M.I. Broese Van Groenou

Sex differences in depression after widowhood. Do men suffer more

Background: This study focuses on sex differences in depression of the widowed. Previous research showed different results in sex differences and in depression after bereavement. We assessed the effects of widowhood on depressive symptoms for men and women and examined whether environmental strain like social support, finances and housekeeping concerns explain these effects. Methods: Data were used from a large community-based study of older people in three regions of the Netherlands. Our study sample consists of 2626 widowed and married subjects in the age group of 55-85 years. Depression was measured using the CES-D scale; the various strains were obtained by structured interviews. Multiple linear regression, performed for men and women separately, were used. Results: The results show that widowhood is associated with higher levels of depressive symptoms and that this association is stronger for men than for women. The effect of widowhood is mediated by different types of environmental strain for men and women. However, a strong direct main effect of widowhood on depression remains. The difference in depression rates between men and women is most evident among those widowed for a longer period of time. Conclusions: It appears that, over time, women adapt to widowhood more successfully than men. From a clinical point of view this is important, as it suggests that men who remain alone after losing their partner are at a higher risk of developing symptoms of chronic depression.

Differential effects of divorce on social integration

Disagreement exists about the relationship between divorce and social integration. A liberation hypothesis predicts an increase in integration, however, an isolation hypothesis predicts a decrease in integration. We combine these hypotheses by specifying that liberation will occur for some dimensions of integration, whereas isolation will occur for others. Using cross-sectional survey data from the Netherlands, results generally lend weak support to the liberation hypothesis. Divorcees report more friendship contacts and are more involved in alternative forms of participation (‘new age’ meetings) compared with the married, but no effects were found for most other liberation indicators. There is more support for the isolation hypotheses at least for some dimensions. We also find that post-divorce resources and constraints play an important intermediating role, especially for women. There is a general negative association between divorce and social integration, but results are nuanced and the effects are not as strong as is often believed.

The end of life: informal care for dying older people and its relationship to place of death

Objective: This study examined the features of informal end-of-life care of older people living in the community and the association between informal care characteristics and dying at home. Methods: Retrospective data were obtained from interviews and self-administered questionnaires of 56 persons who had been primary caregivers of older relatives in the last three months of their lives. Results: Results showed that informal caregivers of terminally ill older people living in the community provided a considerable amount of personal, household, and management care. Secondary informal caregivers and formal caregivers assisted resident primary caregivers less often than nonresident primary caregivers. Primary caregivers who felt less burdened, who gave personal care more intensively, and/or who were assisted by secondary caregivers, were more likely to provide informal end-of-life care at home until the time of death. Conclusions: Our study showed that informal care at the end of life of older people living in the community is complex, since the care required is considerable and highly varied, and involves assistance from secondary informal caregivers, formal home caregivers as well as institutional care. Burden of informal care is one of the most important factors associated with home death. More attention is needed to help ease the burden on informal caregivers, specifically with regard to resident caregivers and spouses. Since these resident caregivers were disadvantaged in several respects (i.e., health, income, assistance from other carers) compared to nonresident caregivers, interventions by formal caregivers should also be directed towards these persons, enabling them to bear the burden of end-of-life care.

PARTNER LOSS IN LATER LIFE: GENDER DIFFERENCES IN COPING SHORTLY AFTER BEREAVEMENT

This longitudinal study aimed to explain coping responses of older women (n = 60)and men (n = 43) at about 1 year following partner loss using a general theory of coping. The theory of mental incongruity predicts that behavioral and mental coping are responses to experienced loneliness and that they are facilitated by actual and perceived opportunities or resources. Results show that the availability of social relationships and better general health encourage coping responses among the bereaved, as well as, unexpectedly, higher social anxiety and financial stress. Results reveal opposite effects for women and men. As time elapses since the death of the partner, men more often share their emotions with others than women. Also, the results suggest that resources play different roles in coping responses of recently bereaved women and men. Among widowers financial stress may impede emotional coping responses, while among widows higher education and having a best female friend seem to function as riskfactors in coping with loss. Relative health, or the feeling one is better off than comparable others, may protect against the negative effects of partner death, particularly among recently bereaved women. It is concluded that the proposed theory offers useful concepts in understanding how recently bereaved individuals cope with partner death; however,it is not helpful in explaining the gender differences found in the present study. Further, the findings question the supposed less favorable health position of older widows and the more favorable social position of older widows and socioeconomic position of older widowers.This longitudinal study aimed to explain coping responses of older women (n = 60)and men (n = 43) at about 1 year following partner loss using a general theory of coping. The theory of mental incongruity predicts that behavioral and mental coping are responses to experienced loneliness and that they are facilitated by actual and perceived opportunities or resources. Results show that the availability of social relationships and better general health encourage coping responses among the bereaved, as well as, unexpectedly, higher social anxiety and financial stress. Results reveal opposite effects for women and men. As time elapses since the death of the partner, men more often share their emotions with others than women. Also, the results suggest that resources play different roles in coping responses of recently bereaved women and men. Among widowers financial stress may impede emotional coping responses, while among widows higher education and having a best female friend seem to function as riskfactors i...

Perceived control in health care: A conceptual model based on experiences of frail older adults

Frail older adults are increasingly encouraged to be in control of their health care, in Western societies. However, little is known about how they themselves perceive control in health care. Therefore, this study aims to investigate the concept of health care-related perceived control from the viewpoint of frail older adults. A qualitative interview study was conducted following a Grounded Theory approach. Thirty-two Dutch frail older adults, aged 65 and over, participated in 20 in-depth interviews (n=20) and three focus group discussions (n=12). Data were analysed according to techniques of coding and constant comparison. From this analysis constituting factors of perceived control emerged, providing elements of a conceptual model. Perceived control reflects the feeling or belief that health care is under control, which is constituted by five, either internal or external, factors: (I) self-confidence in organising professional and/or informal care, (II) self-confidence in health management in the home setting, (III) perceived support from people in the social network, (IV) perceived support from health care professionals and organisations, and (V) perceived support from (health care) infrastructure and services. Therefore, the concept does not only consist of peoples own perceived efforts, but also includes the influence of external sources. Our conceptual model points out what external factors should be taken into consideration by health care professionals and policy makers when enhancing older peoples perceived control. Moreover, it can serve as the basis for the development of a measurement instrument, to enable future quantitative research on health care-related perceived control among older adults.

Cosmic transcendence, loneliness, and exchange of emotional support with adult children: a study among older parents in The Netherlands

Gerotranscendence defines a shift in meta-perspective from earlier materialistic and pragmatic concerns, toward more cosmic and transcendent ones in later life. Population-based studies that have empirically examined this concept using Tornstam’s gerotranscendence scale, highlight cosmic transcendence as a core component, which includes a sense of belongingness with past and future generations. Such generative concerns may increase expectations regarding the quality of the bond with one’s children in later life. This study examined whether the association between emotional support exchanged with children and feelings of loneliness later in life varied by the degree of cosmic transcendence of the older parent. Data from 1,845 older parents participating in a population-based study living in The Netherlands were analyzed from the 1995/1996 cycle of the Longitudinal Aging Study Amsterdam. Interviews included self-report measures of cosmic transcendence, loneliness, emotional support exchanged with children, health indicators, and marital status. Results indicated that a negative association between loneliness and level of emotional support exchanged with children was more pronounced among older parents with higher cosmic transcendence scores, in particular among the married. It is argued that cosmic transcendence reflects a sense of generativity and an increased emotional dependency on children in later life. Under favorable social conditions (supportive relationships with children and being married) cosmic transcendent views had a positive impact on social well-being in later life. When children no longer met emotional needs of older parents, cosmic transcendence increased feelings of loneliness.

Linkages between informal and formal caregivers in home-care networks of frail older adults

ABSTRACT In ageing societies, policy makers aim for more contact between informal and formal care-givers as it may enhance the quality of care. So far, the linkage between formal and informal care-givers is generally studied from a one-sided or a single dyadic perspective, without taking into account that care networks of community-dwelling older adults often exist of multiple informal and formal care-givers. The current study examines discussion of care between all potential informal–formal care-giver dyads in a care network, and relates this to characteristics of the older care recipient, the care network and the care-givers. Seventy-four Dutch older care recipients provided information on all care-givers who helped with five different types of tasks; 410 care-givers reported on the contact between all care-givers identified. Multi-level logistic regression was conducted in 2,150 informal–formal care-giver dyads and revealed that in 26 per cent of all these dyads discussion on care occurred. This was more likely when both care-givers performed multiple types of tasks, the informal care-giver was residing with the care recipient, and contact within the formal and the informal sub-network was higher. To enhance discussion of care between informal and formal care-givers in care networks where no discussion occurs at all, home-care organisations may need to allocate formal care-givers who form a bridge with an extra-residential care-giver of care recipients living alone.

Explaining the gender gap in the caregiving burden of partner caregivers

Abstract Objectives We examine gender differences in the experienced burden of partner caregivers using the stress-appraisal model. Gender differences can be explained by differences in conditions of burden (primary stressors, help from others, hours of caregiving, and secondary stressors) and how strong their effects are. Method The data are from the Netherlands’ Older Persons and Informal Caregivers Survey—Minimum Data Set (N = 1,611 caregivers). We examine mediation and moderation effects using structural equation modeling. Results Women experience greater partner caregiver burden than men, which is related to women experiencing more secondary stressors (relational and financial problems, problems combining different tasks). For women and men alike, there is a positive association between burden and more primary stressors (partner’s care need indicated by health impairment), help from other caregivers, and secondary stressors. For male caregivers, caregiving intensity also contributes to a greater burden. Discussion This study corroborates the structural impact of gender on the conditions of as well as their effects on the partner caregiver burden. Reducing the hours of caregiving for male caregivers in severe care situations and helping female and male caregivers deal emotionally with the caregiving situation can reduce the partner caregiver burden.

Impact of home care management on the involvement of informal caregivers by formal caregivers.

This study explores the link between management characteristics of home care agencies and the involvement of informal caregivers in caregiving. Based on a study of policy documents of two agencies and semi-structured interviews with five team managers and 31 formal caregivers, we conclude that, although the importance of involving informal caregivers is emphasized in official documentation, actual contact with informal caregivers is often lacking. Comparison of the work processes of the two agencies shows that contact with informal caregivers and their potential involvement are enhanced by smaller teams, less task division, and clarity about the responsibilities of formal caregivers.

Sociale participatie van 55-64 jarigen: is de huidige generatie sociaal actiever dan de vorige?

Nowadays people speak of the ‘new’ generation of young old who would be healthier and more socially active compared to the earlier generation. Using data from the Longitudinal Aging Study Amsterdam it was examined to what degree this is a realistic image. The study compared the social participation level of 55-64 year olds in 1992 and the same age group in 2002, and aimed to explain the differences from cohort differences in four determinants of participation: level of education, labour participation, health and partner status. Descriptive analyses showed that the younger cohort was more actively involved in voluntary organisations and participated more often in cultural and leisure activities compared to the older cohort. In addition, the younger cohort was more highly educated, yet reported more functional disabilities, and more often hold paid jobs compared to the older cohort. No cohort differences were found with respect to the proportion of married persons. Logistic regression analyses showed that the higher level of social participation of the younger cohort was mainly due to the higher level of education, but that this effect was reduced by the larger disability of the younger cohort. Job and partner status did not explain the cohort differences in social participation. It is concluded that the current young old are more socially active and higher educated than their predecessors. Their (somewhat) worse health status, however, asks for a more nuanced image of the ‘new’ young old.