Joan K. Monin

Measuring the Experience and Perception of Suffering

PURPOSE assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals. DESIGN AND METHODS scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimers disease (AD) and their family caregivers (N = 105 dyads), married couples in whom 1 partner had osteoarthritis (N = 53 dyads), and African American and Hispanic caregivers of care recipients with AD (N = 121). Care recipients rated their own suffering, whereas caregivers provided ratings of perceived suffering of their respective care recipients. In addition, quality of life, health, and functional status data were collected from all respondents via structured in-person interviews. RESULTS three scales showed high levels of internal consistency, test-retest reliability, and convergent and discriminant validity. The scales were able to discriminate differences in suffering as a function of type of disease, demonstrated high intra-person correlations and moderately high inter-person correlations and exhibited predicted patterns of association between each type of suffering and indicators of quality of life, health status, and caregiver outcomes of depression and burden. IMPLICATIONS suffering is an important but understudied domain. This article provides valuable tools for assessing the experience and perception of suffering in humans.

Predictors and consequences of perceived lack of choice in becoming an informal caregiver

Objectives: Using data from a national sample of informal caregivers to older adults, we identify predictors of lack of choice and the consequences of lack of choice in taking on the caregiving role. Methods: A national telephone survey with 1397 caregivers was carried out to assess whether respondents had a choice in taking on the caregiving role, their demographic characteristics, the nature and duration of their caregiving experience, and its impact on their physical and psychological well-being. We compare caregivers who felt they had no choice in taking on the caregiving role to those who did. Results: In total, 44% of caregivers reported a lack of choice in taking on the caregiving role. Highly educated, older caregivers caring for a younger care recipient with emotional or behavioral problems were most likely to report that they had no choice in taking on the caregiving role. Lack of choice is associated with higher levels of emotional stress, physical strain, and negative health impacts, after controlling for multiple confounds including level of care provided, relationship type, primary health condition of the care recipient, and demographic characteristics. Conclusion: Lack of choice is an independent risk factor for the negative effects of caregiving, and clinicians should be vigilant to lack of choice as a marker of caregiver distress.

Increasing Negativity of Age Stereotypes across 200 Years: Evidence from a Database of 400 Million Words

Scholars argue about whether age stereotypes (beliefs about old people) are becoming more negative or positive over time. No previous study has systematically tested the trend of age stereotypes over more than 20 years, due to lack of suitable data. Our aim was to fill this gap by investigating whether age stereotypes have changed over the last two centuries and, if so, what may be associated with this change. We hypothesized that age stereotypes have increased in negativity due, in part, to the increasing medicalization of aging. This study applied computational linguistics to the recently compiled Corpus of Historical American English (COHA), a database of 400 million words that includes a range of printed sources from 1810 to 2009. After generating a comprehensive list of synonyms for the term elderly for these years from two historical thesauri, we identified 100 collocates (words that co-occurred most frequently with these synonyms) for each of the 20 decades. Inclusion criteria for the collocates were: (1) appeared within four words of the elderly synonym, (2) referred to an old person, and (3) had a stronger association with the elderly synonym than other words appearing in the database for that decade. This yielded 13,100 collocates that were rated for negativity and medicalization. We found that age stereotypes have become more negative in a linear way over 200 years. In 1880, age stereotypes switched from being positive to being negative. In addition, support was found for two potential explanations. Medicalization of aging and the growing proportion of the population over the age of 65 were both significantly associated with the increase in negative age stereotypes. The upward trajectory of age-stereotype negativity makes a case for remedial action on a societal level.

Responding to Partners’ Expression of Anger: The Role of Communal Motivation:

The effects of communal motivation on reactions to relationship partners’ expressed anger were examined. In Study 1, married couples reported on the communal strength of their marriage, their expressions of anger to their spouse, and relationship satisfaction. In Study 2, college students reported on the communal strength of their best friendships, those friends’ expressions of anger, and their evaluations of and provision of support to those friends. In Study 3, communal motivation toward a stranger who expressed mild anger was manipulated and evaluation of that stranger was measured. In all three studies, low communal motivation was associated with more negative evaluations of angry partners, lower relationship satisfaction, and, in Study 2, lower support provision. In contrast, when communal motivation was high, these decreases either did not occur (Studies 1 and 3) or were diminished (Study 2), and in Study 2, partners’ anger was associated with increased provision of social support.

Caregiving spouses’ attachment orientations and the physical and psychological health of individuals with Alzheimer's disease

Objective: Attachment theory is a useful framework for understanding how caregiving dyads regulate emotions and maintain feelings of security in reaction to a loved ones chronic illness. In this study we examined the extent to which the attachment orientations (anxiety and avoidance) of persons with Alzheimers disease (AD) and their spousal caregivers were associated with each partners report of the physical and psychological health symptoms of the person with AD. Method: Fifty-eight individuals with AD and their spousal caregivers each completed a 12-item self-report measure of trait attachment orientation and rated the physical and psychological health symptoms of the person with AD over the past two weeks. Data from the persons with AD were used after determining that they were able to provide reliable responses. Results: As predicted, individuals with AD who were high in anxious attachment self-reported more physical and psychological symptoms, particularly when their caregivers were high in anxious attachment. Also, caregivers perceived more physical symptoms in individuals with AD who were high in avoidant attachment. Conclusion: This study highlights the importance of considering the attachment security of both caregivers and persons with AD when considering how each partner views the psychological and physical health symptoms of the person with AD. Our results have implications for providing care-recipients and caregivers with improved, tailored care.

Spousal Associations Between Frailty and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study

To determine whether older adult spouses’ frailty states and depressive symptoms are interrelated over time.

Demonstration of facial communication of emotion through telehospice videophone contact.

PURPOSE The purpose of this study was to demonstrate the range of emotional expressions that can be displayed by nurse and family caregiver during a telehospice videophone consultation. We hypothesized that a nurse providing telehospice care via videophone would gain access to rich nonverbal emotional signals from the caregiver and communicate her own social presence to the caregiver, to potentially enhance the building of empathy between nurse and caregiver. METHODOLOGY Videorecording of a case exemplar of videophone contact was obtained using the Beamer, a commercially available product that allows display of both caller and receiver on an available television through standard telephone lines. Nonverbal communication through facial expressions of emotion was quantified using detailed coding of facial movement and expression (facial action coding system). RESULTS In this study, we demonstrated the presence of visual nonverbal information in the form of facial expressions of emotion during a videophone interaction between nurse and family caregiver. Over the course of a typical after-hours telehospice call, a variety of facial expressions of emotion were displayed by both nurse and family caregiver. Expression of positive and negative emotions, as well as mixed emotions, was apparent. Through detailed analysis of this case of videophone interaction, we have demonstrated the potential value of videophone contact for providing access to visual nonverbal emotional communication.

Linguistic Markers of Emotion Regulation and Cardiovascular Reactivity Among Older Caregiving Spouses

This study examined linguistic markers of emotion regulation and cardiovascular stress reactivity in spousal caregivers. Fifty-three individuals were audiotaped while they privately disclosed an instance of partner suffering and a typical partner interaction (i.e., a meal together). Systolic blood pressure, diastolic blood pressure, and heart rate (HR) were measured. Linguistic analysis determined emotion and cognitive processing word use. Results revealed that using more positive emotion words was associated with lower HR reactivity in each verbal account. Caregivers who used fewer cognitive processing words (e.g., think, realize, because) overall had the highest HR reactivity to talking about the partners suffering. These findings have implications for interventions for all caregivers as well as distinguishing more resilient caregivers from those who may be at a higher risk for caregiver burden.

Husbands’ and Wives’ Physical Activity and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study

BackgroundWhen examining older adults’ health behaviors and psychological health, it is important to consider the social context.PurposeThe purpose of this study was to examine in older adult marriages whether each spouse’s physical activity predicted changes in their own (actor effects) and their partner’s (partner effects) depressive symptoms. Gender differences were also examined.MethodEach spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989–1990), wave 3 (1992–1993), and wave 7 (1996–1997). Dyadic path analyses were performed.ResultsHusbands’ physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse’s depressive symptoms (partner effects). However, husbands’ physical activity and depressive symptoms predicted wives’ physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity.ConclusionFindings suggest that husbands’ physical activity is particularly influential for older married couples’ psychological health.

Age Differences in the Association of Social Support and Mental Health in Male U.S. Veterans: Results From the National Health and Resilience in Veterans Study.

OBJECTIVE To examine the associations between multiple aspects of social support-perceived support, structural support, and community integration-and mental health difficulties in younger and older male veterans. Drawing from Socioemotional Selectivity Theory (SST), we hypothesized that greater support would be more strongly negatively related to mental health difficulties in older than younger veterans. DESIGN Cross-sectional Web survey of younger and older male veterans recruited from a contemporary, nationally representative sample of veterans residing in the United States. SETTING Data were drawn from the National Health and Resilience in Veterans Study. PARTICIPANTS Participants were 290 younger male veterans (mean age: 37.0 years, SD: 6.9, range: 21-46) and 326 older male veterans (mean age: 81.7 years, SD: 3.2, range: 78-96). MEASUREMENTS Participants completed measures of sociodemographic and military characteristics, perceived and structural social support, community integration, and mental health difficulties. RESULTS In contrast to SST, higher perceived support was associated with fewer mental health difficulties in younger but not older veterans. In line with SST, community integration was associated with fewer mental health difficulties in older but not younger veterans. Structural support was not associated with mental health difficulties in either group. CONCLUSION Results of this study provide mixed support for SST and suggest that different aspects of social support may help promote the mental health of younger and older male U.S. veterans. Promotion of community engagement may help promote mental health in older veterans, whereas promotion of functional social support may help promote mental health in younger veterans.