Carol J. Farran

Race, Finding Meaning, and Caregiver Distress

This study investigated the relationship between race, finding meaning (as a positive psychological resource variable), and the outcomes of caregiver depression and global role strain among 77 African American and 138 White spouse caregivers of persons with dementia. Finding provisional meaning had a direct negative relationship with depression and global role strain. Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.

Finding meaning through caregiving: Development of an instrument for family caregivers of persons with Alzheimer's disease

Systematic assessment of the positive aspects of caregiving has been limited by the lack of comprehensive, theoretically based, and psychometrically sound measures. This study developed and tested a measure primarily designed to assess positive aspects and ways that caregivers find meaning through their experience of caring for a person with dementia. The measure has three subscales: Loss/Powerlessness, which identifies difficult aspects of caregiving; Provisional Meaning, which identifies how caregivers find day-to-day meaning; and Ultimate Meaning, which identifies philosophical/religious/spiritual attributions associated with the experience of caregiving. The measure is useful for understanding the close relationship between both the difficult and positive aspects of caregiving and also may be used to identify a caregivers strengths in clinical and research settings.

LONELINESS AND DEPRESSION IN CAREGIVERS OF PERSONS WITH ALZHEIMER'S DISEASE OR RELATED DISORDERS

Secondary analysis of data from a sample of 242 husbands, wives, and daughters providing care for Alzheimers disease family members was conducted to examine the relationships among loneliness and depression and the following variables: quality of the past relationship, relational deprivation, quality of the current relationship, and distance felt due to caregiving. Loneliness was significantly related to depression (r=.66, p<.001), relational deprivation (r=.36, p<.001), and quality of the current relationship (r=.34, p<.001), indicating that the more loneliness reported by the caregivers, the more the caregiver experienced depression, relational deprivation, and a poorer quality of the current relationship. Significant gender differences were found with the caregiving wives and daughters reporting higher mean scores than caregiving husbands on relational deprivation, loneliness, and depression. Loneliness was the only variable significant for predicting depression in caregiving husbands, wives, and daughters. In order for loneliness and depression to be addressed in Alzheimers disease caregivers, they must first be recognised by nurses.

Elder abuse and mortality: the role of psychological and social wellbeing.

Background: Elder abuse is a pervasive human right and public health issue. Objectives: We aimed to examine the mortality associated with elder abuse across levels of psychological and social factors. Methods: The Chicago Health and Aging Project (CHAP) is a prospective population-based cohort study that began in 1993. A subset of these participants enrolled between 1993 and 2005 had elder abuse reported to social services agencies (n = 113). Mortality was ascertained during follow-up and with the National Death Index. Psychosocial factors (depression, social network and social engagement) were assessed during the CHAP interview. Cox proportional hazard models were used to assess the mortality of elder abuse across levels of psychosocial factors using time-varying covariate analyses. Results: The median follow-up time for the cohort (n = 7,841) was 7.6 years (interquartile range 3.8–12.4 years). In multivariate analyses, those with highest (hazard ratio (HR) 2.60, 95% CI 1.58–4.28) and middle levels (HR 2.18, 95% CI 1.19–3.99) of depressive symptoms had an increased mortality risk associated with elder abuse. For social network, those with lowest (HR 2.50, 95% CI 1.62–3.87) and middle levels (HR 2.65, 95% CI 1.52–4.60) of social network had increased mortality risk associated with elder abuse. For social engagement, those with lowest (HR 2.32, 95% CI 1.47–3.68) and middle levels (HR 2.59, 95% CI 1.65–5.45) of social engagement had increased mortality risk associated with elder abuse. Among those with lowest levels of depressive symptoms, highest levels of social network and social engagement, there was no significant effect of reported or confirmed elder abuse on mortality risk. Conclusion: Mortality risk associated with elder abuse was most prominent among those with higher levels of depressive symptoms and lower levels of social network and social engagement.

Clinical Assessment of Hope

In recent years, nurse researchers have given more attention to the role that hope plays in health and illness. While this research adds to the knowledge base about hope, that this knowledge may become too theoretical and difficult to apply in the clinical setting. Based on a study of hope conducted with community-based older adults, an analysis of the hope instruments used in this study, and ongoing clinical experiences, a guide for the clinical assessment of hope is proposed.

Depression Among Korean, Korean American, and Caucasian American Family Caregivers

This study compared depressive symptoms among Korean, Korean American, and Caucasian American female family caregivers of older persons with dementia. The sample included Korean caregivers living in Seoul, Korea (KK); Korean American (KA) caregivers living in the Chicago and Los Angeles areas; and Caucasian American (CA) caregivers from the Chicago metropolitan area. KK caregivers were more likely to be daughters-in-law, KA caregivers were more likely to be daughters, and CA caregivers were more likely to be wives or daughters. Overall, wives were more depressed than daughters and daughters-in-law. KK caregivers were the most depressed of the three cultural groups. When caregiver relationship and cultural group were examined simultaneously, KK and KA wives were most depressed, and KA daughters-in-law were least depressed. Differences in culture and social role appeared to affect depressive symptoms among these caregivers. The findings suggest a need to further examine the associations between caregivers’ relationships with their care recipients and their own emotional status.

Stroke Caregiver Outcomes from the Telephone Assessment and Skill-Building Kit (TASK)

Abstract Purpose: Stroke caregivers often express the need for information about stroke and assistance with stroke-related care in the early discharge period. The Telephone Assessment and Skill-Building Kit (TASK) is an 8-week program that addresses caregiver needs. This study explored the efficacy of the TASK program in improving stroke caregiver outcomes. Method: Guided by a conceptual model, 6 outcomes (optimism, task difficulty, threat appraisal, depressive symptoms, life changes, general health perceptions) were measured in 40 caregivers randomized to the TASK (n = 21) or an attention control group (n = 19). Data were analyzed using analysis of covariance (ANCOVA), controlling for baseline scores and minutes spent with the nurse. Results: Significant increases in optimism at 4 weeks, 8 weeks, and 12 weeks were found, with medium effect sizes for the TASK group relative to the control group (p < .05). Significant improvements in task difficulty at 4 weeks, and threat appraisal at both 8 weeks and 12 weeks were also found (p < .05). Conclusion: Caregivers receiving the TASK intervention improved in optimism, task difficulty, and threat appraisal. Further testing of an enhanced version of the TASK program is warranted, with attention directed toward more distal stroke caregiver outcomes.

Hope: A relevant concept for geriatric psychiatry

The focus in psychiatry has been on treating people for hopelessness, as opposed to understanding more about maintaining hope. This study reports findings from a study of hope conducted with community-based older adults. A general linear model procedure was used to more clearly understand the relationships among hope and other relevant variables. This model is used as a basis for proposing an intervention model for maintaining hope in older adults.

Content validity and satisfaction with a stroke caregiver intervention program.

BACKGROUND AND PURPOSE Establishing evidence of content validity and satisfaction is an integral part of intervention research. The purpose of this article is to describe content validity and satisfaction relative to the Telephone Assessment and Skill-Building Kit (TASK), an 8-week follow-up program based on individualized assessment of stroke caregiver needs. DESIGN AND METHODS The TASK intervention enables caregivers to develop skills based on assessment of their own needs. During the development of the TASK program, 10 experts rated the validity of the TASK intervention components for accuracy, feasibility, acceptability, and problem relevance. After incorporating feedback from the experts, a randomized controlled clinical trial was instituted using a convenience sample of 40 stroke caregivers to determine satisfaction (usefulness, ease of use, and acceptability) with the TASK intervention (n=21) compared with an attention control group (n=19). Data collection occurred between March 2005 and June 2006. Data were analyzed using descriptive statistics, independent sample t tests, and content analysis. FINDINGS Expert ratings on a 1 to 5 scale, with 5 being strongly agree, provided evidence of content validity (accuracy 4.71, feasibility 4.46, acceptability 4.40, problem relevance 4.67). Caregivers in the TASK group scored significantly higher than the attention control group on all satisfaction measures (usefulness p=.02; ease of use p=.02; acceptability p=.05). Qualitative comments from caregivers provided further evidence of satisfaction. CONCLUSIONS Evidence of content validity and user satisfaction for the TASK intervention relative to an attention control group was found. CLINICAL RELEVANCE The TASK program may be a viable telephone-based program that can be implemented by nurses to support family caregivers during the first few months after stroke survivors are discharged home.

A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease.

Background: The purpose of this pilot study was to examine the effects of lifestyle physical activity in caregivers (CGs) of persons with Alzheimers disease. Methods: Fifteen CGs engaged in lifestyle physical activity during a 6-month, home-based health promotion program. Mean changes in self-reported physical activity were compared using repeated-measures analysis of variance. Results: Fifty percent of CGs increased total self-reported minutes and 42% increased total moderate minutes of physical activity from preintervention to postintervention; however, no CG engaged in vigorous physical activity and there were no significant improvements in self-reported physical activity for the total group. Hot summer weather, heavy noncaregiving responsibilities, heavy caregiving responsibilities, and feelings of anxiety, depressive symptoms, and fatigue were the most frequently identified physical activity barriers. Conclusion: Incorporating an individualized, home-based program of lifestyle physical activity appears feasible; however, attention needs to be given in the future to physical activity barriers identified by this select group of CGs.