Lauren R. Bangerter

Turning points in long distance grandparent-grandchild relationships.

This study examines changes in long-distance relationships between grandparents and their adolescent grandchildren by identifying relational turning points and trajectories. Qualitative analysis of data collected from interviews with grandparents yielded 100 unique turning points. Constant comparative analysis revealed eight distinct categories of relational turning points; Spending Time Together, Family Relational Dynamics, Geographic Distance, Lack of Relational Investment, Use of Technology, Relational Investment, Lack of Free Time, and Grandchild Gaining Independence. These varied in the degree to which they positively or negatively impacted relational closeness. Application of the Retrospective Interview Technique (RIT) yielded five distinctive relational trajectories: Decrease in Closeness, Increase in Closeness, Multidimensional Changes in Closeness, Minimal Changes in Closeness, and Consistent Relational Closeness. The results expose the communicative challenges faced by long-distance-grandparents, the diversity of these relationships, and the ways in which grandparenting bonds change over time. Implications for an enriched understanding of grandparenting relationships and practical applications for families are explored.

Burden and mental health among caregivers of veterans with traumatic brain injury/polytrauma

Veterans who survive multiple traumatic injuries, including traumatic brain injuries (TBI), must often rely on family caregivers for ongoing care and support with reintegration. Understanding factors associated with caregiving that help or harm caregivers’ health is critical for identifying appropriate and effective interventions that support caregiver health and promote the provision of quality care to veterans. This study utilized cross-sectional data from the Family and Caregiver Experiences Study, a survey of 564 caregivers caring for veterans who served after September 11, 2001, survived TBI/polytrauma during service, and received inpatient rehabilitation care in a Veterans Affairs Polytrauma Rehabilitation Center. Structural equation modeling was used to examine the relationship between caregiver stress (i.e., veterans’ neurobehavioral problems and intensity of care required), and caregiver well-being (i.e., caregiver burden and mental health). Analyses also examined how intrapersonal, family or social, and financial resources mediate and moderate the relationship between caregiver stress and well-being. Results indicate that veterans’ neurobehavioral problems and intensity of required care were associated with more caregiver burden, and more burden was associated with poor mental health. Intrapersonal and family or social resources mediated the relationship between veteran functioning and mental health. Family or social resources also moderated the relationship between care intensity and burden. The model explained a moderate amount of variability in burden (59%) and a substantial amount in mental health (75%). We conclude that caregivers of veterans with neurobehavioral problems who require intense care are at risk for burden and poor mental health. Increasing resources to bolster family or social resources may reduce risks.

Do Family Proxies Get It Right? Concordance in Reports of Nursing Home Residents’ Everyday Preferences:

Limited work has examined how well family proxies understand nursing home residents’ preferences. With 85 dyads of a nursing home resident and relative, we utilize descriptive statistics and multi-level modeling to examine the concordance in reports of importance ratings of 72 everyday preferences for residents. Results reveal significant mean differences at the p < .001 level between proxies and residents on 12 of 72 preferences; yet, perfect agreement in responses is poor and only increases when dichotomizing responses into an important versus not important outcome. Multi-level modeling further indicates that dyads are discrepant on reports of the importance of growth activities for residents, with residents reporting higher levels of importance than proxies. This discrepancy is associated with residents’ hearing impairment and proxies’ perception of resident openness. The findings highlight not only how proxies may be able to inform care for residents in nursing homes but also where further discussions are warranted.

Health Care Preferences Among Nursing Home Residents: Perceived Barriers and Situational Dependencies to Person-Centered Care

Although much research has examined end-of-life care preferences of nursing home (NH) residents, little work has examined resident preferences for everyday health care. The current study conducted interviews with 255 residents recruited from 35 NHs. Content analysis identified barriers (i.e., hindrances to the fulfillment of resident preferences) and situational dependencies (i.e., what would make residents change their mind about the importance of these preferences) associated with preferences for using mental health services, choosing a medical care provider, and choosing individuals involved in care discussions. Barriers and situational dependencies were embedded within the individual, facility environment, and social environment. Approximately one half of residents identified barriers to their preferences of choosing others involved in care and choosing a medical care provider. In contrast, the importance of mental health services was situationally dependent on needs of residents. Results highlight opportunities for improvement in practice and facility policies that promote person-centered care. [Journal of Gerontological Nursing, 42(2), 11-16.].

Measuring the Needs of Family Caregivers of People With Dementia: An Assessment of Current Methodological Strategies and Key Recommendations:

While dementia caregivers are regarded as a population with high unmet needs, there is little consensus as to how caregivers’ needs should be conceptualized and measured. This article describes how dementia caregivers’ needs are currently assessed in the scientific literature with the goal of suggesting guidelines for the enhancement of future measurement of caregiver needs. A review of 26 articles identified overarching themes within measurement approaches including variation in methodological rigor, proxy indicators of need, dual needs assessment of caregiver and person with dementia (PWD), and third-party needs assessment. We recommend future research dedicate theoretical attention to the conceptualization and classification of caregivers’ needs to build a stronger foundation for measurement. The measurement development process should capitalize on mixed-methodology and follow instrument development and validation guidelines set forth by measurement theory. Reliable and valid instruments are essential to developing services and policies that address dementia caregivers’ needs.

Everyday Support to Aging Parents: Links to Middle-Aged Children’s Diurnal Cortisol and Daily Mood

Purpose of the Study Middle-aged adults are often called upon to support aging parents. However, providing support to an aging parent with health problems and disability may be a stressful experience. This study asked whether giving everyday support to parents in the context of health problems and disability has implications for middle-aged childrens diurnal cortisol and daily mood. Design and Methods During four consecutive days, 148 middle-aged adults (mean age = 55) reported the support they gave to their parents and provided saliva 4 times a day (wake, 30 min post-wake, lunchtime, and bedtime). Multilevel models estimated within-person differences in positive affect (PA) and negative affect (NA), cortisol awakening response and area under the curve with respect to ground (AUC-G) as a function of giving same-day and previous-day support. We examined whether these associations are exacerbated when a parent has health problems or activities of daily living (ADL) needs. Results Middle-aged children had significantly higher next-day AUC-G on days after they gave support to parents with ADL needs. When participants gave support to parents with ADL needs, they had significantly greater same-day PA and lower next-day NA. Giving support to parents with health problems was associated with significantly higher next-day NA. Implications Giving support to parents is an ambiguous experience with implications for biological stress and daily mood. A biopsychosocial approach reveals under what conditions giving support to parents may become detrimental to health and well-being; this knowledge is essential for the development and implementation of interventions.

Exploring the benefits of Respite Services to Family Caregivers: Methodological issues and current Findings

ABSTRACT Objectives: There is growing emphasis on empirical validation of the efficacy of community-based services for older people and their families, but research on services such as respite care faces methodological challenges that have limited the growth of outcome studies. We identify problems associated with the usual research approaches for studying respite care, with the goal of stimulating use of novel and more appropriate research designs that can lead to improved studies of community-based services. Method: Using the concept of research validity, we evaluate the methodological approaches in the current literature on respite services, including adult day services, in-home respite and overnight respite. Results: Although randomized control trials (RCTs) are possible in community settings, validity is compromised by practical limitations of randomization and other problems. Quasi-experimental and interrupted time series designs offer comparable validity to RCTs and can be implemented effectively in community settings. Conclusion: An emphasis on RCTs by funders and researchers is not supported by scientific evidence. Alternative designs can lead to development of a valid body of research on community services such as respite.

“It’s important, but…”: Perceived Barriers and Situational Dependencies to Social Contact Preferences of Nursing Home Residents

Background and Objectives U.S. Nursing homes (NH) are shifting toward a person-centered philosophy of care, where staff understand each residents preferences, goals and values, and seek to honor them throughout the care delivery process. Social interactions are a major component of life and while low rates of social interactions are typically found among NH residents, little research has examined resident preferences for specific types of social interactions. The purpose of this study is to explore, from the perspective of the NH resident, barriers to social contact preferences and situations when social preferences change. Research Design and Methods Two interviews were conducted with 255 NH residents 3 months apart, recruited from 32 NHs using 13 social-contact items from the Preferences for Everyday Living Inventory-NH. Results Content analysis of 1,461 spontaneous comments identified perceived barriers to preference fulfillment along with reasons why residents would change their mind about the importance of a preference (situational dependencies). Nearly 50% of social preferences for choosing a roommate, having regular contact with friends, giving gifts, and volunteering were associated with barriers. Social preferences were likely to change based upon the quality of the social interaction and the residents level of interest. Discussion and Implications Knowledge of barriers regarding social preferences can inform care efforts vital to advancing the delivery of person-centered care. In addition, understanding the reasons why NH resident preferences change based upon context can help providers with staff training leading to individualized care and develop meaningful social programs that are in line with resident preferences.

Moderators of Mother’s Problems on Middle-Aged Offspring Depressive Symptoms

OBJECTIVES Conservation of Resources (COR) theory postulates that individuals utilize various resources to manage stressful circumstances. Children employ many resources to cope with the problems of parents who suffer from disabilities, cognitive impairment, and functional limitations. This phenomenon is rarely explored among middle-aged offspring and their aging parents. METHOD Drawing from the Family Exchanges Study, we focus on a sample (N = 308) of middle-aged adults (mean age = 51) whose only living parent was their mother. We use multiple regression to examine maternal support and self-reported health as moderators of maternal problems on offspring depressive symptoms. RESULTS Participants whose mothers had few problems generally reported low levels of depressive symptoms. When mothers had high problems, results indicate a negative association between depressive symptoms and physical health. When maternal problems were high, the amount of support offspring receive from their mother had a negative association with offspring depressive symptoms. When mothers had low problems, receiving more maternal support was associated with lower depressive symptoms and receiving low support was associated with increased depressive symptoms. DISCUSSION Middle-aged offspring use both personal and family-based resources to buffer the psychological ramifications of their mothers problems. Our results provide a unique extension of COR theory.

Using spontaneous commentary of nursing home residents to develop resident-centered measurement tools: A case study

ABSTRACT Nursing home (NH) residents routinely complete surveys that assess their health, well‐being, preferences, and care needs. Such surveys reveal important information, however, are largely based on the concerns of providers as opposed to the concerns of residents. Thus, researchers must enhance efforts to ensure that these surveys are guided by the priorities, needs, and concerns of residents. We present a case study to demonstrate how spontaneous commentary of NH residents holds particular efficacy for ensuring that measurement tools are guided by the needs, concerns, and priorities of residents. Spontaneous comments from NH residents (N = 370) collected as part of a study developing the Preferences for Everyday Living Inventory for NH residents (PELI‐NH) were used to refine the PELI‐NH across key phases of measurement development. This work demonstrates how the spontaneous commentary of NH residents may contribute to the refinement of NH measurement tools, and allow researchers to base these tools on the needs and priorities of NH residents.