Allan V. Kaufman

Improving quality of life in diverse rural older adults: a randomized trial of a psychological treatment.

The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care.

Family Caregiving to Those With Dementia in Rural Alabama Racial Similarities and Differences

This study explored differences and similarities in the experiences of African American and White family caregivers of dementia patients living in rural Alabama. This cross-sectional survey used a caregiving stress model to investigate the interrelationships between caregiving burden, mediators, and outcomes. Random-digit-dialing telephone interviews were used to obtain data on a probability sample of 74 non-Hispanic White and 67 African American caregivers. White caregivers were more likely to be married and older, used acceptance and humor as coping styles, and had fewer financial problems. African American caregivers gave more hours of care, used religion and denial as coping styles, and were less burdened. The authors have developed a methodology for obtaining a representative sample of African American and White rural caregivers. Further investigations are needed of the interactions between urban/rural location and ethnic/racial backgrounds of dementia caregivers for heuristic and applied reasons.

Coping Strategies and Caregiving Outcomes Among Rural Dementia Caregivers

We studied the coping styles by which family caregivers living in rural areas of Alabama deal with the demands of caring for an older relative with dementia. Data were obtained from a sample of 141 caregivers through the random-digit dialing telephone survey. Two coping styles were identified: deliberate coping and avoidance coping. Deliberate coping was related to higher life satisfaction scores and, avoidance coping was related to lower life satisfaction scores and higher caregiver burden scores. Avoidance coping appeared to moderate the effects of caregiver health on caregiver burden. Social workers should pay greater attention to caregivers with dysfunctional coping styles.

Racial Differences in Perceived Burden of Rural Dementia Caregivers: The Mediating Effect of Religiosity

This study explores whether religiosity explains racial differences in caregiving burden for a rural sample of dementia family caregivers. Data are from a probability sample of 74 non-Hispanic White and 67 African American dementia caregivers in rural Alabama. SPSS macros for estimating indirect effects in multiple mediator models are used to test the mediation effects of religiosity. White caregivers report higher burden, are less likely to use religious coping, and less likely to engage in organized religion than do African American caregivers. Church attendance is found to significantly (B = —.57, p < .05) mediate the racial differences on caregiving burden (R 2 = .07). Religious involvement in general, and church attendance in particular, seem to provide both spiritual and social psychological benefits to dementia caregivers. Thus, supplementing formal services with the services provided by religious organizations may be important in rural areas where formal resources are scarce.

Home-Delivered Mental Health Services for Aged Rural Home Health Care Recipients

Home health care programs are generally able to meet a wide variety of older persons’ medical care needs, but are often unable to provide for the specialized needs of those patients who are experiencing emotional problems. This situation is most problematic in rural communities where services to meet the mental health needs of homebound elders are often not available. This article reports the results of a study that tested the efficacy of providing home-delivered psychotherapy to 78 elderly patients of a rural home health care agency. Patients who completed the brief, task-centered psychotherapeutic intervention reported improvements in their emotional well-being and indicated significant reduction of the problems associated with the target complaints that were the focus of the interventive activities. These results suggest that home-delivered psychotherapeutic interventions may have an important role to play in treating the mental health problems of older, rural, home health care recipients.

Helping Aging Parents of Adult Children with Serious Mental Illness

ABSTRACT This manuscript reports the results of a study that pilot-tested a home-delivered, multidimensional problem-solving intervention aimed at helping aging parental caregivers of adult children with schizophrenia. The results indicate that the participants (N= 5) who received the 10-session intervention showed increased life satisfaction and emotional well-being and reduced feelings of burden compared with those participants in the control group (N= 10). If a planned larger-scale evaluation of the intervention provides evidence of its effectiveness, practitioners could have a valuable new treatment tool to provide assistance to this caregiver population.

Predictors of Social Isolation in Older Southern Adults: A Cross-Racial Analysis

Using data collected from a sample of older Mississippians, we examine whether race has a modifying effect on the predictors of three underlying dimensions of social isolation: interaction with relatives, feelings of loneliness, and interaction with friends and neighbors. The study shows similarities and differences between black and white respondents regarding those factors predictive of social isolation within each subgroup. These findings are helpful in developing profiles to describe those older blacks and whites who may be at greatest risk of experiencing social isolation.

Interaction and Loneliness: A Dimensional Analysis of the Social Isolation of a Sample of Older Southern Adults

This study, using data drawn from a sample of 1,879 older Mississippians, demonstrates that social isolation is both complex and multidimensional in nature. Interaction with relatives, feelings of loneliness, and interaction with friends and neighbors composed the three primary dimensions underlying the varying patterns of social isolation found among study respondents. Study findings suggest that certain groups of older people are at greater risk than others of experiencing the potentially harmful effects of social isolation and that human service practitioners must consider the various dimensions of social isolation when designing interven tive strategies that attempt to combat the causes or consequences of this psychosocial phenomenon.

Providing Mental Health Services to Older People Living in Rural Communities

Summary Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional well-being and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.

The Mentally Retarded Aged

The mentally retarded aged are a relatively small and little known subgroup of our rapidly growing older population, whose special circumstances and often unique human service needs have been largely ignored by the social work profession. As the absolute number of mentally retarded aged persons continues to grow, social workers will have increased opportunities to develop and deliver sorely needed services to these individuals and to their families. The article presents three case management practice models appropriate for providing social work services to three distinct residential subgroups of mentally retarded aged.