Daniel W. Durkin

Testing a Theoretical Model of the Stress Process in Alzheimer's Caregivers With Race as a Moderator

PURPOSE The primary aim of this study was to test the stress process model (SPM; Pearlin, Mullan, Semple, & Skaff, 1990) in a racially diverse sample of Alzheimers caregivers (CGs) using structural equation modeling (SEM) and regression techniques. A secondary aim was to examine race or ethnicity as a moderator of the relation between latent constructs (e.g., subjective stressors and role strain) in the SPM. SAMPLE Participants included White or Caucasian (n = 212), Black or African American (n = 201), and Hispanic or Latino (n = 196) Alzheimers CGs from the Resources for Enhancing Alzheimers Caregiver Health (REACH) II clinical trial. RESULTS SEM revealed that the Pearlin model obtains a satisfactory fit across race or ethnicity in the REACH II data, despite significant racial differences in each of the latent constructs. Race or ethnicity moderated the impact of resources on intrapsychic strain, such that CGs reported similar intrapsychic strain across race at lower levels of resources, but White or Caucasian CGs reported more intrapsychic strain than Black or African American or Hispanic or Latino CGs when resources are higher. IMPLICATIONS Strengths and weaknesses for each race or ethnicity vary considerably, suggesting that interventions must target different aspects of the stress process to provide optimal benefit for individuals of different cultural or ethnic backgrounds.

Perceived Income Inadequacy as a Predictor of Psychological Distress in Alzheimer's Caregivers

The authors examined perceived income inadequacy as a predictor of self-reported depressive symptomatology and anxiety in the original sites of the Resources for Enhancing Alzheimers Caregiver Health I project. Perceived income inadequacy, self-reported household income, and control factors (e.g., subjective health) were entered into hierarchical regression analyses predicting psychological distress. Findings suggest that perceived income inadequacy and not household income significantly predicted more self-reported depressive symptomatology and greater self-reported anxiety. This supports previous findings that objective income measures alone are not adequate indicators of socioeconomic status in older adults.

Evaluation of two fatigability severity measures in elderly adults.

To document the stability, concurrent validity, and clinical correlates of two fatigability severity measures as recommended by the American Geriatrics Society.

Preserving Identity and Planning for Advance Care (PIPAC): preliminary outcomes from a patient-centered intervention for individuals with mild dementia

Objectives: The purpose of this pilot study was to conduct limited-efficacy testing of the newly developed Preserving Identity and Planning for Advance Care (PIPAC) intervention on self-reported and proxy-reported emotional and health-related outcomes of individuals in the early stages of dementia. Method: A two-group comparison design was implemented. Blocked randomization was used to assign individuals with mild dementia and a family contact to either (1) the four-session, multi-component intervention group focused on reminiscence and future planning or (2) the minimal support phone contact comparison group. Of the 19 enrolled dyads, 18completed post-treatment assessments (i.e. 10 intervention and 8 comparison group). Individuals with dementia were M= 82.8 (SD = 6.46) years old; 31.6% were men and 68.4% were women. Participants were predominantly white/Caucasian (n = 18, 94.7%) with one black/African-American (5.3%). Results: Analyses of covariance controlling for baseline differences revealed clinically meaningful differences (with medium to large effect sizes) between groups at post-treatment for depressive symptoms, quality of life, health-related quality of life indicators, and decisional conflict. Individuals in the intervention group were also observed to exhibit higher levels of coping. Feasibility data collected from participants and interventionists were encouraging. Conclusion: Emotion-focused, patient-centered interventions like PIPAC hold promise for advancing treatment options in the early and mild stages of dementia. A full-scale, randomized clinical trial of this intervention is warranted to determine both short-term and long-term impacts on clinical outcomes including improved depressive symptomatology, quality of life, and health-related factors that impact daily functioning in social environments.

A controlled trial of an intervention to increase resident choice in long term care.

OBJECTIVE The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care. DESIGN A controlled trial with a delayed intervention design. SETTING Four community, for-profit nursing homes. PARTICIPANTS A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences. INTERVENTION Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff. MEASUREMENTS Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention. RESULTS There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001). CONCLUSION A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.

Widowhood, religiousness and self-assessed well-being among older adults

ABSTRACT Background: The well-being of older, widowed persons is of concern to aging practitioners, including those in faith-based organizations. Some have suggested that engaging in religious/spiritual activities may mitigate the negative effects of widowhood for older adults. This cross-sectional study examined predictors of self-assessed well-being of widowed and married elders. The aim of this study was to determine whether participation in religious/spiritual activities mediated the relationship between marital status and well-being after controls were instituted. Method: This study is a secondary analysis of data collected for the National Opinion Research Centers 1998 General Social Survey. Analyses are based on 150 married and 120 widowed persons aged 60 or older. We regressed married/widowed status, demographic characteristics, self-reported health, and four measures of religious/spiritual activity on a fouritem index of self-assessed well-being. Results: Widowed elders reported lower levels of well-being than married elders, even after we controlled for sociodemographic characteristics, self-perceived health, and measures of religious/spiritual activity. Socioeconomic status (SES) and self-perceived health had positive relationships with well-being, and frequency of prayer had a negative relationship with well-being. Conclusion: Congregations wishing to improve well-being among widowed and married elders should consider focusing on ministries to improve financial well-being and health and advocacy for programs that benefit low income elders. Church-based programs targeting widowed elders should focus on positive religious coping and prayer.

The Impact of Family Visitation on Feeding Assistance Quality in Nursing Homes

The purpose of this study was to determine: (a) the frequency of family visitation during mealtime and (b) whether the presence of family during meals had an impact on the quality of feeding assistance care and resident intake. Participants included 74 nursing home residents from two Veterans Affairs (VA) and four community facilities in one geographic region. Mealtime periods in which family was present were compared with mealtime periods when family was not present for the same resident. Results showed that family visitation was infrequent during mealtime; however, feeding assistance time was significantly higher when visitors were present. Despite the increase in assistance time, there was not a significant difference in intake. Strategies that encourage the involvement of family in mealtime assistance may have additional benefits not directly associated with meal consumption, including providing family members with meaningful activity during a visit and enhancing residents’ quality of life and well-being.

The Quality of Feeding Assistance Care Practices for Long-Term Care Veterans: Implications for Quality Improvement Efforts

The primary purpose of this study was to determine the quality of feeding assistance care and identify areas in need of improvement for a sample of long-term care veterans. A secondary purpose was to compare these findings with the results of previous studies in community facilities to determine ways in which the VA sample might differ. A repeated measures observational study was conducted in two VA facilities with 200 long-stay residents. Research staff conducted standardized observations during and between meals for 3 months. There was a trend for better feeding assistance care quality during meals in the VA sample, but there were still multiple aspects of care in need of improvement both during and between meals. Higher licensed nurse staffing levels in the VA should enable effective supervision and management, but observation-based measures of care quality are necessary for accurate information about daily feeding assistance care provision.

The value of resident choice during daily care: do staff and families differ?

Allowing long-term care (LTC) residents to make choices about their daily life activities is a central tenet of resident-centered care. This study examined whether staff and family rated care episodes involving choice differently from care episodes not involving choice. Seventeen nurse aide and 15 family participants were shown paired video vignettes of care interactions. Participants were asked to rate their preferred care vignette using a standardized forced-choice questionnaire. Focus groups were held separately for staff and family members following this rating task to determine reasons for their preferences. Both staff and family rated the vignettes depicting choice as “strongly” preferred to the vignettes without choice. Reasons provided for the preference ratings during the focus group discussions related to resident well-being, sense of control, and respondents’ own personal values. These findings have implications for LTC staff training related to resident-centered care to promote choice.

“It Was Very Rewarding for Me …”: Senior Volunteers’ Experiences With Implementing a Reminiscence and Creative Activity Intervention

PURPOSE OF THE STUDY To describe the experience of recruiting, training, and retaining retired senior volunteers (RSVs) as interventionists delivering a successful reminiscence and creative activity intervention to community-dwelling palliative care patients and their caregivers. DESIGN AND METHODS A community-based participatory research framework involved Senior Corps RSV programs. Recruitment meetings and feedback groups yielded interested volunteers, who were trained in a 4-hr session using role plays and real-time feedback. Qualitative descriptive analysis identified themes arising from: (a) recruitment/feedback groups with potential RSV interventionists; and (b) individual interviews with RSVs who delivered the intervention. RESULTS Themes identified within recruitment/feedback groups include questions about intervention process, concerns about patient health, positive perceptions of the intervention, and potential characteristics of successful interventionists. Twelve RSVs achieved 89.8% performance criterion in treatment delivery. Six volunteers worked with at least one family and 100% chose to work with additional families. Salient themes identified from exit interviews included positive and negative aspects of the experience, process recommendations, reactions to the Interventionist Manual, feelings arising during work with patient/caregiver participants, and personal reflections. Volunteers reported a strong desire to recommend the intervention to others as a meaningful volunteer opportunity. IMPLICATIONS RSVs reported having a positive impact on palliative care dyads and experiencing personal benefit via increased meaning in life. Two issues require further research attention: (a) further translation of this cost-effective mode of treatment delivery for palliative dyads and (b) further characterization of successful RSVs and the long-term impact on their own physical, cognitive, and emotional functioning.