Dale A. Lund

Wives, Husbands, and Daughters Caring for Institutionalized and Noninstitutionalized Dementia Patients: Toward a Model of Caregiver Burden:

The primary purposes of this article are to clarify some of the inconsistencies in the previous research studies done on factors associated with caregiver burden; to identify specific sets of variables that best explain the differential burden levels among caregivers; and to provide a substantial foundation for developing a model of caregiver burden useful for both research and clinical interventions. The caregivers gender, relationship to the patient, and the residential location of the patient (same house, community, or institution) are major considerations in our analyses. This study is also unique, because it uses a relatively large national sample of caregivers, which is necessary to accomplish the studys objectives. Mailed questionnaires were completed by 409 caregivers identified by fifty local support groups in sixteen different states in the United States. Generally, the primary correlates of burden were factors related to the levels and types of impairment in patient functioning, caregiver life satisfaction, and social support. Each category of caregiver circumstances had a unique set of three to five correlates with the total amount of variance explained in burden ranging from 25 percent (husbands living with the patients) to 68 percent (husbands with spouses in nursing homes). Implications for future research and interventions are discussed.

Exploring the Caregiver Burden Inventory (CBI): Further Evidence for a Multidimensional View of Burden.

The purpose of this study was to examine the multidimensional nature of caregiver burden by specifically analyzing the patterns of association between five dimensions of burden as measured by the Caregiver Burden Inventory [1] and selected demographic, health, functioning, and well-being indicators. Subscales measuring each dimension were internally consistent and relatively independent in a sample of 160 caregivers. Time dependence burden was most influenced by patient impairment and caregiving involvement, whereas emotional burden was largely a function of caregiving satisfaction. Most of the variance in developmental burden was explained by depression and caregiving satisfaction. Contrary to expectations, physical health measures explained little variance in physical burden, of which most was explained by depression. Less than 10 percent of the variance in social burden was explained by depression and caregiver days sick. The findings lend support to a multidimensional view of burden and with minor modifications, the CBI appears to be a promising instrument with which to measure the construct.

Identifying Elderly with Coping Difficulties after Two Years of Bereavement

This study answers three research questions. First, what proportion of the elderly are experiencing major coping difficulties after two years of bereavement? Second, what factors in early bereavement distinguish between those with difficulties and the others? Third, what set of factors are the best predictors of coping difficulties at two years? Of the 138 persons who completed a two-year longitudinal study of bereavement, twenty-five (18%) were found to be having difficulties after two years according to a scale which combined perceived stress, coping, and depression. The poor copers did not differ from the others with respect to any of the sociodemographic, health, or social support variables. However, those who were poor copers had lower self-esteem, experienced several feelings/behaviors with greater intensity/frequency in early bereavement. Low self-esteem, even prior to bereavement, is likely to be predictive of coping difficulties two years following the death of a spouse. Three weeks after the spouses death, the poor copers expressed confusion and a desire to die with greater intensity. They also were less likely to be proud of how they were managing the death, they cried more frequently, and did not try to keep as busy in this early bereavement period.

Maintaining Caregiving at Home: A Culturally Sensitive Grounded Theory of Providing Care in Thailand

Grounded theory methodology was used to generate a substantive theory that describes and explains the caregiving process of Thai caregivers for their elderly stroke relatives. Data were collected from a purposive sample of 20 family caregivers living in Chachoengsao province, Thailand, by using interviews, observations, and the primary researcher’s memos. The central idea emerging from the data was maintaining caregiving at home that encompassed these seven contextual situations: (a) caregiving as an integral part of life; (b) caregiving as an unavoidable task; (c) caregiving with love, sympathy, and attachment; (d) family and kinship support; (e) community support; (f) managing treatment; and (g) managing problems and difficulties. Culture, tradition, and religion dominated throughout these situations. Application of the theory is discussed relative to providing culturally sensitive nursing education, intervention, and research.

Gray and green?: Stewardship and sustainability in an aging society

Abstract The natural environment has been a missing part of the context in public policy forums and educational programs when discussing the implications of an aging society. We believe that stewardship and the sustainability of natural resources should be considered in addition to economics and health care when addressing the themes of well-being and quality of life for future generations. This article presents on overview of the usage of the concept environment in aging studies and presents critically important concepts such as sustainability, stewardship, natural capital, carrying capacity, and ecological footprint in recognizing the relevancy of including the natural environment in discussions about our aging society. Also we propose directions for future research and discuss advocacy and organizational activities related to ecology and aging studies.

Music thanatology: Prescriptive harp music as palliative care for the dying patient

Music thanatology represents an emerging area in which the raw materials of music, usually harp and/or voice, assist and comfort the dying patient. During prescriptive ”music vigils,“ the clinician-mnusician carefully observes physiological changes, cues, and breathing patterns, thereby synchronizing the music to reflect or support the patient physiology and overall condition. Using data collected from 65 patients, this study was designed to assess the effectiveness of prescriptive harp music on selected palliative care outcomes using a sample of de-identified data forms from past music vigils. Patients were administered a 25- to 95-minute intervention of prescriptive harp music. Data collected included vital signs and observational indicators before (Ti) and after (T2) the vigil. Patients were more likely to experience decreased levels of agitation and wakefulness while also breathing more slowly and deeply with less effort at the conclusion of the music vigil. Results from this study suggest that a prescriptive vigil conducted by a trained music thanatologist could provide an effective form ofpalliative care for dying patients.

Beyond bereavement support group meetings: Exploring outside social contacts among the members

This article examines the extent to which bereavement support group participants engage in social interaction with fellow group members outside of the meetings, demographic influences on outside contact, and the relationship between this social interaction and bereavement outcomes. Data are presented from a longitudinal study that included 144 recently bereaved spouses between the ages of 51 and 89 who participated in a support group intervention. During the course of the study the majority of the participants had contact with other group members in addition to the scheduled meetings even though the group leaders did not encourage outside contact. Although the frequency of the interaction was only moderate, the support group participants reported feeling relatively close to their fellow group members. Men were as likely as women to have outside contact but they delayed in doing so. Those who engaged in outside contact were slightly more depressed, experienced more stress, and were more lonely at the time of the contact relative to others. Those who maintained some kind of interaction by Time 3 (1 year bereaved), however, reported less loneliness by the end of the study (Time 4). Findings are discussed in terms of the frequency and duration of support group interventions, the gender composition of the groups, and the need to incorporate into future studies a more systematic examination of outside interaction among support group participants.

Stress-related growth among the recently bereaved

Although stress-related growth (SRG), or a personal transformation beyond adaptation, can be an outcome for some individuals after a traumatic life experience like spouse or partner loss, it is often assumed that some time needs to pass before this happens. This study reports on early experiences of SRG relatively soon after the loss of a spouse or partner in mid and later life. Self-administered questionnaires were completed by 292 recently bereaved (2–6 months) partners, aged 50+, as part of the Living After Loss study conducted in Salt Lake City and San Francisco. Substantial variability in SRG was observed where 21% scored ≥1 SD above and approximately 18% scored ≥1 SD below the sample mean of 17.2 (SD = 7.0). Regression analyses revealed that SRG was more likely for those who had expected their partners’ deaths, who were more religious and who engaged in loss- and restoration-oriented coping processes, and was independent of grief levels. Findings suggest that some individuals drew upon their religious beliefs as a way to find meaning and make sense of what happened as they rebuilt their ‘assumptive world’. Also, those who anticipated their partners death could have had more opportunity to cognitively process the loss, address the challenges of widowed life and learn new skills and discover previously unrecognized strengths.

Experiences and Early Coping of Bereaved Spouses/Partners in an Intervention Based on the Dual Process Model (DPM)

This study was designed to test the effectiveness of the Dual Process Model (DPM) of coping with bereavement. The sample consisted of 298 recently widowed women (61%) and men age 50+ who participated in 14 weekly intervention sessions and also completed before (O1) and after (O2) self-administered questionnaires. While the study also includes two additional follow-up assessments (O3 and O4) that cover up to 14–16 months bereaved, this article examines only O1 and O2 assessments. Based on random assignment, 128 persons attended traditional grief groups that focused on loss-orientation (LO) in the model and 170 persons participated in groups receiving both the LO and restoration-orientation (RO) coping (learning daily life skills). As expected, participants in DPM groups showed slightly higher use of RO coping initially, but compared with LO group participants they improved at similar levels and reported similar high degrees of satisfaction with their participation (i.e., having their needs met and 98–100% indicating they were glad they participated. Even though DPM participants had six fewer LO sessions, they showed similar levels of LO improvement. Qualitative data indicate that the RO component of the DPM might be more effective if it is tailored and delivered individually.

Stress, self-esteem and coping during bereavement among the elderly

The purpose of the study was to assess the stability of self-esteem as a coping resource during bereavement and to develop a dynamic model of the efficacy of coping ability in relation to the perceived stressfulness of the spouses death. Data were obtained from a longitudinal study of bereavement. Interviews and mailed questionnaires were completed by 192 persons at three time periods which covered the first year of bereavement. Results indicate that initially effective copers remain effective throughout the first year, those with initially high levels of self-esteem maintain their positive assessments, and those who initially experience high stress levels also continue to report high levels one year later. Early bereavement stress was reduced by positive self-evaluations. Persistent stress is associated negatively with coping at one year. The mediating influence of stress at six months also contributes most significantly to the negative effects on self-esteem. Perceived coping ability significantly reduces stress only at six months. Implications for ongoing interventions are discussed.