Jessica M. McIlvane

Perceptions of Illness, Coping, and Well-being in Persons With Mild Cognitive Impairment and Their Care Partners

Despite greater attention to mild cognitive impairment (MCI), little is known about reactions to this potentially threatening diagnosis among persons with MCI (PWMCI) and their care partners. Psychologic reactions, perceptions of illness, and coping responses of 46 individuals recently diagnosed with MCI and 29 care partners were assessed with questionnaires assessing psychologic well-being, illness perceptions, coping, and perceived needs for services. Care partners and PWMCI report normal levels of psychologic well-being, showing less distress than is commonly found in Alzheimer disease (AD) caregivers. Problem-focused (eg, active coping) and emotion-focused coping strategies (eg, acceptance) were used more often than dysfunctional coping strategies (eg, self-distraction) by PWMCI and care partners. Both groups tended to minimize the likelihood of conversion to AD, and endorsed mental and physical exercise, optimism, dietary changes, and stress reduction as strategies to prevent conversion. Although PWMCI minimized their impairment, care partners reported providing an average of 24 hours per week of caregiving and reported that the PWMCI did need significant help with complex activities. Respondents reported using few formal services but they anticipate substantial future need for services. Results suggest that PWMCI and care partners are likely to minimize the threat of AD and to perceive that conversion is controllable and preventable with health promotion activities. Study implications for the development of intervention programs for PWMCI and their care partners are discussed.

Social relations and depressive symptomatology: Self-efficacy as a mediator

This study investigates general and social self-efficacy as possible mediators of the relationship between quantity and quality of social relations and depressive symptomatology. Mediation models were examined using a regionally representative sample of middle-aged (35–59) and older adults (60+). Hierarchical regression analyses, controlling for age, race, sex, education, health, and family composition, revealed partial mediation for several social relations predictor variables. Whereas general self-efficacy acted as a partial mediator for only middle-aged adults, social self-efficacy was a partial mediator between social relations and depressive symptomatology only among older adults. Findings suggest that self-efficacy may function as a mechanism through which social relations influence depressive symptoms, and that the importance of this mechanism as domain-specific or domain-general may vary with age.

The Impact of Obesity and Arthritis on Active Life Expectancy in Older Americans

This article examines the relationship of obesity and arthritis to length of life and length of disabled life in older American men and women. Secondary data analysis is conducted on three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (n = 7,381). Using integrated Markov chains, total, active, and disabled life expectancy in Americans aged ≥70 is estimated, with and without obesity and arthritis. Results indicate that neither obesity nor arthritis is related to the length of life for older men and women, alone or in combination. However, both conditions are significantly individually associated with increased length of disabled life in older men (1.4 years attributable to obesity; 1.2 years to arthritis at age 70; P < 0.05) and women (1.7 years attributable to obesity; 2.1 years to arthritis at age 70; P < 0.05). In addition, the combination of the two is significantly related to decreased active life, with nearly 50 and 60% of remaining life for 70‐year‐old men and women lived with disability, respectively (P < 0.05). Coupled with the fact that both obesity and arthritis are growing in prevalence, these findings represent one of the few clearly negative health trends in older adults today. These results should provide incentives for health‐care professionals to make concerted efforts to address both conditions in clinical settings.

Disentangling the effects of race and SES on arthritis-related symptoms, coping, and well-being in African American and White women.

This study examined both unique and interactive effects of race and socioeconomic status (SES) on arthritis-related symptoms, coping, and well-being in African American and White women. Participants included 77 African American and 98 White women, aged 45 to 90, who completed structured, face-to-face interviews. A series of 2 × 2 MANCOVAs examined race (African American, White) and SES (high/low education or high/low occupational status) differences in arthritis-related symptoms, coping, and well-being. African Americans used more religious coping, wishful-thinking, seeking social support, and emotional expression than Whites. Individuals with low SES reported worse arthritis-related symptoms, poorer well-being, and greater use of coping strategies that tend to be maladaptive. Race × SES interactions revealed higher depressive symptoms in African Americans with low versus high education and coping differences in African Americans with low versus high occupational status; however differences in depressive symptoms and coping based on SES were not evident for Whites. Results demonstrate unique and interactive race and SES differences for arthritis-related symptoms, coping, and well-being showing the complexity of race and SES in the realm of physical and mental health.

Are behavioral interventions for arthritis effective with minorities? Addressing racial and ethnic diversity in disability and rehabilitation.

OBJECTIVE To determine whether research evaluating the effectiveness of behavioral interventions for arthritis demonstrates that these interventions are effective with, and appropriately utilized by, minority participants. METHODS A systematic review was conducted of arthritis intervention research from 1997 to 2008. For each article, information was gathered on the percentage of participants who were from different racial/ethnic groups, whether interventions were shown to be effective for minority participants, whether differential attrition analyses were conducted, whether efforts were reported in minority recruitment and retention, and whether attempts were made to make interventions culturally appropriate. RESULTS We identified 25 randomized intervention studies. Of these, only 2 reported on whether the intervention was similarly effective for white and black patients (equal effectiveness was found), and 6 studies reported examining differences in attrition by race (higher attrition in nonwhites was found in 1 study). Most studies did not report the percentage of participants from specific minority groups, and in many studies the percentage of minority participants was small. No studies reported making systematic efforts to assure that interventions were culturally appropriate for minority participants. CONCLUSION Minority patients with arthritis are at risk for higher levels of disability than white patients, but little is known about whether evidence-based interventions for arthritis are effective for culturally diverse patients. In addition, minority patients appear to be underrepresented in intervention research, and too little attention has been paid to minority recruitment and assuring that interventions are culturally appropriate for diverse patients.

Preferences for arthritis interventions: identifying similarities and differences among African Americans and whites with osteoarthritis.

To determine if there are differences or similarities in arthritis intervention preferences and barriers to participation between African Americans and whites with osteoarthritis (OA).

Explaining the Relationship between Pain and Depressive Symptoms in African-American and White Women with Arthritis

Arthritis is a common chronic illness that disproportionately affects women and African Americans and is often associated with depression. The mechanisms through which arthritis-related pain are associated with depression remain unclear. This study examined the relationship between arthritis-related pain and depressive symptoms to determine if functional impairment and sense of mastery mediated this relationship. Participants included 77 African-American and 98 white women with arthritis (aged 45-90) who completed structured questionnaires assessing pain, functional impairment, sense of mastery and depressive symptoms. Regression analyses showed that sense of mastery and functional impairment partially mediated the relationship between pain and depressive symptoms for whites such that the previously significant pain-depression relationship (beta = 0.40, p < 0.001) was no longer significant (beta = 0.05, p = 0.62). Only sense of mastery partially mediated between pain and depressive symptoms for African Americans. Again, the previously significant pain-depression relationship (beta = 0.32, p < 0.01) was reduced (beta = 0.16, p = 0.19). Implications of the study suggest that it is important for service providers and healthcare professionals to be aware of different lifetime experiences and perceptions of illness in order to better serve the needs of women from different race groups.

Older Adults Are Less Likely to Identify Depression Without Sadness

Many older adults do not identify depression or the need for professional treatment. Late-life depression frequently occurs without dysphoria (i.e., depressed mood or sadness); in such cases, older adults may have particular difficulty identifying depression, leading to poor health outcomes. The aims were to examine the hypotheses that older adults would be more likely to identify depression and need for professional help in a vignette of a depressed older adult with sadness versus without sadness. In a randomized experiment, 244 community-dwelling older adults (60+) read one of two vignettes and answered questions about their perceptions of the problem, solutions, and their own background. Less than half (40.98%) identified the person as depressed (sad vignette: 48.33%; vignette without sadness: 33.87%). Participants were more likely to identify depression if they had personal mental health experience, more positive expectations regarding aging, and read the sad vignette. They were more likely to recommend professional help if they identified depression. Older adults’ identification of depression and need for professional help remain low, particularly in the absence of dysphoria.

Impact of race and diagnostic label on older adults' emotions, illness beliefs, and willingness to help a family member with osteoarthritis.

Objective: To examine how race and the diagnostic label of Osteoarthritis (OA) affects older adults’ emotions, illness beliefs, and willingness to help a family member. Methods: African American and White older adults were randomly assigned to read vignettes describing a sister suffering from chronic pain and disability, either with or without the OA label. Race × diagnostic label ANOVAs were conducted. Results: Compared to Whites, African Americans were more optimistic that OA could improve with health care, and showed greater willingness to help their sister. The OA label had little impact on emotions, beliefs, or willingness to help. African Americans rated the sister as having more control of their problem than Whites without the OA label, but providing the diagnosis eliminated this difference. Discussion: The diagnostic label of OA had little effect on these older adults, but racial differences indicate that cultural values regarding family caregiving are important in arthritis care.