A Double Whammy? Psychosocial Disadvantages of Dementia Caregivers with Cancer Histories.

Guided by the Diathesis-Stress model, this study examined how cancer history interacted with caregiving status to determine the psychosocial functioning of dementia caregivers. This study assessed a set of indicators for psychological health and social connections among 85 spousal caregivers of persons with Alzheimer's disease and 86 age- and gender-matched spouses of healthy controls at study entry and 15-18 months later. Results showed that dementia caregivers with cancer histories reported lower social connections relative to caregivers without cancer histories or non-caregivers with or without cancer histories, and reported lower psychological health relative to non-caregivers with and without cancer histories at two time points. The findings highlight that a history of cancer is a predisposing vulnerability factor for psychosocial dysfunctions among dementia caregivers and address gaps in knowledge about the psychosocial adjustment of cancer survivors as caregivers.

Does caregiving cause psychological distress? The case for familial and genetic vulnerabilities in female twins.

BACKGROUND: Informal caregiving can be deleterious to mental health, but research results are inconsistent and may reflect an interaction between caregiving and vulnerability to stress. METHODS: We examined psychological distress among 1,228 female caregiving and non-caregiving twins. By examining monozygotic and dizygotic twin pairs discordant for caregiving, we assessed the extent to which distress is directly related to caregiving or confounded by common genes and environmental exposures. RESULTS: Caregiving was associated with distress as measured by mental health functioning, anxiety, perceived stress, and depression. The overall association between caregiving and distress was confounded by common genes and environment for mental health functioning, anxiety, and depression. Common environment also confounded the association of caregiving and perceived stress. CONCLUSIONS: Vulnerability to distress is a factor in predicting caregivers' psychosocial functioning. Additional research is needed to explicate the mechanisms by which common genes and environment increase the risk of distress among informal caregivers.

Impact of informal caregiving on depressive symptoms among a national cohort of men.

BACKGROUND: There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men. METHODS: We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations. RESULTS: In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses. CONCLUSION: These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.

The dialectical behavior therapy ways of coping checklist: development and psychometric properties.

Skills training is a crucial mode of treatment in dialectical behavioral therapy (DBT; Linehan, 1993b), yet a psychometrically sound measure of DBT skills use does not exist. We adapted the Revised Ways of Coping Checklist (RWCCL; Vitaliano, Russo, Carr, Maiuro, & Becker, 1985) to create the DBT Ways of Coping Checklist (DBT-WCCL). Using factor analysis procedures, two subscales emerged: one assessing coping via DBT skills, the DBT Skills Subscale (DSS), and one assessing coping via dysfunctional means, the Dysfunctional Coping Subscale (DCS). Principal component, internal consistency, test-retest reliability, and content validity analyses suggested that the scale has good to excellent psychometric properties. In addition, the DSS successfully discriminated patients who received skills training during 4 months of treatment from patients who did not. Moderators of skills use are also discussed. The DBT-WCCL appears to be a promising new measure of DBT skills use.

Caregiver Psychological Distress: Longitudinal Relationships With Physical Activity and Diet.

Given limited longitudinal research with caregivers (CGs, n = 122) of spouses with Alzheimer disease, and demographically matched noncaregivers (NCGs, n = 117), we compared these groups on psychological distress (anxiety, depression), burden, and health behaviors over 2 years. Analyses examined group differences in relationships of micronutrient recommended daily allowances (RDAs) and physical activity considering hours of care, psychological distress, and burden. Participants were measured and assessed on whether they met micronutrient intake and physical activity totaled over an average week. Regression analyses showed a total effect whereby NCGs had greater increases in meeting micronutrient allowances (RDAs) than CGs (b = 10.91, standard error [SE] = 4.74, 95% confidence interval [CI]: 1.56-20.26). Additionally, over time, NCGs had greater increases in physical activity, which was mediated by hours of care (b = 0.149, SE = 0.060, 95% CI: 0.034-0.270). These results suggest CGs may lack proper nutrients, and care hours may influence their health behaviors.

Social Determinants of Health: Underreported Heterogeneity in Systematic Reviews of Caregiver Interventions.

BACKGROUND AND OBJECTIVES: Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. RESEARCH DESIGN AND METHODS: We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. RESULTS: We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. DISCUSSION AND IMPLICATIONS: Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies.

How does anger coping style affect glycemic control in diabetes patients?

BACKGROUND: Although various forms of anger have been found to influence the psychological and physical health in many chronic illness populations, little is known about the effects of anger in diabetes patients. PURPOSE: Associations between anger coping style, diabetes-related psychological distress, and glycosylated hemoglobin (HbA1c) were examined in 100 diabetes patients. METHOD: Participants completed the Problem Areas in Diabetes and Coping Styles questionnaires, and had HbA1c assessments at study entry (Time 1 = T1), six months (T2), and 12 months after T1 (T3). RESULTS: Linear regression analyses revealed T1 anger coping associated with T3 HbA1c (beta = .22, p < .05), but T1 HbA1c did not associate with T3 anger coping (beta = .13, p = NS). After controlling for significant covariates (of gender, age, education, type and duration of diabetes), regression analyses revealed that T2 diabetes-related psychological distress partially mediated this association. CONCLUSION: These results suggested that higher levels of anger coping may promote poorer glycemic control in diabetes patients by provoking greater diabetes-related distress. Areas of future research on this topic are discussed.

The role of resilience on psychological adjustment and physical health in patients with diabetes.

OBJECTIVE: This study used a longitudinal design to investigate the buffering role of resilience on worsening HbA(1c) and self-care behaviours in the face of rising diabetes-related distress. METHOD: A total of 111 patients with diabetes completed surveys and had their glycosylated haemoglobin (HbA(1c)) assessed at baseline and at 1-year follow-up. Resilience was defined by a factor score of self-esteem, self-efficacy, self-mastery and optimism. Diabetes-related distress and self-care behaviours were also assessed. RESULTS: Baseline resilience, diabetes-related distress and their interaction predicted physical health (HbA(1c)) at 1 year. Patients with low, moderate and high resilience were identified. Those with low or moderate resilience levels showed a strong association between rising distress and worsening HbA(1c) across time (r=.57, .56, respectively). However, those with high resilience scores did not show the same associations (r=.08). Low resilience was also associated with fewer self-care behaviours when faced with increasing distress (r=-.55). These correlation coefficients remained significant after controlling for starting-points. CONCLUSION: In patients with diabetes, resilience resources predicted future HbA(1c) and buffered worsening HbA(1c) and self-care behaviours in the face of rising distress levels.

Demographic-Specific Rates for Life Events in the Cardiovascular Health Study and Comparisons With Other Studies.

PURPOSE OF THE STUDY: (1a) We use the Cardiovascular Health Study (CHS), a multi-site heterogeneous sample of Medicare enrollees (N = 5,849) to provide rates for specific life events experienced within 6 months; (1b) We present rates for 29 other studies of community-residing older adults (N = 41,308); (2) For the CHS, we provide demographic-specific rates and predicted probabilities for age [young-old (65-75) vs old-old (≥75)], gender, race, marital status, and education. DESIGN/METHODS: The CHS sample is 57.6% women, 84.2% white (15.8% black), and 66.3% married. Mean age is 72.8 years (standard deviation [SD] = 5.6, range = 65-100) and education is 13.7 years (SD = 4.8). Life events were interviewer-assessed. Regressions estimated associations of life event rates with demographic groups (e.g., age), controlling for other demographic variables (e.g., gender, etc.). RESULTS: (1a) CHS rates ranged from 44.7% (death of someone close) to 1.1% (retirement/work changes). (1b) Most life event studies used total scores and only 5 that met our inclusion criteria used time intervals <1 year; longer intervals were associated with higher rates. (2) In the CHS, the life event for illnesses was related to 5 demographic variables (net the other 4 demographic variables), difficulties caregiving to 4, and worse relationships to 3 demographic variables. Race was related to 8 life events, marital status to 7, education to 6, and age to 4 events. IMPLICATIONS: By identifying demographic groups at highest risk for life events, this research focuses on older adults at greatest risk for health problems. These data are necessary for translating research into interventions, practice, and policy.

Objective and Subjective Cognitive Problems among Caregivers and Matched Non-caregivers.

Purpose of the study: Caregivers (CGs) have been shown to do more poorly than non-caregivers (NCGs) on objective cognitive tests (Trails B and Digit Symbol Test, DST), but less is known about whether these groups differ in: (a) reports of subjective cognitive problems (SCPs, memory complaints, etc.) and (b) relationships of SCPs with objective cognitive tests, depression, and stress exposure. Such relationships are important because researchers/clinicians use SCPs as proxies for objective cognitive tests. Design and methods: One hundred and twenty-two spouse CGs of persons with Alzheimer's disease and 117 demographically matched NCG spouses were compared on Trails B and DST at baseline (T1), 1 year later (T2), and 2 years later (T3) and on SCPs at T1. Results: Trails B was slower in CGs than NCGs and DST declined in CGs relative to NCGs. CGs reported more SCPs than NCGs. Depression mediated group differences in Trails and DST and was also associated with SCPs. Trails B and DST explained variance in SCPs in NCGs, but not in CGs. Hours of care explained variance in SCPs in CGs, but not in NCGs. Implications: When using SCPs to make inferences about CG cognitive function, researchers/clinicians should consider the possible influence of stress exposures and depression. The lack of associations of objective and subjective cognitive measures may be a reflection of poorer self-monitoring among CGs, a potential new area of CG research.

Associations among perceptions of social support, negative affect, and quality of sleep in caregivers and noncaregivers.

The authors used structural equation modeling to examine associations among perceptions of negative affect, social support, and quality of sleep in a sample of caregivers (n = 175) and noncaregiver control participants (n = 169). The authors hypothesized that caregiver status would be related to sleep quality directly and also indirectly by way of negative affect and social support. This hypothesis was partially supported in that caregiving was found to be indirectly related to sleep quality. However, after accounting for the indirect effects of negative affect and social support, the direct effect of caregiving on sleep quality was no longer statistically significant. The structural model accounted for approximately 43% of the variance in sleep quality. The present findings may be useful in the development of successful sleep interventions for caregivers.

Caregiving and gingival symptom reports: psychophysiologic mediators.

OBJECTIVE: We first assessed the association of caregiving with gingival symptom reports. We then assessed whether the observed relationship was mediated by psychophysiologic host factors. METHODS: Caregivers of spouses with Alzheimer's disease (n = 123) were compared with demographically similar noncaregiver spouses (n = 117). RESULTS: The percentage of caregivers (17%) who reported gingival symptoms was twice that of noncaregivers (8.5%) (p < .05), despite the fact that caregivers and noncaregivers did not differ in oral health care. The relationship between caregiving and gingival symptom reports was mediated by psychophysiologic variables. Caregivers were higher on hassles (p < .05), depressed mood (p < .05), and metabolic risk (insulin, glucose, obesity; p < .05) than were noncaregivers. Greater gingival symptom reports were also associated with greater hassles (p < .01), depressed mood (p < .001), and metabolic risk (p < .001). Measures of subcutaneous fat, inflammation, and frank diabetes were related to gingival symptom reports but not to caregiver status. CONCLUSIONS: A higher percentage of caregivers reported gingival symptoms than noncaregivers. These results have implications for research on aging, psychophysiology, and chronic stress.

Neighborhood characteristics moderate effects of caregiving on glucose functioning.

OBJECTIVE: Adverse neighborhood environments and caregiving for a relative with dementia are both stressors that have been associated with poor health. The present study examined the extent to which three self-report measures of neighborhood characteristics interact with caregiving status (caregiver versus noncaregiver) to modify an important stress related health outcome: plasma glucose. METHODS: The study sample consisted of 147 community recruited caregivers and 147 participants who did not have caregiving responsibilities. We hypothesized that negative neighborhood characteristics would magnify effects of caregiving on plasma glucose levels. Regression analyses were conducted to examine the interaction of three neighborhood characteristic measures with caregiving status in predicting fasting plasma glucose (FPG) and glycosylated hemoglobin concentration (HbA1c), with control for age, race, gender, relation to care recipient (spouse or relative), body mass index, income, and education. RESULTS: Of the three neighborhood measures, the one reflecting crime concerns significantly moderated the effect of caregiving on FPG (p < .002) and HbA1c (p < .001). For participants with better neighborhood characteristics, caregivers and noncaregivers were similar with respect to indicators of glucose metabolism; however, for participants with worse neighborhood characteristics, caregivers had higher levels of FPG and HbA1c, as compared with noncaregivers. CONCLUSIONS: Poor health outcomes, such as impaired glucose control, may be found among caregivers who fear neighborhood crime.

Psychophysiological mediators of caregiver stress and differential cognitive decline.

The authors examined relationships between chronic stress and cognitive decline and whether such relationships were mediated by psychophysiological factors. Ninety-six caregivers of spouses with Alzheimer's disease (AD) were compared with 95 similar noncaregiver spouses. All were free of diabetes. Although the groups started similarly, over 2 years caregivers declined by a small but significant amount (1 raw score point and 4 percentile points, each p<.05) on Shipley Vocabulary. In contrast, noncaregivers did not change. Higher hostile attribution (beta=-.09; p<.05) and metabolic risk (beta=-.10; p<.05) in caregivers mediated the cognitive decline. This is the first study of cognitive decline and mediators in caregivers. This work has implications for caregiver and care-recipient health and for research on cognition, psychophysiology, diabetes, and AD.

Is caregiving hazardous to one's physical health? A meta-analysis.

Caring for a family member with dementia is generally regarded as a chronically stressful process, with potentially negative physical health consequences. However, no quantitative analysis has been conducted on this literature. The authors combined the results of 23 studies to compare the physical health of caregivers with demographically similar noncaregivers. When examined across 11 health categories, caregivers exhibited a slightly greater risk for health problems than did noncaregivers. However, sex and the health category assessed moderated this relationship. Stronger relationships occurred with stress hormones, antibodies, and global reported health. The authors argue that a theoretical model is needed that relates caregiver stressors to illness and proffers moderating roles for vulnerabilities and resources and mediating roles for psychosocial distress and health behaviors.

Patterns of change in hostility from college to midlife in the UNC Alumni Heart Study predict high-risk status.

OBJECTIVE: To examine hostility measured in college and patterns of change in hostility from college to midlife as predictors of high health-related risk later in midlife. METHODS: Logistic regression models were used to test hostility/risk associations. RESULTS: College hostility predicted being a current smoker, consuming more than two drinks of alcohol, low social support, achieving less than expected in career and in relationships, risk for depression, and appraisal of life changing for the worse in terms of family events at midlife. Change in hostility did not predict smoking and drinking; however, it did significantly predict social isolation, lower income (only for women), obesity, avoidance of exercise, high-fat diet, and negative changes in economic life, work life, and physical health events-all risk indicators measured during the next decade. Appraisals of social support, lowered expectations, risk for depression, and reports of family life changing for the worse were predicted at both time periods. When change in hostility was modeled with college hostility, all risk indicators were significantly predicted by college hostility. CONCLUSIONS: High hostility in college and change in hostility from college to midlife predicts a full range of health risk indicators. When compared with the average population decline in hostility, gains in hostility at midlife are related to increased risk while declines in hostility are related to reduced risk. Higher midlife hostility is associated with increased odds of being in the higher risk group. Future research should focus on developing interventions to reduce hostility.

Attitudes toward community-based services among Japanese American families.

PURPOSE: This descriptive study explored attitudes toward community-based long-term care services and factors influencing service utilization among Japanese American families. DESIGN AND METHODS: Using grounded theory methodology, the Japanese American sample included 26 family caregivers, 4 persons receiving care, and 14 professional providers (n = 44). RESULTS: Attitudes toward services were identified along six dimensions: ability to meet care needs, autonomy in daily life, quality of care and staff, cost, emotional connotations, and social and physical environment. Participants used formal services in a dynamic manner, meeting both episodic and chronic needs. Families played an active role in sustaining and augmenting the caregiving situation, regardless of living arrangement. IMPLICATIONS: This research highlights the range of criteria included in attitude formation about services and the dynamic nature of the interplay between families and formal services.

Evolving values in community-based long-term care services for Japanese Americans.

This study used grounded theory to explore how long-term care services are perceived and what factors influence family caregiving and long-term care service utilization choices among Japanese Americans. Family and generational perspectives elucidated a dialectic between forces of integration into the broader culture, and reconnection with the culture of origin within the context of powerful ethnically based historical and generational experiences. This study describes the evolution of the values underlying service delivery and family expectations and demonstrates the dynamic relationships among cultural expectations, historical context, and service evolution for a group of members involved in the caregiving experience.