Judith J. McCann

Elder abuse and mortality: the role of psychological and social wellbeing.

Background: Elder abuse is a pervasive human right and public health issue. Objectives: We aimed to examine the mortality associated with elder abuse across levels of psychological and social factors. Methods: The Chicago Health and Aging Project (CHAP) is a prospective population-based cohort study that began in 1993. A subset of these participants enrolled between 1993 and 2005 had elder abuse reported to social services agencies (n = 113). Mortality was ascertained during follow-up and with the National Death Index. Psychosocial factors (depression, social network and social engagement) were assessed during the CHAP interview. Cox proportional hazard models were used to assess the mortality of elder abuse across levels of psychosocial factors using time-varying covariate analyses. Results: The median follow-up time for the cohort (n = 7,841) was 7.6 years (interquartile range 3.8–12.4 years). In multivariate analyses, those with highest (hazard ratio (HR) 2.60, 95% CI 1.58–4.28) and middle levels (HR 2.18, 95% CI 1.19–3.99) of depressive symptoms had an increased mortality risk associated with elder abuse. For social network, those with lowest (HR 2.50, 95% CI 1.62–3.87) and middle levels (HR 2.65, 95% CI 1.52–4.60) of social network had increased mortality risk associated with elder abuse. For social engagement, those with lowest (HR 2.32, 95% CI 1.47–3.68) and middle levels (HR 2.59, 95% CI 1.65–5.45) of social engagement had increased mortality risk associated with elder abuse. Among those with lowest levels of depressive symptoms, highest levels of social network and social engagement, there was no significant effect of reported or confirmed elder abuse on mortality risk. Conclusion: Mortality risk associated with elder abuse was most prominent among those with higher levels of depressive symptoms and lower levels of social network and social engagement.

Predictors of beginning and ending caregiving during a 3-year period in a biracial community population of older adults

OBJECTIVES We sought to identify predictors of beginning and ending caregiving. METHODS At baseline and 3-year follow-up, we interviewed 4245 community residents (61.4% Black, 38.4% White, 0.20% other) aged 65 years or older. We used logistic regression to test predictors of beginning caregiving among baseline noncaregivers and of continuing caregiving among baseline caregivers. RESULTS After control for demographic variables, physically healthier individuals were significantly more likely to become caregivers and to continue caregiving. Mental health had little influence on beginning caregiving, but declining mental heath was associated with continuing caregiving. CONCLUSIONS Maintenance of physical health and function is essential to the ability of older adults to begin and to continue caregiving. Studies that compare the health of current caregivers with that of noncaregivers may substantially underestimate the impact of caregiving on health.

Comparison of self-reported pain and the PAINAD scale in hospitalized cognitively impaired and intact older adults after hip fracture surgery.

PURPOSE The purpose of this study was a psychometric evaluation of the PAINAD to assess pain in hospitalized cognitively impaired and intact older adults admitted for surgical repair of a hip fracture. METHOD A descriptive correlational design was used. A convenience sample of older patients hospitalized for surgical repair of a hip fracture was used. Twelve of the patients had cognitive impairment and 13 were cognitively intact. All were assessed for pain using both the self-report numeric rating scale and an observational assessment tool, the PAINAD. FINDINGS A positive correlation was found between the PAINAD and a self-report pain scale, providing evidence of concurrent validity. PAINAD scores were higher when patients were likely to experience pain than when unlikely, providing evidence of discriminant validity. The results of this study provide evidence supporting the validity and reliability of the PAINAD in the pain assessment of hospitalized post-orthopaedic surgical older adults who are unable or reluctant to self-report pain.

Comparison of informal caregiving by black and white older adults in a community population

OBJECTIVES: To examine the prevalence of informal caregiving and demographic factors associated with caregiving time in older community residents and compare caregiving prevalence and time spent providing care by black and white residents.

Do Behavioral Disturbances in Persons with Alzheimer's Disease Predict Caregiver Depression over Time?

Random effects models were used to examine the association between behavioral disturbances in persons with Alzheimers disease (N = 90) and caregiver depressive symptoms at 2-month intervals over an 18-month period. There was substantial variability in trajectories of change in caregiver depressive symptoms over time but no systematic increase in distress despite increased severity of dementia symptoms. Total behavioral disturbances were associated with higher levels of caregiver depressive symptoms: this effect was primarily attributable to aggressive behaviors. No consistent departure from linearity was evident in the relationship between behavior and depression over time.

A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease.

Background: The purpose of this pilot study was to examine the effects of lifestyle physical activity in caregivers (CGs) of persons with Alzheimers disease. Methods: Fifteen CGs engaged in lifestyle physical activity during a 6-month, home-based health promotion program. Mean changes in self-reported physical activity were compared using repeated-measures analysis of variance. Results: Fifty percent of CGs increased total self-reported minutes and 42% increased total moderate minutes of physical activity from preintervention to postintervention; however, no CG engaged in vigorous physical activity and there were no significant improvements in self-reported physical activity for the total group. Hot summer weather, heavy noncaregiving responsibilities, heavy caregiving responsibilities, and feelings of anxiety, depressive symptoms, and fatigue were the most frequently identified physical activity barriers. Conclusion: Incorporating an individualized, home-based program of lifestyle physical activity appears feasible; however, attention needs to be given in the future to physical activity barriers identified by this select group of CGs.

Caregiver Psychological Adjustment and Institutionalization of Persons With Alzheimer’s Disease

This prospective study examines the relationship between caregiver psychological adjustment and institutionalization of persons with Alzheimer’s disease (AD). Method: A 3-year longitudinal study was conducted with a clinic-based cohort of 396 persons with AD and their respective family caregivers. Caregiver adjustment was sequentially measured in 3-month intervals using standard scales of appraisal (perceived burden and satisfaction) and emotion (depressive symptoms and positive affect). Results: In multivariable proportional hazards regression models predicting time to institutionalization controlling for AD severity, hazard ratios were significant for appraisal measures of caregiver adjustment, perceived burden (1.053; 95% confidence interval [CI], 1.014, 1.093), and satisfaction (.929; 95% CI, .883, .977). In contrast, levels of caregivers’ positive and negative emotion did not reliably predict institutionalization. Discussion: The findings highlight the importance of caregiver appraisals in decisions to institutionalize persons with a dementia syndrome, but the limited impact of caregiver emotion was unexpected and requires further study.

Upper and Lower Extremity Motor Performance and Functional Impairment in Alzheimer’s Disease

This report examines the relation of upper and lower extremity motor performance to functional impairment among 371 persons with probable Alzheimer’s disease (AD). Cognitive and motor performance tests were administered at 6-month intervals for up to 4 years. Motor performance was assessed using 3 lower extremity tests and 2 upper extremity tests. Functional impairment was measured at 3-month intervals using caregiver ratings of impairments in activities of daily living, mobility, and range of motion. Both lower and upper extremity performance were inversely related to functional impairments on all 3 scales (all Ps < .001), after controlling for age, sex, and level of cognitive impairment. This suggests that motor performance contributes to functional impairments in AD, independent of cognitive impairment. It is important to preserve motor performance in individuals with AD because it influences physical function throughout the course of the disease.

Racial differences in the progression of cognitive decline in Alzheimer disease.

OBJECTIVE Alzheimer disease (AD) is the leading cause of dementia in older persons, but little is known about racial differences in its clinical manifestations. The purpose of the current study was to examine the association of race with rate of cognitive decline in AD. METHODS Older persons with clinically diagnosed AD were recruited from healthcare settings. At 6-month intervals for up to 4 years, they completed a battery of nine cognitive tests from which a previously established measure of global cognition was derived. Follow-up data were available on 452 participants (27.6% African American, 68.8% women), 88.1% of those eligible. RESULTS A growth curve approach was used to estimate individual paths of change in global cognition. In a model that controlled for age and education, African Americans had a lower level of global cognition at baseline than non-African Americans, but declined at a 25% slower rate on average. In additional models, there was no indication that the association of race with cognitive decline varied by age, gender, or education. CONCLUSION The rate of cognitive decline in AD appears to be slower in African Americans than non-African Americans.

Caring for Self While Caring for Others: The Two-Track Life of Coping with Alzheimer's Disease

Relationships between depressive symptoms and altered immune function have been documented in the literature; however, the links between depressive symptoms, altered immune function, and changes in physical health are less clear. Although a number of caregiver descriptive studies have examined immunological outcomes, only one intervention study with caregivers of individuals with Alzheimers disease, known to the authors, has included immunological outcomes. The purpose of this pilot study was to assess the effectiveness of a caregiver skill-building intervention to decrease caregiver depressive symptomatology and care-receiver behavioral symptoms; and to assess the feasibility and stability of the delayed type hypersensitivity (DTH) skin test with this population. Caregiver depressive symptoms decreased, while care-receiver behaviors did not. Findings suggested that the DTH skin test could be successfully administered to caregivers of individuals with Alzheimers disease and that this skin test had short-term stability. There were no significant relationships between caregiver depressive symptoms and immune function. Study findings suggest that nurses can play a pivotal role in intervening with family caregivers and potentially decreasing their depressive symptoms.