Juleen Rodakowski

Role of Social Support in Predicting Caregiver Burden

OBJECTIVE To examine the unique contribution of social support to burden in caregivers of adults aging with spinal cord injury (SCI). DESIGN Secondary analyses of cross-sectional data from a large cohort of adults aging with SCI and their primary caregivers. SETTING Multiple community locations. PARTICIPANTS Caregivers of community-dwelling adults aging with SCI (n=173) were interviewed as part of a multisite randomized controlled trial. The mean age ± SD of caregivers was 53±15 years and of care-recipients, 55±13 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was caregiver burden measured with the Abridged Version of the Zarit Burden Interview. A hierarchical multiple regression analysis examined the effects of social supports (social integration, received social support, and negative social interactions) on burden in caregivers of adults aging with SCI while controlling for demographic characteristics and caregiving characteristics. RESULTS After controlling for demographic characteristics and caregiving characteristics, social integration (β=-.16, P<.05), received social support (β=-.15, P<.05), and negative social interactions (β=.21, P<.01) were significant independent predictors of caregiver burden. CONCLUSIONS Findings demonstrate that social support is an important factor associated with burden in caregivers of adults aging with SCI. Social support should be considered for assessments and interventions designed to identify and reduce caregiver burden.

Can performance on daily activities discriminate between older adults with normal cognitive function and those with mild cognitive impairment

To examine whether preclinical disability in performance of cognitively focused instrumental activity of daily living (C‐IADL) tasks can discriminate between older adults with normal cognitive function and those with mild cognitive impairment (MCI) and, secondarily, to determine the two tasks with the strongest psychometric properties and assess their discriminative ability so as to generate diagnosis‐relevant information about cognitive changes associated with MCI and mild neurocognitive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria.

Does social support impact depression in caregivers of adults ageing with spinal cord injuries

Objective: The objective of this study was to examine the role of social support in predicting depression in caregivers of adults aging with spinal cord injuries. Design: Cross-sectional secondary data analyses were conducted for this study. Setting: Participants were recruited from multiple community locations in Pittsburgh, PA and Miami, FL. Subjects: Community-dwelling caregivers of aging adults with spinal cord injuries (N = 173) were interviewed as part of a multisite randomized controlled trial. Main measures: The Center for Epidemiological Studies Depression Scale measured caregiver depression symptom levels. A hierarchical multiple regression analysis examined the effect of social support (social integration, received social support, and negative social interactions) on depressive symptom levels for the caregivers of adults aging with spinal cord injuries, controlling for demographic characteristics, and caregiving characteristics. Results: Caregivers were, on average, 53 years old (SD = 15) and care-recipients were 55 years old (SD = 13). Average Center for Epidemiological Studies Depression Scale scores indicated that 69 (40%) of caregivers had significant depressive symptoms (mean 8.69, SD = 5.5). Negative social interactions ( β ^ = 0.27, P< 0.01) and social integration ( β ^ = −0.25, P< 0.01) were significant independent predictors of depressive symptom levels in caregivers of adults aging with spinal cord injuries. Conclusions: Findings demonstrate that negative social interactions and social integration are associated with the burden in caregivers of adults aging with spinal cord injuries. Negative social interactions and social integration should be investigated in assessments and interventions intended to target caregiver depressive symptom levels.

Additive effect of age on disability for individuals with spinal cord injuries

OBJECTIVE To examine the additive effect of age on disability for adults with spinal cord injury (SCI). DESIGN Prospective cohort study. SETTING SCI Model Systems. PARTICIPANTS Individuals with SCI (median age at injury, 32 y; range, 6-88 y) with a discharge motor FIM score and at least 1 follow-up motor FIM score who also provided measures of other covariates (N=1660). Of the total sample, 79% were men, 72% were white, 16% had incomplete paraplegia, 33% had complete paraplegia, 30% had incomplete tetraplegia, and 21% had complete tetraplegia. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary study outcome was the motor subscale of the FIM. A mixed-models approach was used to examine the additive effect of age on disability for individuals with SCI. RESULTS When controlling for motor FIM at discharge from rehabilitation, level and severity of injury, age at injury, sex, race, and the age × time interaction were not significant (P=.07). Age at the time of SCI was significantly associated with motor FIM (F1,238=22.49, P<.001). Two sensitivity analyses found significant interactions for both age × time (P=.03, P=.02) and age × time-square (P=.01, P=.006) models. Trajectory of motor FIM scores is moderated slightly by age at the time of injury. The older participants were at the time of injury, the greater the curvature and the more rapid decline were found in later years. CONCLUSIONS These findings indicate that age moderately influences disability for some individuals with SCI: the older the age at the time of injury, the greater the influence age has on disability. The findings serve as an important empirical foundation for the evaluation and development of interventions designed to augment accelerated aging experienced by individuals with SCI.

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults.

Attribution of Mild Cognitive Impairment Etiology in Patients and Their Care-Partners

This study examined the attribution of mild cognitive impairment (MCI) etiology assigned by individuals with MCI and their care partners, and the extent to which the dyads agreed on the attribution of MCI etiology.

Adverse Consequences of Unmet Needs for Care in High-Need/High-Cost Older Adults

Objectives We explore adverse consequences of unmet needs for care among high-need/high-cost (HNHC) older adults. Method Interviews with 4,024 community-dwelling older adults with ADL/IADL/mobility disabilities from the 2011 National Health and Aging Trends Study (NHATS). Reports of socio-demographics, disability compensatory strategies, and adverse consequences of unmet needs in the past month were obtained from older adults with multiple chronic conditions (MCC), probable dementia (DEM), and/or near end-of-life (EOL) and compared older adults not meeting these criteria. Results Older adults with MCC (31.6%), DEM (39.6%), and EOL (48.7%) reported significantly more adverse consequences than low-need older adults (21.4%). Persons with MCC & DEM (53.4%), MCC & EOL (53.2%), and all three (MCC, DEM, EOL, 65.6%) reported the highest levels of adverse consequences. HNHC participants reported more environmental modifications, assistive device, and larger helper networks. HNHC status independently predicted greater adverse consequences after controlling for disability compensatory strategies in multivariate models. Discussion Adverse consequences of unmet needs for care are prevalent among HNHC older adults, especially those with multiple indicators, despite more disability-related compensatory efforts and larger helper networks. Helping caregivers provide better informal care has potential to contain healthcare costs by reducing hospitalization and unplanned readmissions.

Developing a Non-Pharmacological Intervention for Individuals With Mild Cognitive Impairment

The purpose of this study is to describe one potential intervention model that is designed to slow decline to disability for individuals at-risk for dementia due to Mild Cognitive Impairment. Strategy training is a treatment model that focuses on behavioral activation through addressing barriers to daily activities. Strategy training encourages development of goals and plans to address self-identified impaired processes, and it maintains or improves individuals’ ability to perform desired activities. Progression to dementia may be slowed due to the link between engagement in daily activities and production of biological factors associated with neurocognitive health. We demonstrated that an older adult with mild cognitive impairment is able to develop goals, establish effective plans, and engage in daily activities through the strategy training intervention model.

Caregiver health literacy predicting healthcare communication and system navigation difficulty.

Introduction: The role of caregiver health literacy in predicting difficulty communicating with health care professionals and navigating services and supports for older adults was examined and informed by the health literacy skills framework (Squiers, Peinade, Berkman, Boudewyns, & McCormack, 2012). Method: Secondary analyses of cross-sectional data from the Pittsburgh Regional Caregivers Survey in 2017 were conducted. A total of 761 caregivers of older adults reported communicating with health care providers and accessing services and supports. Health care provider communication and navigation of services and supports (HCNS) was assessed through self-report questions on communication about needs of the care recipient and caregiver, and the ability to locate and arrange services and supports for the care recipient. Health literacy was assessed with self-report questions on confidence filling out forms, need for help with reading information, and comprehension with written information. A logistic regression was conducted to determine the relationship between health literacy and high HCNS difficulty while controlling for demographic and contextual caregiving characteristics. Results: A fifth of the caregivers demonstrated low health literacy (n = 150, 19.7%). For a caregiver with low health literacy, the odds of having high levels of difficulty with HCNS was 2.52 times larger than the odds for a caregiver with adequate health literacy while controlling for demographic and contextual caregiving factors (odds ratio = 2.52, 95% confidence interval [1.57, 4.06]; p < .001). Discussion: Findings demonstrate that poor caregiver health literacy is an important factor associated with HCNS difficulty. The health literacy of caregivers should be considered for assessments and interventions designed to identify and reduce the difficulty caregivers experience with HCNS.

Trajectory of Disability in Older Adults With Newly Diagnosed Diabetes: Role of Elevated Depressive Symptoms

OBJECTIVE We examined whether the trajectory of disability differed between older adults with and without elevated depressive symptoms before and after the onset of diabetes mellitus (DM) over 10 years (2004–2014) and explored difficulties in basic and instrumental activities of daily living between the two groups. RESEARCH DESIGN AND METHODS A generalized linear mixed-model analysis was conducted using five waves (8th–12th) of Health and Retirement Study (HRS) data. We included 419 older adults who self-reported new DM diagnosis within the previous 2 years and used the Center of Epidemiologic Studies Depression Scale to measure elevated depressive symptoms. Disability was measured by 10 items defined in the HRS data set. RESULTS The trajectory of disability differed between older adults with and without elevated depressive symptoms after newly diagnosed DM over time. Significant and clinically meaningful between-group differences were found in disability after the onset of DM (waves 10 and 11) but not before the onset of DM (waves 8 and 9). Among older adults with elevated depressive symptoms, disability at pre-DM waves (8 and 9) was significantly less than post-DM waves (10–12). Difficulties with shopping, walking, and dressing were mostly reported by older adults with elevated depressive symptoms. CONCLUSIONS Older adults with newly diagnosed DM and elevated depressive symptoms have a clinically meaningful and faster disablement trajectory than those without elevated depressive symptoms. Future interventions may take an indicated approach to disability prevention in older adults with newly diagnosed DM, especially in those with a change in depression severity.