Gillian H. Ice

Measuring Stress in Humans: A Practical Guide for the Field

Foreword Part I. General Principles: 1. Conducting a field study of stress: general principles Gary D. James and Gillian H. Ice Part II. Measuring Stress Responses: 2. Cultural fimensions of the dtress process: measurement issues in fieldwork William Dressler 3. Measuring the emotional and behavioral response to stressors Gillian H. Ice 4. Measuring hormonal variation in the sympathetic adrenal medullary system: catecholamines Daniel Brown 5. Measuring hormonal variation in the hypothalamic pituitary adrenal axis (HPA): cortisol Tessa Pollard and Gillian H. Ice 6. Measuring physiological changes in the cardiovascular system: ambulatory blood pressure Gary D James 7. Measuring immunological markers Thomas W. McDade Part III. Practical Issues in Studying Stress: 8. Special populations Sharon R. Williams 9. Study design and data analysis Gary D. James and Gillian H. Ice 10. Ethics in human subjects research Gary D. James and Gillian H. Ice 11. Epilogue: summary and future directions Gary D. James and Gillian H. Ice.

Stress associated with caregiving: An examination of the stress process model among Kenyan Luo elders

Globally, a growing number of grandparents are caring for their grandchildren. The impact and burden associated with increases in custodial grandparenting, however, may differ by culture. In the United States, the caregiving role has been shown to be a significant source of stress for older adults. In cultures in which grandparents are more commonly involved in the care of young children, however, increasing caregiving roles may not be viewed as stressful. This study examines the impact of caregiving on perceived and physiological measures of stress among 640 Luo elders (60+) in western Kenya, where high HIV prevalence among younger-to-middle aged adults has led to a heavy burden of orphan care. Perceived stress levels were measured using the Luo Perceived Stress Scale (LPSS). Salivary cortisol and casual blood pressure were used as biomarkers of stress. Results were analyzed using random mixed effects models. Overall this study showed that caregivers have higher levels of perceived stress than non-caregivers. For women, household composition, including the number of orphans and adults in the homestead impacted perceived stress. Among men, those who perceived caregiving as burdensome had higher perceived stress. Despite the association between caregiving and perceived stress, there was a minimal relationship between caregiving and the two biomarkers of stress. This may be because caregiving is superimposed onto other stressors and therefore has a minimal physiological impact. These results highlight the importance of local context in determining the impact of the caregiving role on older adult well-being.

Health and Health Perceptions Among Kenyan Grandparents

The dramatic increase in the aging population in developed countries has led to an explosion of research on health and aging in the United States. Few studies, however, have been conducted in developing countries, even though many of these populations are experiencing a faster rate of growth in the 65+ population. Thus, although our knowledge of health and aging has increased, our knowledge of the variation in health as people age is limited. While the numbers of older adults is increasing in Africa, very little is known about the health and well-being of African elders. Recently, a growing number of researchers have focused on the plight of elders who find themselves caring for orphaned grandchildren. While several anecdotal reports have suggested that this new burden negatively impacts their health, there are few studies that systematically examine the health of African elders. As part of the Kenyan Grandparents Study, the health of 287 grandparents (age 73 ± 8) was examined using multiple methods including objective measures, clinical history, physical examination, and a modified version of the SF-36. Although all health variables were correlated with each other, different patterns were found between predictor variables and the various measures of health. Caregiving status was only associated with mental health, with caregivers having better mental health than non-caregivers. Age was associated with poorer health as measured by several SF-36 scales, physical exam, and body mass index (BMI). Women generally had a greater number of health complaints and lower quality of life as measured by the SF-36. Higher socioeconomic status was associated with better health as measured by physical exam, clinical history, SF-36, and BMI. Caring for a greater number of orphans was associated with better health on examination but no other measure of health. More social support was associated with better physical function and general health as measured by the SF-36. These data suggest that there is no strong evidence that caregiving results in poor health.

Does being an orphan decrease the nutritional status of Luo children

The HIV/AIDS pandemic is creating a generation of orphaned children in Africa. The number of orphans will continue to increase long after the HIV/AIDS crisis has peaked; therefore, it is important to determine how best to assist these children. Current studies investigating the impact of orphanhood have conflicting results and conclusions. Several studies report that orphans are at a disadvantage and are more likely to suffer from malnutrition, whereas other studies report no difference between the nutritional status of orphans and nonorphans. Four hundred eleven Luo children (mean age 9 ± 1 years) were recruited to participate in a study investigating the impact of orphanhood on nutritional status. Participants underwent an interview, anthropometric measurements, testing for anemia, a clinical history, and a physical exam. Anthropometric variables and hemoglobin level were compared across groups using a t‐test. The reference population used for comparison of anthropometric variables is the 2000 CDC growth reference data. All analyses were gender specific, and the effect of length of orphanhood was also investigated. The data presented here suggest that there is no significant difference between the nutritional status of orphaned and nonorphaned Luo children. This study supports research indicating there is little, if any, difference in nutritional indicators between orphans and nonorphans. Orphans may live in households with higher socioeconomic statuses than nonorphans. Luo orphans may not be at higher risk for poor nutritional status than nonorphans; therefore, interventions targeted at this age group should include both orphaned and nonorphaned children. Am. J. Hum. Biol., 2009.

Caregiving and cardiovascular disease risk factors in male and female Luo elders from Kenya

Background: The HIV/AIDS pandemic has created over 11 million orphans, who are primarily being cared for by grandparents. It has been suggested that this renewed parenting responsibility presents elders with added stressors. Few studies have systematically examined the impact of caregiving on health outcomes. Aim: The aim of this study was to examine the impact of caregiving on cardiovascular risk. It was hypothesized that caregiving would increase cardiovascular disease risk as measured by Framingham risk scores. Subjects and method: 386 Luo elders (age = 73±8), divided into caregiving and non-caregiving groups, were recruited from the Nyanza Province, Kenya. Data were obtained from the participants including: Total cholesterol, HDL cholesterol, glucose, blood pressure, age, sex and smoking status. Results: No significant difference was found between the Framingham risk scores of caregivers and non-caregivers. Among women increased BMI was positively associated with Framingham score (p=0.017), and among men increased waist circumference was positively associated with the score (p<0.001). Among women, the number of orphans under ones care lowered the risk of falling into the top quartile of the Framingham score while being a caregiver increased the risk of falling into the top quartile. Conclusion: This study demonstrates that there is not a simple relationship between caregiving and cardiovascular risk.

Gerontology Education and Research in Kenya Establishing a U.S.-African Partnership in Aging

Abstract This article reprises four presentations on “Gerontology Education in Kenya,” a seminar at the 2004 Annual Meeting ofthe Association of Gerontology in Higher Education. It describes the process by which the Gerontology Institute of Georgia State University established a 3-year gerontology education and research partnership with Kenyatta University in Nairobi, Kenya, and the field experiences of two scholars who have conducted aging research in Kenya. We provide four key elements of cultural competence and recommendations for American gerontologists wishing to establish international linkages.

Diurnal blood pressure patterns in long-term care settings.

BackgroundSome research suggests that individuals whose blood pressure does not decline at night may be at increased risk of end-organ damage. Few studies have examined ambulatory blood pressure among elders, particularly those living in institutions. This study therefore evaluates ambulatory blood pressure variation in two groups of institutionalized elderly, independent living and nursing home residents. It was suggested that the nursing home sample would have a higher rate of non-dipping than the independent-living residents. Design and methodsTwenty-seven residents (aged 87 ± 8 years) of a nursing home facility and 29 residents (aged 80 ± 6 years) from two independent living facilities wore ambulatory monitors for approximately 24 h. Several definitions of dipping were examined. ResultsNeither mean daytime nor mean night-time systolic blood pressure differed between the two groups. Daytime diastolic blood pressure was significantly higher in the independent living sample, as was night-time diastolic pressure in the nursing home residents. Neither asleep nor awake blood pressure varied significantly between groups. The decline in night-time blood pressure and sleep blood pressure was significantly greater among the independent living residents (P  < 0.05). Ratios of night-time/daytime and asleep/awake blood pressure were significantly higher in the nursing home group. Non-dippers were significantly more frequent among the nursing home residents. ConclusionsNursing home residents were significantly more likely to be non-dippers. Both groups of resident were more frequently non-dippers than were individuals in community-dwelling samples. The high prevalence of non-dipping among institutionalized elderly people may be a result of age, health status or institutional activity patterns.

Non-therapist identification of falling hazards in older adult homes using digital photography

Evaluation and removal of home hazards is an invaluable method for preventing in-home falls and preserving independent living. Current processes for conducting home hazard assessments are impractical from a whole population standpoint given the substantial resources required for implementation. Digital photography offers an opportunity to remotely evaluate an environment for falling hazards. However, reliability of this method has only been tested under the direction of skilled therapists. Ten community dwelling adults over the age of 65 were recruited from local primary care practices between July, 2009 and February, 2010. In-home (IH) assessments were completed immediately after a photographer, blinded to the assessment form, took digital photographs (DP) of the participant home. A different non-therapist assessor then reviewed the photographs and completed a second assessment of the home. Kappa statistic was used to analyze the reliability between the two independent assessments. Home assessments completed by a non-therapist using digital photographs had a substantial agreement (Kappa = 0.61, p < 0.001) with in-home assessments completed by another non-therapist. Additionally, the DP assessments agreed with the IH assessments on the presence or absence of items 96.8% of the time. This study showed that non-therapists can reliably conduct home hazard evaluations using digital photographs.

‘If I went to my mom with that information, I’m dead’: sexual health knowledge barriers among immigrant and refugee Somali young adults in Ohio

ABSTRACT Objectives: Adequate knowledge of sexual health among young adults is a critical step in prevention of sexually transmitted diseases and maintenance of adult sexual health. Knowledge of specific barriers to accessing sexual health knowledge can help tailor approaches appropriately. The purpose of this paper was to identify sexual health knowledge barriers among Somali young adults in Ohio. Design: In-depth interviews were conducted with a convenience sample of 27 Somali young adults aged 18–25 years. Using a grounded theory approach, a semi-structured interview guide comprising open-ended questions and probes was utilized to collect data. Data were analyzed and coded using constant comparative analysis. Results: Findings revealed sexual health knowledge barriers in the following broad categories: religion, culture and stigma. Cultural and religious norms were deemed an important influence on the community norms largely impacting sexual health knowledge due to stigma and fear of judgment. Participants overcame barriers by seeking information from external sources such as doctors, Internet and peers. Conclusion: Study findings support an approach that will address sexual health barriers in the Somali immigrant young community at multiple levels: individual, interpersonal and community levels. A collaborative effort across religious, cultural and educational setting is necessary to tailor approaches that meet the needs of the priority group.

Measuring Stress in Humans: General principles

Foreword Part I. General Principles: 1. Conducting a field study of stress: general principles Gary D. James and Gillian H. Ice Part II. Measuring Stress Responses: 2. Cultural fimensions of the dtress process: measurement issues in fieldwork William Dressler 3. Measuring the emotional and behavioral response to stressors Gillian H. Ice 4. Measuring hormonal variation in the sympathetic adrenal medullary system: catecholamines Daniel Brown 5. Measuring hormonal variation in the hypothalamic pituitary adrenal axis (HPA): cortisol Tessa Pollard and Gillian H. Ice 6. Measuring physiological changes in the cardiovascular system: ambulatory blood pressure Gary D James 7. Measuring immunological markers Thomas W. McDade Part III. Practical Issues in Studying Stress: 8. Special populations Sharon R. Williams 9. Study design and data analysis Gary D. James and Gillian H. Ice 10. Ethics in human subjects research Gary D. James and Gillian H. Ice 11. Epilogue: summary and future directions Gary D. James and Gillian H. Ice.