Mary R. Janevic

The costs of caring: impact of dementia on family caregivers.

With the aging of the population, an increasing number of older adults are diagnosed with Alzheimers disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experi ence a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dement ing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role. (J Geriatr Psychiatry Neurol 2001; 179-187).

The effect of social relations with children on the education-health link in men and women aged 40 and over

Accumulated evidence demonstrates a strong relationship between socioeconomic status (SES) and health. Our examination of this relationship focuses on education, an established indicator of SES, and tests whether social relations, particularly with children, mediate and/or moderate the education-health link for middle-aged and older parents. The data are drawn from a regionally representative sample of adults (aged 40-93) in the Detroit area, USA. All analyses are stratified by gender (N=males: 330; females: 468). A series of multiple regression analyses were performed to test whether social relations mediate the association between education and health. Although analyses revealed no mediation effect, both men and women with less education were found to have smaller social networks. Women with more education confided less in their children than women with less education did. A series of hierarchical regression analyses were performed to test whether social relations variables moderate the relationship between education and health. Separate analyses by gender indicated that men, but not women, with less education who had larger networks and who perceived emotional, financial and sick care support to be available from a child had lower scores on a health problems index. Findings indicate that the health of lower-educated men in the presence of key social supports parallels the advantaged health status of men with higher levels of education. These findings suggest that social relationships may be a protective factor for the health of men in the lower socioeconomic strata.

Effects of a Telephone-Based Exercise Intervention for Dementia Caregiving Wives A Randomized Controlled Trial

Despite the importance of self-care for dementia caregivers, few interventions have included a focus on health behaviors. This study reports outcomes of a telephone-based exercise intervention designed for women caring for a spouse with dementia. Caregivers (N = 137) were randomized to intervention or control conditions. Participants with at- or below-median exercise scores at baseline had a significantly greater increase in exercise at 6-month follow-up compared with their control counterparts. At 6 months, participants had greater reductions in perceived stress relative to controls. Participants also reported significantly greater increases in exercise self-efficacy than caregivers in the control group at both follow-up points. Results indicate that spouse caregivers are able to increase their physical activity and that a focus on exercise in multicomponent interventions may be beneficial. Debate and discussion are needed to inform expectations for program effects and their maintenance and to explore the interface between enhanced self-care and caregiving perceptions.

Factors influencing quality of life in older women with heart disease.

Background.Better understanding of factors influencing the quality of life (QOL) of cardiac patients can guide treatment decisions. Objectives.To describe the impact of clinical and psychosocial factors on the QOL of older women with heart disease. Research design. Baseline and 12-month data from women participating in an intervention study. Subjects.Eligible participants, identified from medical records, were female, ≥60 years of age, and diagnosed with cardiac disease. A volunteer sample of 570 women (87% white) completed baseline interviews, with 485 women completing the 12-month assessment. Measures.Utilizing Wilson and Cleary’s conceptual framework (1995), measures of clinical, psychosocial, and functional status were examined for their associations with QOL. Results.At baseline, General Health Perceptions and Symptom Status accounted for 38% and 26%, respectively, of the variation in the QOL rating. Using logistic regression models, seven measures were significant predictors (P <0.05) of maintenance/improvement versus decline in QOL over 12 months: baseline QOL rating; baseline value and change in satisfaction with social activities over 12 months; change in satisfaction with physical activities; change in satisfaction with mental activities; and baseline value and change in perceived stress. For women who maintained or improved their satisfaction with social activities, the odds for also maintaining or improving QOL were 4.5 times the odds for women whose satisfaction with social activities deteriorated. Conclusions.Satisfaction with social activities and perceived stress are important predictors of subsequent QOL. Consideration of the impact of treatments on these factors may help to prevent deterioration of QOL among older female cardiac patients.

Maternal education and adverse birth outcomes among immigrant women to the United States from Eastern Europe: A test of the healthy migrant hypothesis

Immigrant women to the U.S. often have more favorable birth outcomes than their native-born counterparts, including lower rates of preterm birth and low birth weight, a phenomenon commonly attributed to a healthy migrant effect. However, this effect varies by ethnicity and country of origin. No previous study has examined birth outcomes among immigrants from the post-Communist countries of Eastern Europe, a group which includes both economic migrants and conflict refugees. Using data on 253,363 singletons births from New York City during 1995-2003 we examined the risk of preterm birth (PTB) (<37 weeks) or delivering a term small-for-gestational-age (SGA) infant among immigrants from Russia and Ukraine (RU), Poland, and former Yugoslavia Republics (FYR) relative to US-born non-Hispanic whites (NHW). Women in all three Eastern European groups had significantly later entry into prenatal care, were more likely to be Medicaid recipients, and had lower educational attainment than US-born NHW. In binomial regression analyses adjusting for age, education, parity, and pre-pregnancy weight, women from RU and FYR had lower risk of PTB than US-born NHW, whereas women from Poland had similar risk. Lower SGA risk was found among women from Poland and FYR, but not RU. When stratified by education, women with <12 years of education from all Eastern European groups had a reduced risk of PTB relative to US-born NHW. An educational gradient in PTB and SGA risk was less pronounced in all Eastern European groups compared to US-born NHW. The healthy migrant effect is present among immigrants from Eastern Europe to the U.S., especially among women with less education and those from the former Yugoslavia, a group that included many conflict refugees.

An Examination of Adverse Asthma Outcomes in U.S. Adults with Multiple Morbidities

RATIONALE More Americans are managing multiple chronic conditions. Little is known regarding combinations of multiple chronic conditions with asthma. OBJECTIVES To examine the prevalence and demographic distribution of five common chronic conditions (arthritis, heart disease, cancer, diabetes, and hypertension) in adults with and without asthma and the adverse asthma outcomes associated with multiple chronic conditions. METHODS Cross-sectional interview data from the National Health and Nutrition Examination Survey were analyzed (n = 22,172) between 2003 and 2010. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations. MEASUREMENTS AND MAIN RESULTS Of the 10% of subjects with asthma, 54% had one or more coexisting health condition(s). The prevalence of two or three or more other chronic conditions was greater among those with asthma compared with those without (P < 0.001). Common comorbidities with asthma were hypertension (34%) and arthritis (31%). For every additional comorbid chronic condition, there was an increase in the prevalence of reported asthma symptom episodes (prevalence ratio [PR], 1.06; 95% confidence interval [CI], 1.00-1.13), frequent activity limitation (PR, 1.14; 95% CI, 1.04-1.25), sleep disturbances (PR, 1.22; 95% CI, 1.04-1.43), and emergency department visit for asthma (PR, 1.45; 95% CI, 1.19-1.76) when adjusted for socioeconomic and demographic factors and body mass index. The population-attributable risk for emergency department visits for asthma among individuals with asthma who have other chronic comorbidities was 19.5%. CONCLUSIONS Half of the adult population with asthma in the United States suffers from comorbid conditions, which are associated with adverse asthma-related outcomes and account for up to 20% of emergency room visits for asthma.

Older adults' driving reduction and cessation: Perspectives of adult children

Purpose of the Study. Adult children are often directly affected by aging parents’ decision to limit or stop driving. This qualitative study examined the process of driving reduction and cessation (DRC) from the perspective of adult children, with a focus on family communication. Design and Methods. Four focus group interviews were conducted with 37 adult children (29/37 female; mean age = 45.5) of older parents using a structured protocol. Transcripts were analyzed by two independent coders to identify major themes. Results. Themes represented three aspects of the DRC process: family communication and dynamics (i.e., discussion, negotiation, and planning; avoidance and side stepping; resignation and refusal), taking action to end a parent’s driving career (i.e., engaging a third party; taking away the car), and post-cessation reflection (i.e., relief; social benefits; resentment and guilt). Implications. Despite the potential benefits of planning for DRC, families are unsure about how best to approach this topic. Adult children worry about assuming responsibility for their parents’ transportation needs and their parents’ reactions to restricted mobility. Despite a reluctance to communicate openly about DRC, adult children and their parents share similar and significant concerns that merit increased attention.

Study protocol for Women of Color and Asthma Control: a randomized controlled trial of an asthma-management intervention for African American women.

BackgroundAmong adults in the United States, asthma prevalence is disproportionately high among African American women; this group also experiences the highest levels of asthma-linked mortality and asthma-related health care utilization. Factors linked to biological sex (e.g., hormonal fluctuations), gender roles (e.g., exposure to certain triggers) and race (e.g., inadequate access to care) all contribute to the excess asthma burden in this group, and also shape the context within which African American women manage their condition. No prior interventions for improving asthma self-management have specifically targeted this vulnerable group of asthma patients. The current study aims to evaluate the efficacy of a culturally- and gender-relevant asthma-management intervention among African American women.Methods/DesignA randomized controlled trial will be used to compare a five-session asthma-management intervention with usual care. This intervention is delivered over the telephone by a trained health educator. Intervention content is informed by the principles of self-regulation for disease management, and all program activities and materials are designed to be responsive to the specific needs of African American women. We will recruit 420 female participants who self-identify as African American, and who have seen a clinician for persistent asthma in the last year. Half of these will receive the intervention. The primary outcomes, upon which the target sample size is based, are number of asthma-related emergency department visits and overnight hospitalizations in the last 12 months. We will also assess the effect of the intervention on asthma symptoms and asthma-related quality of life. Data will be collected via telephone survey and medical record review at baseline, and 12 and 24 months from baseline.DiscussionWe seek to decrease asthma-related health care utilization and improve asthma-related quality of life in African American women with asthma, by offering them a culturally- and gender-relevant program to enhance asthma management. The results of this study will provide important information about the feasibility and value of this program in helping to address persistent racial and gender disparities in asthma outcomes.Trial RegistrationClinicalTrials.gov: NCT01117805

Socioeconomic status, social support, age, and health.

This study examines the hypothesis that aspects of social relations moderate the relationship between SES and health; that is, this association varies with differences along four major dimensions of social relations: instrumental, emotional, and negative support, and network structure. In 1992, 923 white and black respondents aged 40 and over were interviewed as part of the Survey of Social Relations. 1 The sample was drawn from a stratified probability sample in the Detroit metropolitan area. Social relations variables included the number of people in social network, perceived instrumental support (whether spouse and child would provide care if respondent was ill), emotional support (whether respondent confides in spouse and child), and negative support (whether spouse and child get on the respondent’s nerves). Respondents rated all social support variables on a five-point scale (1, strongly agree; 5, strongly disagree). Education level was used as an SES indicator. Years of education were split into three groups: less than high school, high school, and more than high school. Health was measured by a global self-rated health question (5, poor; 1, excellent). Following Baron and Kenny, 2 we assessed the moderating impact of the social relations variables on the relationship between SES and health by regressing health on (1) the independent SES variable (education level), (2) the social relations variable that is hypothesized to be the moderator, and (3) the interaction of (1) and (2). A significant interaction term implies that the social relations variable is moderating the impact of SES on health. Analyses were conducted separately for each of two age groups: 40–59 and 60–93. Findings indicate that there is no interaction effect of SES and social network size on health. However, interaction effects are evident for instrumental, emotional, and negative support. These are summarized in T ABLE 1. Graphs of the significant interactions suggest complex associations among SES, social relations variables, and health. For example, F IGURE 1 demonstrates that respondents aged 40–59 with more than a high school education and who confide in their spouse are healthier than those who do not. This relationship was reversed among respondents with less than a high school education. However, in the 60–93 age group, health is about the same for all respondents who confide in their spouse. Among those in this age group who do not confide in their spouse, education level has a negative effect on health: people with less than a high school education report poorer health; those with more than a high school education report better health. A consistent pattern that emerged was that respondents in the middle education group (high school) were the least likely in both

The Social Relations–Physical Health Connection: A Comparison of Elderly Samples from the United States and Japan

Cross-national comparison of the social relations–physical health association in the elderly can broaden our understanding of the implications of social relationships in this age group. Using representative cross-sectional samples of adults aged 60–93 years from metropolitan areas in the United States and Japan (n = 1005), we used analysis of variance to examine between-country differences in the association of illness with measures of network structure, social support, and negative relations. One significant between-country difference in this association was found: in Japan only, ill women reported more available financial help from their child than did non-ill women (p < .05). Ill women in both countries reported less sick care available from their spouse than did ill men (p < .05) and more negative relations with their child than did non-ill women (p < .05). These results suggest the primacy of gender, rather than cultural context, in shaping the association between social relations and health.