Michael S. Caserta

Exploring the Caregiver Burden Inventory (CBI): Further Evidence for a Multidimensional View of Burden.

The purpose of this study was to examine the multidimensional nature of caregiver burden by specifically analyzing the patterns of association between five dimensions of burden as measured by the Caregiver Burden Inventory [1] and selected demographic, health, functioning, and well-being indicators. Subscales measuring each dimension were internally consistent and relatively independent in a sample of 160 caregivers. Time dependence burden was most influenced by patient impairment and caregiving involvement, whereas emotional burden was largely a function of caregiving satisfaction. Most of the variance in developmental burden was explained by depression and caregiving satisfaction. Contrary to expectations, physical health measures explained little variance in physical burden, of which most was explained by depression. Less than 10 percent of the variance in social burden was explained by depression and caregiver days sick. The findings lend support to a multidimensional view of burden and with minor modifications, the CBI appears to be a promising instrument with which to measure the construct.

Identifying Elderly with Coping Difficulties after Two Years of Bereavement

This study answers three research questions. First, what proportion of the elderly are experiencing major coping difficulties after two years of bereavement? Second, what factors in early bereavement distinguish between those with difficulties and the others? Third, what set of factors are the best predictors of coping difficulties at two years? Of the 138 persons who completed a two-year longitudinal study of bereavement, twenty-five (18%) were found to be having difficulties after two years according to a scale which combined perceived stress, coping, and depression. The poor copers did not differ from the others with respect to any of the sociodemographic, health, or social support variables. However, those who were poor copers had lower self-esteem, experienced several feelings/behaviors with greater intensity/frequency in early bereavement. Low self-esteem, even prior to bereavement, is likely to be predictive of coping difficulties two years following the death of a spouse. Three weeks after the spouses death, the poor copers expressed confusion and a desire to die with greater intensity. They also were less likely to be proud of how they were managing the death, they cried more frequently, and did not try to keep as busy in this early bereavement period.

Symptom experiences and quality of life of rural and urban older adult cancer survivors

This study examined the symptom experience, health-related quality of life, and functional performance of elderly cancer survivors at 1 and 3 months after the completion of initial treatment. The study used a descriptive, comparative, repeated-measures design. A mixed-methods approach combined completion of survey instruments with qualitative interviews. Of the 52 participants, 22 resided in rural (n = 12) or semirural (n = 10) areas and 30 lived in urban settings. There were 23 women and 29 men ranging in age from 65 to 81 years (mean age, 71.53 years). Survivors experienced a significant number of symptoms (mean, 4.58), which were, on average, moderate in intensity and did not differ based on urban or rural residence. The Medical Outcomes Study SF-12 Physical Component Summary was less than the national norm for elderly individuals or those with a chronic disease. There was minimal improvement 3 months after treatment. Elderly survivors, regardless of whether they were rural or urban, experienced a significant number of unrelieved symptoms, including fatigue, pain, and difficulty sleeping. Eighty-eight percent had other chronic diseases. Comorbidities were associated with greater symptom intensity and less physical health status. Survivorship care for elderly adults should include a comprehensive geriatric assessment and tailored strategies for symptom management.

Music thanatology: Prescriptive harp music as palliative care for the dying patient

Music thanatology represents an emerging area in which the raw materials of music, usually harp and/or voice, assist and comfort the dying patient. During prescriptive ”music vigils,“ the clinician-mnusician carefully observes physiological changes, cues, and breathing patterns, thereby synchronizing the music to reflect or support the patient physiology and overall condition. Using data collected from 65 patients, this study was designed to assess the effectiveness of prescriptive harp music on selected palliative care outcomes using a sample of de-identified data forms from past music vigils. Patients were administered a 25- to 95-minute intervention of prescriptive harp music. Data collected included vital signs and observational indicators before (Ti) and after (T2) the vigil. Patients were more likely to experience decreased levels of agitation and wakefulness while also breathing more slowly and deeply with less effort at the conclusion of the music vigil. Results from this study suggest that a prescriptive vigil conducted by a trained music thanatologist could provide an effective form ofpalliative care for dying patients.

Beyond bereavement support group meetings: Exploring outside social contacts among the members

This article examines the extent to which bereavement support group participants engage in social interaction with fellow group members outside of the meetings, demographic influences on outside contact, and the relationship between this social interaction and bereavement outcomes. Data are presented from a longitudinal study that included 144 recently bereaved spouses between the ages of 51 and 89 who participated in a support group intervention. During the course of the study the majority of the participants had contact with other group members in addition to the scheduled meetings even though the group leaders did not encourage outside contact. Although the frequency of the interaction was only moderate, the support group participants reported feeling relatively close to their fellow group members. Men were as likely as women to have outside contact but they delayed in doing so. Those who engaged in outside contact were slightly more depressed, experienced more stress, and were more lonely at the time of the contact relative to others. Those who maintained some kind of interaction by Time 3 (1 year bereaved), however, reported less loneliness by the end of the study (Time 4). Findings are discussed in terms of the frequency and duration of support group interventions, the gender composition of the groups, and the need to incorporate into future studies a more systematic examination of outside interaction among support group participants.

Stress-related growth among the recently bereaved

Although stress-related growth (SRG), or a personal transformation beyond adaptation, can be an outcome for some individuals after a traumatic life experience like spouse or partner loss, it is often assumed that some time needs to pass before this happens. This study reports on early experiences of SRG relatively soon after the loss of a spouse or partner in mid and later life. Self-administered questionnaires were completed by 292 recently bereaved (2–6 months) partners, aged 50+, as part of the Living After Loss study conducted in Salt Lake City and San Francisco. Substantial variability in SRG was observed where 21% scored ≥1 SD above and approximately 18% scored ≥1 SD below the sample mean of 17.2 (SD = 7.0). Regression analyses revealed that SRG was more likely for those who had expected their partners’ deaths, who were more religious and who engaged in loss- and restoration-oriented coping processes, and was independent of grief levels. Findings suggest that some individuals drew upon their religious beliefs as a way to find meaning and make sense of what happened as they rebuilt their ‘assumptive world’. Also, those who anticipated their partners death could have had more opportunity to cognitively process the loss, address the challenges of widowed life and learn new skills and discover previously unrecognized strengths.

Experiences and Early Coping of Bereaved Spouses/Partners in an Intervention Based on the Dual Process Model (DPM)

This study was designed to test the effectiveness of the Dual Process Model (DPM) of coping with bereavement. The sample consisted of 298 recently widowed women (61%) and men age 50+ who participated in 14 weekly intervention sessions and also completed before (O1) and after (O2) self-administered questionnaires. While the study also includes two additional follow-up assessments (O3 and O4) that cover up to 14–16 months bereaved, this article examines only O1 and O2 assessments. Based on random assignment, 128 persons attended traditional grief groups that focused on loss-orientation (LO) in the model and 170 persons participated in groups receiving both the LO and restoration-orientation (RO) coping (learning daily life skills). As expected, participants in DPM groups showed slightly higher use of RO coping initially, but compared with LO group participants they improved at similar levels and reported similar high degrees of satisfaction with their participation (i.e., having their needs met and 98–100% indicating they were glad they participated. Even though DPM participants had six fewer LO sessions, they showed similar levels of LO improvement. Qualitative data indicate that the RO component of the DPM might be more effective if it is tailored and delivered individually.

Bereaved older adults who seek early professional help

The purpose of this exploratory study was to determine the characteristics of older bereaved spouses who sought early professional help related to their grief. Among a sample of 339 bereaved older adults, aged 50 years or older, 39 (11.5%) reported that they had obtained some form of professional help. The most commonly reported source of help sought was from clergy followed by that provided by the health-care system and community groups. Those who sought help reported higher depression, lower coping ability, and poorer perceived health as well as slightly lower self-esteem and instrumental and resource-identification skills. With a few exceptions, the particular source of help sought was not statistically related to many of the indicators examined.

Humor, laughter, and happiness in the daily lives of recently bereaved spouses.

The positive psychology movement has created more interest in examining the potential value of experiencing positive emotions (e.g., humor, laughter, and happiness) during the course of bereavement. This study of 292 recently widowed (5–24 weeks) men (39%) and women (61%) age 50 and over examined both the perceived importance of and actual experience of having positive emotions in their daily lives and how they might impact bereavement adjustments. We found that most of the bereaved spouses rated humor and happiness as being very important in their daily lives and that they were also experiencing these emotions at higher levels than expected. Experiencing humor, laughter, and happiness was strongly associated with favorable bereavement adjustments (lower grief and depression) regardless of the extent to which the bereaved person valued having these positive emotions.

Health promotion and the older population: Expanding our theoretical horizons

As the year 2000 approaches (and beyond) more health educators will be involved in the implementation of health promotion programs and related activities specifically designed for the older population. Most health educators draw upon a variety of theoretical frame-works as they design programs. Traditionally, health education has been grounded in behavior change theories such as the Health Belief Model, the Theory of Reasoned Action, and Banduras Social Learning/Cognitive Theories. When the focus is gerontological, however, an opportunity exists to expand health educations theoretical horizons by incorporating features drawn from gerontology itself. Principles of adult cognitive development, social gerontology and person-environment fit can potentially complement and supplement those models already in use as more programs are targeted for a growing older population.