Neena L. Chappell

Informal and Formal Care: Exploring the Complementarity

Although several authors have speculated about the type of relationship between informal and formal care, relatively little empirical work directly examines the interface between the two support systems. This paper examines the correlates of using neither system, only one system and several combinations of both systems. It explores the characteristics of those who do and do not make complementary use of both systems and under what circumstances the two systems are complementary. Multivariate analyses are performed, using logistic regression analyses, to examine the correlates of the different sources of support. Analyses demonstrate that those who utilize the formal care system do so while retaining care from the informal network. Use of the formal system in conjunction with informal care appears to take place in two instances:when seniors are in need and critical elements of their informal network are lacking, or when they have an intact informal support network, but their health needs are extremely high. In both of these instances the formal system enters to assist the informal network. The data point to the complementarity of the two care systems, not in terms of task specificity, but rather, in terms of a sharing of overall task load.

Confidants Do They Make a Difference in Quality of Life

This article empirically explores the interrelations of three variables-sex, marital status, and the confidant relationship-and their joint effects on quality of life. It draws on a stratified rand...

Receptivity to new technology among older adults

PURPOSE Both absolute and relative increases in the older adult population are occurring concurrently with the growth of high technology. Technological devices offer sophisticated solutions to some of the problems associated with ageing. This study borrows from the health utilization literature in order to develop and test a model for understanding receptivity to specific technological products by older adults. RESULTS Receptivity is directly influenced by predispositional, need and social support factors, as well as by ones level of concern for problems that could be alleviated through the use of technology. Hierarchical regression equations reveal that this latter variable, concern, has the strongest influence on receptivity, while need factors display strong indirect effects. Those with unsatisfactory contact with others are also more receptive, suggesting that the lack of social support acts as a need factor. Contrary to past research, women are more receptive to technology than men. CONCLUSIONS The results indicate that new technology geared toward enhancing the quality of life of seniors in their homes would be welcomed by many.

Staff-based measures of individualized care for persons with dementia in long-term care facilities

Although individualized care for persons with dementia in long-term care institutions has become accepted as best practice, there have not been easy-to-use, multi-item reliable measures of the concept for scientific research or for administrative use. Following review of the literature, consultation with experts in the field, and direct observation within long-term care facilities, three domains of individualized care (knowing the person/resident, resident autonomy and choice, communication — staff-to-staff and staff-to-resident) were chosen as appropriate for the development of multi-item paper-and-pencil staff completion scales. These scales are presented in this article, including, where appropriate, shorter scales derived from factor analyses. The findings suggest that these domains of individualized care lend themselves to brief multi-item measures and that not all conceptual domains of individualized care co-occur in practice. Further, supplemental staff training in individualized care practice may be warranted.

Behavioural Problems and Distress among Caregivers of People with Dementia

This paper seeks to identify specific problem behaviours related to the distress experienced by informal caregivers of dementia victims. Analyses are conducted using a random sample of caregivers rather than a restricted clinical sample. Distress is measured in terms of both depression and caregiver burden. The findings reveal that specific behaviours on the part of the care receiver are strong correlates of the distress experienced by caregivers. In particular, aimlessness, aggressive behaviours, forgetfulness, and restlessness are correlated with heightened feelings of burden. Apathy or a lack of interest in daily activities is strongly correlated with both feelings of burden and depression. The identification of specific problem behaviours suggests where efforts should be placed in order to alleviate the distress experienced by informal caregivers.

Mobility Restriction and the Use of Devices among Seniors

A growing population of seniors in North America, coupled with increasing life expectancies, means there will likely be increased future demand for products to alleviate mobility problems commonly faced by elders. Although past research has documented the prevalence of mobility restriction among elderly populations, and the tendency of some to seek personal assistance to alleviate their difficulties, there is little research that looks at the use of assistive devices. This study examines use among those faced with at least one of four common mobility problems. Logistic regression and analysis of variance reveal the overwhelming importance of the sheer number of mobility restrictions in determining the likelihood that an individual is a device user, over and above factors such as the severity of problems, social network characteristics, and predisposition factors.

Informal Support Networks among the Elderly

This article points to the current popularity of a family-nonfamily conceptual distinction in current gerontological research. It argues for the utility of a peer, intergenerational distinction, highlighting nonfamily age peers as an important but relatively neglected area of study. It presents empirical data exploring these concepts. It is only after a diversity of types of supports are examined (including availability of social support, interaction in and satisfaction with these relationships, and participation in various recreational activities) that the particular importance of nonfamily age peers becomes apparent. The data indicate the importance of these concepts, differentially, depending on the activity and type of interaction examined.

Aging and Late-Life Depression

Objectives: The objective of this study is to examine the relationship between age and depression among people aged 65 and older. Method: The study uses three waves of longitudinal data (1991, 1996, 2001) from a community and institutional sample of Canadians aged 65 and older. The study uses generalized linear mixed-model techniques to estimate the trajectories of depressive symptoms and major depression in late life. Results: There is a linear increase in depressive symptoms after age 65, but this occurs in the context of medical comorbidity and is not an independent effect of aging. There is a significant u-shaped relationship between age and major depression, after adjusting for selected covariates. Discussion: The relationship between age and late-life depression is complex, and it depends on how the dependent variable is measured. Late-life depression develops through a different set of risk factors than it does in earlier stages of the life course. The “fourth age” appears to be a period of psychiatric morbidity.

Social Support, Caregiving, and Aging

Cet article examine la littérature internationale rédigée en anglais sur le thème du soutien social et des soins gérontologiques depuis le début des années 1990. La littérature s’est développée, mais il manque de consensus sur le sens des termes et sur la mesure. L’intérêt reste une constante pour l’aide pratique, les prestations de soutien social, et la demande et les résultats négatifs pour les aidants, avec de plus en plus de questions plus théoriques, auxquelles on accorde de moins en moins d’importance, sur les résultats négatifs du soutien reçu, ainsi que sur les conséquences positives de la prestation de soins. Le soutien social, néanmoins, est dûment reconnu comme un déterminant social de la santé et reçoit l’attention au niveau des politiques—qui sont tous deux d’importants changements à partir de deux décennies—et ajoutent a l’intérêt ce domaine recevra de chercheurs dans les décennies à venir. Il reste de nombreuses questions sans réponses quant à l’évolution du contexte sociétal, mais il est clair que le soutien social des personnes – y compris la vieillesse et tout au long de la vie – se poursuivra dans l’avenir, quoique dans des formes toujours renouvelées. This article reviews the international English-language literature on social support and caregiving in gerontology since the early 1990s. The literature has grown, but consensus on the terms’ meaning and measurement is lacking. Interest is ongoing in practical help, in benefits of social support, and in demands and negative outcomes for caregivers, with growing but less emphasis on more theoretical questions, on negative outcomes from the receipt of support, and on positive consequences of providing care. Nevertheless, social support is duly recognized as a social determinant of health and receiving attention at policy levels – both are significant shifts from two decades ago and add to the interest this area will receive from researchers in coming decades. There remain many unanswered questions regarding the changing societal context, but it is clear that the social support of others – throughout our lives including old age – will continue in the future, albeit in ever-changing forms.

Measuring family perceived involvement in individualized long-term care

Although family involvement is considered an important aspect of care for residents with dementia in long-term care facilities, measurement is lacking. The purpose of this study is to present a multi-item reliable measurement instrument assessing family perceived involvement. Literature reviews, observations within facilities, iterative consultations with an expert panel and extensive pilot testing of items for family perceived involvement were undertaken, to establish face and content validity. Two scales were developed: family perceived involvement and family assessment of importance of their involvement in individualized care for their resident relative. Strong evidence of face and content validity, internal consistency and test-retest reliability were established for both scales. Short versions of the original scales were derived via factor analysis. These instruments provide researchers and facilities with the ability to measure both degree of family perceived involvement and the importance the family places on that involvement using a relatively brief set of statements.