May L. Wykle

Grandmothers and Caregiving to Grandchildren: Continuity, Change, and Outcomes Over 24 Months

PURPOSE Transitions in caregiving, such as becoming a primary caregiver to grandchildren or having adult children and grandchildren move in or out, may affect the well-being of the grandmother. DESIGN AND METHODS This report describes caregiving patterns at 3 time points over 24 months in a sample of 485 Ohio grandmothers and examines the effects of stability and change in grandmother caregiving roles (raising a grandchild, living in a multigenerational home, or not caregiving to grandchildren). Drawing on the Resiliency Model of Family Stress, the study examined caregiving stress and reward, intrafamily strain, social support, resourcefulness, depressive symptoms, mental and physical health, and perceived family functioning. Caregiver group, time of measurement, switching between caregiver groups, and baseline age, race, education, work status, and marital status were considered as independent variables within the context of a one-way treatment structure in a mixed-model multivariate analysis. RESULTS There were significant caregiver group effects for all variables, except mental health and resourcefulness. Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning, the worst physical health and more depressive symptoms, and the least reward and subjective support. Across groups, there were significant time effects, with worsening physical health and increased stress over time. Switching to higher levels of caregiving was associated with worsening physical health and increases in stress, intrafamily strain, and perceived problems in family functioning. IMPLICATIONS Recommendations for research and for practice, especially during times of caregiving transition or for grandmothers raising grandchildren, are discussed.

Family caregiving across the lifespan

Introduction - Eva Kahana, David E Biegel, and May L Wykle PART ONE: PARADIGMS FOR CAREGIVING Developmental Challenges and Family Caregiving - Eva Kahana et al Bridging Concepts and Research Someone to Watch Over Me - Joan Aldous Family Responsibilities and Their Realization Across Family Lives Altruism Through the Life Course - Elizabeth Midlarsky Optimal Use of Formal and Informal Systems Over the Life Course - Eugene Litwak, Dorothy Jones Jessop, and Heather J Moulton PART TWO: ILLNESS AND LIFE STAGE: CHALLENGES FOR CAREGIVING Caregiving and Children - Joan M Patterson and Barbara J Leonard Caregivers of Persons Living With AIDS - Patricia Flatley Brennan and Shirley M Moore Predictors of Caregiver Burden Among Support Group Members of Persons With Chronic Mental Illness - David E Biegel, Li-yu Song and Venkatesan Chakravarthy Psychoeducational Programs - Catherine F Kane From Blaming to Caring The Home Care of a Patient With Cancer - Charles W Given and Barbara A Given The Midlife Crisis Caregiving Issues After a Heart Attack - Rosalie F Young and Eva Kahana Perspectives on Elderly Patients and Their Families PART THREE: THE INTERFACE BETWEEN FORMAL CARE PROVIDERS AND CAREGIVING FAMILIES Care at Home - Lucy Rose Fischer and Nancy N Eustis Family Caregivers and Home Care Workers The Caregiver as the Hidden Patient - Jack H Medalie Challenges for Medical Practice Caregiving Issues in Families of Children With Chronic Medical Conditions - Anne E Kazak and Dimitri A Christakis Relationships Between the Frail Elderlys Informal and Formal Helpers - Linda S Noelker and David M Bass Conclusion - Eva Kahana, David E Biegel, and May L Wykle

Milieu Change and Relocation Adjustment in Elders

Relocation is a major life event for elders and has been found to adversely affect their adjustment and ability to perform daily activities. Rosenbaums theory of learned resourcefulness suggests that such adverse effects can be minimized if elders have positive cognitions and are resourceful. A cross-sectional design was used to examine the hypothesized relationships among the study variables in a sample of 104 cognitively unimpaired elders (aged 65+ years) who have relocated to retirement communities in Northeast Ohio. Results indicate that positive cognitions had a direct positive effect on learned resourcefulness and on relocation adjustment. Furthermore, learned resourcefulness had a moderating effect on the relationship between relocation controllability and relocation adjustment when controlling for covariates. It is imperative to generate interventions to enhance positive thinking and learned resourcefulness for elders facing the need to relocate and to create the therapeutic milieu within the retirement communities.

Relationships between caregiver stress and self-care behaviors in response to symptoms

The specific aims of this study were to (a) identify relationships among care-giving stress, caregivers’ functional ability, and number of self-care behavior responses to physical and psychological symptoms in caregivers of persons with dementia and (b) examine the mediating function of functional ability in the relationship between caregiving stress and self-care behavior response to symptoms. A correlational, cross-sectional design was used, and a survey was mailed to 99 caregivers. The survey questionnaire contained items about demographics, caregiving stress, functional ability, and self-care behavior. The results indicate that caregivers who reported higher levels of caregiving stress had poorer self-rated health, poorer physical function, more symptoms, high levels of depressed mood, and more self-care behaviors. Caregiving stress was indirectly related to self-care behavior response to symptoms through functional ability, which suggests a need for developing early interventions to enhance the functional ability and self-care behaviors in response to some caregivers’ symptoms.

Effects of Social Support and Coping of Family Caregivers of Older Adults with Dementia in Taiwan.

The purpose of this study was to explore the relationship of demographic characteristics, contextual factors, social support, and coping on health outcomes of family caregivers of older adults with dementia in Taiwan. This study also examined caregiving stress and whether support moderated the effects of caregiver stress on health. Lazarus and Folkmans (1984) Stress model guided this study. The descriptive cross-sectional study included subjects who were primary family caregivers of older adults with dementia from two settings in southern Taiwan. A convenience sample of 148 participants was interviewed. Data analysis consisted of Pearsons correlations, and simple and multiple regression analysis. Findings indicated that younger caregivers, those with paid assistants, and those with longer duration of caregiving had better health. Females with lower income and without assistants had more depressive symptoms. In addition, moderating effects of social support were supported. The results from this study provided a basis for developing interventions to minimize negative impacts on caregivers.

Internet versus Face-to-Face Therapy: Emotional Self-Disclosure Issues for Young Adults

The purpose of this study was to compare differences in emotional self-disclosure between young adult Internet users who prefer face-to-face therapy to those who prefer Internet therapy. A convenience sample of 328 was recruited from Facebook to complete an online survey. A total of 263 preferred face-to-face therapy (F2FT) while 65 preferred Internet therapy (IT). Significant differences were found with the F2FT group willing to disclose emotions of depression, jealously, anxiety, and fear to a therapist more frequently than the IT group. The majority reported a preference for F2FT over IT. Recommendations for future professional practice and research are included.

Translation and validation of Caregiving Satisfaction Scale into Korean.

The purpose of this study was to establish the equivalence and to examine the psychometric properties of a Korean translation of the Caregiving Satisfaction Scale (CSS). A convenience sample of 44 bilingual Koreans was selected. The Cronbach’s alpha for the English and Korean versions were .87 and .90, respectively. There was significant mean difference between items 3 and 12 of the English items and their Korean translations. Pearson’s Correlations demonstrated that 13 of the 15 CSS items had significant correlations (r = .35 ~ .75, p < .05) between two versions. The correlation between total scores of both versions was .86 (p < .001). Overall, none of the items would be regarded as having unacceptable numeric properties. According to the fine process for translation, back-translation, and bilingual field test, the Korean version of the CSS appears to have concrete construct validity and reliability for use in measuring caregiver satisfaction in the Korean population.

Self care: Japan and the U.S. compared

Experience of common symptoms and subsequent self care behaviors among older adults are compared between Japan and the United States, two industrial countries with different cultural backgrounds and health insurance systems. Based on a modification of the Health Belief Model, perceived susceptibility to illness and belief in the efficacy of physician care were selected as major explanatory concepts for the decision to use self care for a complaint. Among 900 respondents in Japan and 728 in the United States, in three communities of varying size, self evaluations of good health, an indicator of low susceptibility, were very similar. Although Japanese respondents claimed fewer experiences of physician error, they still expressed lower preference for physician care than did those in the U.S. In addition, the Japanese reported far fewer symptoms than their U.S. counterparts during a three month period, and were more likely to use self care, even for symptoms they considered more serious. Disparate effects of such variables as good health behaviors, presence of a chronic condition and desire for autonomy are discussed in terms of cultural differences in the two countries.

Predictors of resourcefulness in African American women.

Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. Objective: Using Rosenbaum’s theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. Methods: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. Results: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. Discussion: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.

Psychometric characteristics of the Depressive Cognition Scale in African American women.

Depression in African-American women frequently goes unnoticed and untreated since commonly used depression scales fail to focus on early symptom recognition, do not address contextual factors, and lack adequate psychometric testing in African-American women. This analysis of the Depressive Cognition Scale was conducted with 213 African-American female caregivers and noncaregivers. Alpha coefficients for both groups (α ‘s = .75 and .87) showed internal consistency. Correlations with resourcefulness, depression, and daily hassles scales in the expected directions demonstrated construct validity (R’s = −.36, .26, and .31, respectively). Factor structures for caregivers and noncaregivers differed, suggesting certain depressive cognitions were strongly integrated into the caregiver role. As a reliable and valid measure of depressive cognitions, the DCS would be useful for early detection of depression in African-American women.