Heather M. Young

Predictors of Burden in Spouse Caregivers of Individuals With Alzheimer's Disease

This study used the following model of distress: Distress = [Exposure to Stress + Vulnerability]/[Psychological and Social Resources]. The constructs in the model were operationalized as (a) distress in response to caregiver experiences (burden); (b) exposure to stress (care recipient functional impairment in activities of daily living [ADLs]); (c) vulnerability (caregiver health problems, anger, and anxiety); and (d) resources (coping, outlook on life, and social supports). Long-term burden (15-18 months after entry) was predicted by several baseline variables: burden, care recipient ADLs, vulnerability and resource variables, and specific interactions of burden, ADLs, vulnerability, and resource variables. The interactions showed that caregivers with high vulnerability and low resources had higher burden scores than caregivers with other combinations of these variables.

Is Caregiving a Risk Factor for Illness

This article focuses on the physical health of persons who provide care to family members and friends with dementia. Such caregivers are under extended chronic stress because of the particular demands that this illness places on them. Caregiver research has made important contributions in two areas of health psychology. First, this research has increased understanding of the impact of chronic illness in families. Second, it has explored the complex relationships between stress and human responses (psychological and physiological) in the context of aging, using caregiving as a prototypic chronic stressor. This article discusses the relationship between distress, health habits, physiological changes, and, ultimately, health risks. There is evidence for greater health risks in caregivers than in noncaregivers. In addition, vulnerabilities and resources influence the relationship between caregiver stressors and health. One of the greatest methodological challenges of research on caregiver health is that the studies occur under natural conditions, so that it is not possible to randomly assign people to be caregivers and then observe changes in their health. Careful designs are required to infer the reasons for health risks.

Psychosocial factors associated with cardiovascular reactivity in older adults

&NA; This study examined associations of psychosocial factors with cardiovascular reactivity in two groups of men and women—spouse caregivers of individuals with Alzheimers disease (M age = 69.4 N = 82) and controls (M age = 68.5, N = 78) group‐matched for age and gender. Cardiovascular responses to an emotional task (speech sample about ones spouse) yielded higher systolic and diastolic blood pressures (SBP, DBP) than a spoken cognitive task, which in turn yielded higher BPs and heart rate (HR) than the baseline rest period. HR was greater in response to the two tasks than in response to the baseline period, but it did not differ across tasks. Regression models of SBP, DBP, and HR reactivity in response to the two tasks demonstrated that after controlling for hypertension and gender, combinations of hostility, anger expression, avoidance coping, Type A behavior and Expressed Emotion (criticism) explained more reactivity in response to the emotional (8–12%) than the cognitive task (4–7%). Caregivers were more reactive than controls only if they were hypertensive. Psychosocial factors may be as important in explaining reactivity in older adults as in younger adults.

Psychophysiological Mediators of Caregiver Stress and Differential Cognitive Decline

The authors examined relationships between chronic stress and cognitive decline and whether such relationships were mediated by psychophysiological factors. Ninety-six caregivers of spouses with Alzheimers disease (AD) were compared with 95 similar noncaregiver spouses. All were free of diabetes. Although the groups started similarly, over 2 years caregivers declined by a small but significant amount (1 raw score point and 4 percentile points, each p<.05) on Shipley Vocabulary. In contrast, noncaregivers did not change. Higher hostile attribution (beta=-.09; p<.05) and metabolic risk (beta=-.10; p<.05) in caregivers mediated the cognitive decline. This is the first study of cognitive decline and mediators in caregivers. This work has implications for caregiver and care-recipient health and for research on cognition, psychophysiology, diabetes, and AD.

Predicting breast self-examination using the theory of reasoned action.

The personal and normative influences on breast self-examination (BSE) behavior in older women were examined using the Theory of Reasoned Action. The sample consists of 93 volunteers ranging in age from 52 to 90 years. A structured questionnaire was used for data collection. Direct and indirect measures of attitude and social norm were used to predict intention to perform BSE and BSE frequency. Contrary to the model assumptions, indirect measures accounted for more variance in both intention and behavior, and explained actual behavior better than intention to perform. Both the indirect and direct measures of attitude and social norm explained a significant amount of the variance in intention and BSE frequency. There were significant differences on all the model components (direct and indirect measures of attitude, social norm, and intention) between frequent and infrequent BSE performance groups. Discriminant analysis using the indirect measures of attitude and social norm correctly classified 76% of the women into frequent and infrequent performance groups.

Depressed Mood Mediates Decline in Cognitive Processing Speed in Caregivers

PURPOSE Very few studies have examined cognitive decline in caregivers versus noncaregivers, and only 1 study has examined mediators of such decline. We evaluated the relationship between caregiver status and decline on the digit symbol test (DST; a measure of processing speed, attention, cognitive-motor translation, and visual scanning) and whether this relationship was mediated by depressed mood. DESIGN AND METHODS Caregivers for spouses with Alzheimers disease (n = 122) were compared with demographically similar noncaregiver spouses (n = 117) at study entry (Time 1 = T1), T2 (1 year later), and T3 (2 years after T1). RESULTS Caregivers had lower DST scores and higher Hamilton depression scores at T1, T2, and T3 than noncaregivers (all p < .05). Hierarchical linear modeling revealed that although caregivers started well below noncaregivers, they experienced a more rapid rate of decline than noncaregivers (p = .047). Caregivers declined 4.5 times faster than noncaregivers. Greater depressed mood at T1 (p < .01) and T2 (p < .01) predicted DST decline and mediated DST decline in caregivers vs. noncaregivers. IMPLICATIONS Depressed mood in caregivers relative to noncaregivers may influence their greater risk for DST decline. This is important because the DST predicts problem solving and everyday functions necessary for independent living and the potential well-being of their care recipients.

Types, prevalence, and potential clinical significance of medication administration errors in assisted living.

OBJECTIVES: To describe the types and potential clinical significance of medication administration errors in assisted living (AL).

Moving to congregate housing: The last chosen home

Abstract The purpose of this study was to explore the experience of moving to congregate housing among a group of older adults. Theoretical sampling yielded a sample of 21 new relocatees ranging in age from 72 to 96 (71% female). Using grounded theory, the process of moving was described and included four phases: deciding to move, preparing to move, making the move, and settling in. The move to congregate housing was characterized as the last chosen move and occurred in response to an acknowledgment of personal vulnerability. Feeling at home, or successful relocation, was associated with involvement in the process of moving and achievement of a good fit with the new environment.

Personalized Telehealth in the Future: A Global Research Agenda

As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.

Attitudes Toward Use of Nursing Homes and Home Care in Older Japanese-Americans

OBJECTIVE: A cohort of 1142 older Japanese Americans was identified to study preferences and attitudes regarding use of long‐term care (nursing home or home care).