three themes were identified in caregivers' descriptions of disruptions to their sleep quality: sleep quality fluctuating with the status of the PWD, a need for vigilance to safeguard the PWD at night, and worry about current and future events, which caused rumination. Caregivers did not receive formal help from healthcare providers but did participate in activities that promote good sleep. Caregivers identified barriers to health promotion activities, including lack of time, decreased energy, and additional costs for providing care for the PWD. CONCLUSION: This research provides exemplars of caregivers' thoughts, preferences, values, and beliefs regarding their sleep experience in the context of caregiving. The caregiver's perspective should be taken into consideration when clinical nurse specialists provide evidence-based care. Clinical implications are provided.

Mastery: a comparison of wife and daughter caregivers of a person with dementia.

PURPOSE: The purpose was to obtain a better understanding of the role of mastery (global and caregiving) in wives' versus daughters' experience of caring for a person with dementia. METHOD: A total of 67 caregivers participated in a cross-sectional study. Variables measured were global mastery, caregiving mastery, stress, and depressive symptoms. Analysis included t tests, correlations, and multiple regressions. FINDINGS: Wives and daughters reported similar levels of stress and depressive symptoms. The correlations between stressors, caregiver stress, and depressive symptoms were significant for wives but not daughters. The relationships between global mastery and stress, and global mastery and depressive symptoms were significant for both wives and daughters, but the magnitude was less for daughters in the relationship of global mastery and depressive symptoms. Caregiver mastery was strongly related to stress and depressive symptoms for wives but not for daughters. CONCLUSIONS: Consideration must be given to the differences in the experience of mastery so that evaluations and interventions can be tailored to the unique experiences of wives and daughters.

Case studies of Hispanic caregivers of persons with dementia: reconciliation of self.

An interpretive phenomenology perspective is used to explore the lived experience of two Hispanic caregivers and the phenomenon of mastery. The analysis showed how theses caregivers derive meaning of their experience through a process of reconciliation of self between the roles of parental caretaker, respectful daughter, and caregiver. This reconciliation of self is a form of mastery, and the process of reconciliation is grounded in cultural values of intergenerational reciprocity and familism. Nurses have the unique opportunity to support a caregiver in his or her interaction with the person with dementia. The implications for practice include the need for nurses to acknowledge, validate, and support caregiver's experience of reconciling self as a form of health promotion.

Pilot study of a brief behavioral sleep intervention for caregivers of individuals with dementia.

Informal caregivers of individuals with dementia experience higher rates of poor sleep quality and depression than the general population. Short-term behavioral interventions have been shown to improve sleep quality in other caregiver populations. The purposes of this study were to determine the feasibility of the CAregiver Sleep Intervention (CASI) in a small sample of caregivers of both community-dwelling and institutionalized individuals with dementia. The caregivers were given CASI, a 5-week behavioral sleep intervention combining relaxation, stimulus control, and sleep hygiene with personal goal setting, delivered at the caregiver's convenience. Caregivers reported no increased burden with CASI. The intervention was well received, and sleep quality and depression trended toward improvement. CASI appears to be feasible and beneficial in this small sample and warrants further study in caregivers of individuals with dementia.