Sara Sanders

Loneliness and depression in independent living retirement communities: risk and resilience factors

Socio-emotional selectivity theory posits that as individuals age, they desire less social stimulation and novelty, and tend to select close, reliable relationships to meet their emotional needs. Residence in congregate facilities affords social exposure, yet does not guarantee access to close relationships, so that loneliness may be a result. Further, the gerontology literature has suggested that loneliness in late life may be a risk factor for serious mental health concerns such as depression. This article examined data on loneliness and depressive symptoms from older adults aged 60–98, residing in two age-segregated independent living facilities. Overlap between those scoring in the depressed range on the Geriatric Depression Scale and those scoring more than one standard deviation above the mean on the UCLA Loneliness Scale was less than 50%, although zero-order correlation of the two continuous scores was moderately high. Potential risk and resilience factors were regressed on the continuous scores of the two scales in separate hierarchical multiple regression analyses. Depression was predicted by being older, number of chronic health conditions, grieving a recent loss, fewer neighbor visitors, less participation in organized social activities and less church attendance. Grieving a recent loss, receiving fewer visits from friends, and having a less extensive social network predicted loneliness. In addition, loneliness scores explained about 8% of the unique variance in depression scores, suggesting it is an independent risk factor for depressive symptoms. Loneliness scores were seen to be more widely dispersed in these respondents, with less variance explained by the available predictors. Suggestions are made for addressing loneliness in older adults as a means of preventing more serious mental health consequences.

The Experience of High Levels of Grief in Caregivers of Persons with Alzheimer's Disease and Related Dementia

An abundance of literature on caregivers of individuals with dementia has been written since the mid-1980s. However, most of this literature focused on the experience of stress, burden, and depression in caregivers, thus excluding the grief experience that also accompanies the caregiving experience. The purpose of this multimethod study is to describe the lived experience of 44 spouses and adult children who are caregivers of persons with Alzheimers disease and related dementias (ADRD) and scored high on the Marwit and Meuser Caregiver Grief Inventory, Short Form (MM-CGI-SF). This study presents qualitative results from a mixed-methods descriptive study (N = 201). Seven themes emerged from the qualitative data that detailed the caregiving experience of the individuals with high grief: (a) yearning for the past, (b) regret and guilt, (c) isolation, (d) restricted freedom, (e) life stressors, (f) systemic issues, and (g) coping strategies. The first 2 themes reflect grief reactions, whereas isolation, restricted freedom, life stressors, and systemic issues possessed elements of both grief and caregiver burden and stress. Coping strategies used by this group of caregivers included spiritual faith, social supports, and pets. Quantitative analysis confirmed that these themes are unique to individuals with high levels of grief compared with those with moderate/low levels of grief, except for the coping strategies of social support and spiritual faith. Caregivers with high levels of grief may benefit from supportive interventions that are based on reducing feelings of isolation, lack of freedom, and increased guilt and regret, while also addressing feelings of loss. Interventions that facilitate building a supportive network are suggested. Using a screening tool such as the MM-CGI-SF will help in identifying caregivers with high levels of grief who may be in need of additional support.

Chapter 8; Alzheimer's Disease and Related Dementias

SUMMARY The number of individuals with Alzheimers disease or a related dementia is growing at a staggering rate. Thus, it is essential that social workers in geriatric settings are knowledgeable about this disorder and the appropriate interventions to use at all stages of the disease. The purpose of this article is to examine the types of non-pharmacological, psychosocial treatments that are used to manage the behavioral manifestations and changes in the mood of individuals with Alzheimers disease or a related dementia. While great strides have been made in pharmacological treatments of Alzheimers disease, less attention has been given to the types of psychosocial interventions that are readily employed in community-based and long-term care settings to assist in the care of these individuals. This article provides an overview of psycho-social interventions, as well as identifies the direction for future evidence-based treatment studies, for individuals with Alzheimers disease and related dementia.

Is the glass half empty or full? Reflections on strain and gain in cargivers of individuals with Alzheimer's disease.

Abstract While caregivers of individuals with Alzheimers disease or a related dementia experience a range of caregiving burdens or strains, it has been found that they also experience positive outcomes or gains. This study examined both the caregiver strains and gains in a diverse urban sample of 85 caregivers (spouses and adult children). Eighty-one percent of the caregivers reported both strains and gains, while 19% of the caregivers reported only experiencing strains. The caregiver strains originated from worries and uncertainties, balancing multiple demands, and feeling overwhelmed with care, while spiritual growth, personal growth, and feelings of mastery produced feelings of gain. Implications for clinical social work practice will be presented.

Are They Grieving? A Qualitative Analysis Examining Grief in Caregivers of Individuals with Alzheimer's Disease

Abstract Although there is an abundance of caregiving literature, there is a paucity of research that examines the grief reactions of care-givers of individuals with Alzheimers disease. Qualitative research methodology was utilized to identify themes about the grief reactions expressed by caregivers. Results found that although some caregivers reported that they were not grieving, there was still a strong sense of loss in their descriptions of their caregiving experience. Additionally, for the caregivers who reported that they were grieving, their grief was characterized by multiple losses that accumulated during the disease process.

Alzheimer’s Caregiver Differences in Experience of Loss, Grief Reactions and Depressive Symptoms Across Stage of Disease A Mixed-Method Analysis

The self-reported losses, grief reactions, and depressive symptoms experienced by caregivers in the early, middle, and late stages of dementia were assessed using open-ended descriptive questions and scaled measures including the Meuser-Marwit Caregiver Grief Inventory (MM-CGI; Marwit & Meuser, 2002). Ninety-nine caregivers associated with an urban Alzheimer’s Association chapter were surveyed by post. While there were moderate levels of grief and depression reported across the entire sample, those caring for individuals in the late stage of dementia reported significantly more symptoms of grief and depression than those in the early or middle stages. Responses to open-ended questions regarding losses and grief also differed across the groups in the three disease stages. The late-stage group’s comments most resembled bereavement, in keeping with the higher grief and depression scores among members of this group. Findings suggest there are different emotional tasks faced by caregivers as the dementia progresses, and it is important to acknowledge the particular losses and facilitate grieving at each stage.

A Pilot Study About the Needs of Older Gays and Lesbians: What Social Workers Need to Know

Abstract In a pilot study, a population of gay and lesbian elders were surveyed to determine what types of long term plans they have made in preparation for their old age, what types of information they feel service providers need to know to better meet their long-term needs, and what is their perception of aging. The results of this pilot study demonstrated that almost three-fourths of the total sample have started to make plans for growing old. The respondents reported that social workers needed to be more knowledgeable about gay lifestyles and the importance of their partners. It was also found that the views of aging became more positive as the gay and lesbian individuals grow older.

The Secondary Traumatic Stress Scale (STSS): Confirmatory Factor Analyses with a National Sample of Mental Health Social Workers

SUMMARY The Secondary Traumatic Stress Scale (STSS; Bride, Robinson, Yegidis, & Figley, 2004) is an easy to administer 17-itemself-report measure of secondary trauma. Bride et al. (2004) reported a measure of three domains of traumatic stress specifically associated with secondary exposure to trauma: intrusion, avoidance, and arousal. The STSS was reported to have high levels of internal consistency reliability and indicated evidence of convergent, discriminant, and factorial validity. The purpose of this paper is to examine the reliability and validity of the STSS with a national, random sample of mental health social workers. To assess the fit of the data to the three-factor structure proposed by Bride et al., a confirmatory factor analysis was performed on data from 275 social workers who indicated exposure to client trauma. The model fit the data adequately although high factor intercorrelations strongly suggest a unidimensional scale. Subsequent confirmatory factor analysis of a unidimensional scale and a second order factor analysis yielded similar results. Findings indicate the need for further scale validation. Challenges remain for measuring and distinctly differentiating between secondary trauma symptoms of arousal, avoidance, and intrusion. Implications and suggestions for future research are discussed.

Assessing and treating pain in hospices: current state of evidence-based practices

The aim of this study was to report on current provider evidence-based assessment and treatment practices for older adults with cancer in community-based hospice settings. Using the Cancer Pain Practices Index, a tool developed by the researchers to measure evidence-based pain management practices, patients received an average of 32% of those key evidence-based practices (EBPs) that were applicable to their situations. When examining individual practices, most of the patients had their pains assessed at admission using a valid pain scale (69.7%) and had primary components of a comprehensive assessment completed at admission (52.7%); most patients with admission reports of pain had an order for pain medication (83.5%). However, data revealed a number of practice gaps, including additional components of a comprehensive assessment completed within 48 hours of admission (0%); review of the pain treatment plan at each reassessment (35.7%); reassessment of moderate or greater pain (5.3%); consecutive pain reports of 5 or greater followed by increases in pain medication (15.8%); monitoring of analgesic-induced side effects (19.3%); initiation of a bowel regimen for patients with an opioid order (32.3%); and documentation of both nonpharmacological therapies (22.5%) and written pain management plans (0.6%). Findings highlight positive EBPs and areas for improving the translation of EBPs into practice. Data suggest that cancer pain is not being documented as consistently assessed, reassessed, or treated in a manner consistent with current EBP recommendations for older adults with cancer in community-based hospices.

Prevalence of and Reactions to Fatal and Nonfatal Client Suicidal Behavior: A National Study of Mental Health Social Workers:

A majority of mental health social workers come in contact with suicidal clients during their career. As a result, social workers may experience high levels of stress that can ultimately impact their quality of and ability to practice. The present study examined the prevalence of fatal and nonfatal client suicidal behavior experienced by mental health social workers and examined their subsequent reactions. A random national sample of 697 mental health social workers from the NASW database was anonymously surveyed. Findings indicate that both fatal and nonfatal client suicidal behavior is not a rare occurrence for mental health social workers and that both types of behaviors relate to increased levels of subjective stress as measured by the Impact of Event Scale (IES);. Implications of these findings are discussed.