Baila Miller

The Effect of caregiver's burden on change in frail older persons' use of formal helpers

We used a national longitudinal probability sample of frail older persons and their caregivers to examine three questions: 1) What are the probabilities of transition to use of formal helpers over a two-year period? 2) What is the role of predisposing, enabling, older persons need, and caregivers need variables in changes in the use of formal helpers? 3) Do determinants of change in the use of formal helpers vary by level of caregivers burden? Results show a slight trend to increased use in formal help over time. Personal burden, but not interpersonal burden, had a lagged effect on increased use of formal services. Use of formal helpers was greater in situations combining high levels of older persons need, high levels of caregivers personal burden, and insufficient support from the informal network.

Family Caregivers and Limitations in Social Activities

Constriction of social and personal activities is one of the most frequently noted consequences of caring for a frail elder. This study analyzed the correlates of perceived limitations in social activities using data from a national sample of the frail elderly and their caregivers. Two research issues were addressed: 1) What differences in demographic, family, and caregiving attributes are associated with variation in perceived restricted social activities? and, 2) How does the process influencing restriction of social activities vary by family relationship of the caregiver? Higher levels of elder dependency and task demands were characteristic of those who reported social limitations, and daughters and wives were more likely to report such limitations than sons and husbands. Subjective assessment of time and task demands, however, were more important influences than objective caregiving activities for all family caregivers.

Adult children's perceptions of caregiver stress and satisfaction

A guiding hypothesis of gerontological research on caregiving burdens and stress is that caregiver stress and satisfaction are negatively related. I explored this hypothesis using a subsample of adult child caregivers from the 1982 National Long Term Care Survey. Contrary to expectation, I found a positive zero-order correlation between stress and satisfaction. Demographic characteristics of the caregiver, level of parental impairment, level of care provided, and caregiving problems explain 25% of the variance in perceived stress but only 5% of the variance in satisfaction. Adult children most involved in the caregiving experience report both high stress and high satisfaction.

A paradox of medicalization: Physicians, families and Alzheimer's disease

Abstract Although medicalization of dementing disorders encompasses broad societal developments, such trends influence and are influenced by the context of everyday expectations and behaviors. This study provides evidence based on data from physicians in the medical community and family caregivers in the lay community that the medicalization process of Alzheimers disease and related disorders remains incomplete. The findings suggest that physicians and families currently resolve the paradox between physician capability and family expectations by accepting the definition of Alzheimers disease as a unique, highly variable, currently incurable illness.

Caregiver Burden and the Continuum of Care A Longitudinal Perspective

This article integrates the results of a series of prospective studies that used data from the 1982-1984 National Long Term Care Survey to (a) provide a comprehensive view of the effects of caregiver burden over a two-year period, (b) suggest ways in which caregiver burden intersects with the continuum of care, and (c) explore the implications for long-term care research and policy. Each dimension of caregiver burden had different consequences for each long-term care outcome. Neither personal nor inter-personal burden had an independent effect on changes in the informal task support network. Personal burden, but not interpersonal burden, influenced changes in the use of formal services. Interpersonal burden, but not personal burden, influenced nursing home admissions.

Shared Ethnicity and Relationship Multiplexity within the Informal Networks of Retired European American Sunbelt Migrants A Case Study

In this article, the authors explore the impact of shared ethnicity and chain migration on the structure of relationships within the informal networks of elderly European Americans who migrated to a Florida retirement location. Data were collected through structured interviews with a probability sample of retired migrants. Hierarchical linear modeling was used to assess the impact of characteristics of elders and of network members on relationship multiplexity, a concept developed by network theorists to describe the content of relationships. The conceptualization of multiplexity in this article combines information on type and direction of activity reported by the elderly respondents with respect to each member of their network. Friendships involving shared ethnic background between the elder and network member occupied an intermediate position between kin relations and other friendships, a pattern that remained when “back home” location was controlled for.

Moral reasoning and Alzheimer's care: Exploring complex weavings through narrative

Abstract This article reports on selected results of an inquiry-guided study in which we used literature and autobiography to challenge current rationalist perspectives on the use of formal services by caregivers of Alzheimers sufferers. Starting with Gilligan s concepts of two basic forms of moral reasoning—justice versus care-based—we interpreted the moral reasoning about caregiving expressed in four novels: Diary of a Good Neighbor, Memory Board, Memento Mori, and The Other Side. Although we found Gilligans dichotomous framework not directly applicable, we did find ample evidence of the salience of moral reasoning to questions of who should care and on what basis. We also found that stories, as they are woven from threads of family history, social position and mores, as well as ideas about intimate love, religion, and autonomy, reveal the interconnectedness of so-called private choices to the social ideologies that constrain and shape these choices.