Silvia Sörensen

Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis.

Providing care for a frail older adult has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. In this meta-analysis, the authors integrated findings from 84 articles on differences between caregivers and noncaregivers in perceived stress, depression, general subjective well-being, physical health, and self-efficacy. The largest differences were found with regard to depression (g = .58), stress (g = .55), self-efficacy (g = .54), and general subjective well-being (g = -.40). Differences in the levels of physical health in favor of noncaregivers were statistically significant, but small (g = .18). However, larger differences were found between dementia caregivers and noncaregivers than between heterogeneous samples of caregivers and noncaregivers. Differences were also influenced by the quality of the study, relationship of caregiver to the care recipient, gender, and mean age of caregivers.

Influences of Socioeconomic Status, Social Network, and Competence on Subjective Well-Being in Later Life: A Meta-Analysis

Meta-analysis is used to synthesize findings from 286 empirical studies on the association of socioeconomic status (SES), social network, and competence with subjective well-being (SWB) in the elderly. All three aspects of life circumstances are positively associated with SWB. Income is correlated more strongly with well-being than is education. The quality of social contacts shows stronger associations with SWB than does the quantity of social contacts. Whereas having contact with friends is more strongly related to SWB than having contact with adult children, there are higher associations between life satisfaction and quality of contact with adult children when compared with quality of friendships. Moderating influences of gender and age on the effects of SES, social network, and competence on SWB are also investigated.

Helping caregivers of persons with dementia: which interventions work and how large are their effects?

BACKGROUND In recent years, many different forms of interventions for caregivers of people with dementia have been developed. However, their results have been, in part, inconclusive. METHODS Meta-analysis was used to integrate the results of 127 intervention studies with dementia caregivers published or presented between 1982 and 2005. RESULTS Interventions had, on average, significant but small effects on burden, depression, subjective well-being, ability/knowledge and symptoms of care recipient. Only multicomponent interventions reduced the risk for institutionalization. Psychoeducational interventions that require active participation of caregivers had the broadest effects. Effects of cognitive-behavioral therapy, support, counseling, daycare, training of care recipient, and multicomponent interventions were domain specific. The effect sizes varied by study characteristics, such as caregiver gender and year of publication. CONCLUSIONS Because most interventions have domain-specific outcomes, clinicians must tailor interventions according to the specific needs of the individual caregivers. Although more recent interventions showed stronger effects, there is room for further improvements in interventions.

Spouses, adult children, and children-in-law as caregivers of older adults: a meta-analytic comparison.

The present meta-analysis integrates the results from 168 empirical studies on differences between caregiving spouses, adult children, and children-in-law. Spouses differ from children and children-in-law significantly with regard to sociodemographic variables; also, they provide more support but report fewer care recipient behavior problems. Spouse caregivers report more depression symptoms, greater financial and physical burden, and lower levels of psychological well-being. Higher levels of psychological distress among spouses are explained mostly--but not completely--by higher levels of care provision. Few differences emerge between children and children-in-law, but children-in-law perceive the relationship with the care recipient as less positive and they report fewer uplifts of caregiving.

Dementia care: mental health effects, intervention strategies, and clinical implications

Caring for elderly people with dementia is associated with well-documented increases in burden, distress, and decrements in mental health and wellbeing. More severe behavioural, cognitive, and functional impairments in a patient are associated with higher levels of burden and distress. Distress increases with care hours per week, number of tasks, and declining coping and support resources. Demographic factors also affect levels of burden and distress. Promising, evidence-based interventions exist, but substantial economic and policy barriers preclude their widespread dissemination. Health-care policy makers should consider addressing these barriers; clinicians and families must campaign for reimbursement; and clinical researchers must develop more potent preventive interventions. In this article we review how dementia care affects the mental health of the carer and identify interventions that might be useful in mitigating carer burden and distress.

Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison

The present meta-analytic study gives a systematic review of research on depression and the subjective well-being of caregivers. We integrate results from 60 studies on informal caregivers’ subjective well-being (e.g., positive affect, life-satisfaction) and contrast them with the result of studies on caregiver depression. Analyses were based on a two-factor model of subjective well-being that distinguishes between positive and negative dimensions of well-being (e.g., happiness and depression). The strongest effects were domain-specific: uplifts of caregiving were associated with subjective well-being and caregiving stressors were associated with depression. In addition, weaker effects that crossed domains were present: uplifts were weakly associated with depressive symptoms. In addition, lower levels of caregivers’ subjective well-being were weakly related to care receivers’ physical and cognitive impairments, as well as behaviour problems, but not to the amount of caregiving. Type of care recipients’ illness and the measure of well-being moderated, in part, the association between stressors/uplifts and subjective well-being.

Racial and ethnic differences in the relationship of caregiving stressors, resources, and sociodemographic variables to caregiver depression and perceived physical health.

Racial and ethnic differences in the association of stressors, resources, and sociodemographic characteristics with depressive symptoms and perceived physical health were investigated. Data from 653 White non-Hispanic caregivers, 278 African American, and 218 Hispanic Alzheimers caregivers (209 males, 940 females) who were assessed at the baseline data collection of the REACH study, a multisite trial of caregiver interventions, was obtained. Multiple sample analysis, which allows testing whether a pattern of relationships is invariant across different samples, was used. Results support the hypothesis that, despite significant differences in resources and stressors, the predictors of depression and health are relatively uniform across groups. Ethnic differences were found for the effect of age, income, gender, and care receivers self-care impairments on caregiver depression. For perceived physical health, there were ethnic differences for the effect of income, gender, and type of caregiver relationships.

Personality is associated with perceived health and functional status in older primary care patients.

Using data collected on 265 primary care medical patients 60 years of age and older, the authors examined the personality bases of subjective health (perceived health, functional status) after controlling for observer-rated depression and medical burden. Four hypotheses were tested: High Neuroticism is associated with poorer perceived health, low Extraversion is associated with poorer perceived health, low Openness to Experience is associated with worse functional status, and age moderates the relationships between personality and subjective health. Findings supported the notion that personality is associated with subjective health; moreover, this effect appeared to grow more pronounced with increasing age. This study underscores the conceptual and heuristic value of examining moderators of the links between personality variables and health.

CHANGES IN ATTITUDES AMONG CHILDREN AND ELDERLY ADULTS IN INTERGENERATIONAL GROUP WORK

Negative attitudes among members of different age groups interfere with intergenerational communication. Changes in intergenerational attitudes in 32 8- to 11-year-old children and 20 elderly adults were investigated using activity groups. Applying the theory of realistic intergroup conflict, we varied the amount of joint activity between groups. In the experimental group, joint activities (e.g., writing stories, making glove puppets, performing a puppet show) were organized by the researcher. In the control group, although there was visual contact among them, the children and elderly participants worked alone. The elderly adults ratings of the participating children became more positive only in the experimental group. However, childrens ratings of the elderly participants improved regardless of the experimental condition. Seven weeks after the end of the intervention, only the children s changes in attitudes toward the elderly participants remained significant. Improvements in intergenerational attitudes during group activities were associated with increased frequency of intergenerational contact outside the group.Negative attitudes among members of different age groups interfere with intergenerational communication. Changes in intergenerational attitudes in 32 8- to 11-year-old children and 20 elderly adults were investigated using activity groups. Applying the theory of realistic intergroup conflict, we varied the amount of joint activity between groups. In the experimental group, joint activities (e.g., writing stories, making glove puppets, performing a puppet show) were organized by the researcher. In the control group, although there was visual contact among them, the children and elderly participants worked alone. The elderly adults ratings of the participating children became more positive only in the experimental group. However, childrens ratings of the elderly participants improved regardless of the experimental condition. Seven weeks after the end of the intervention, only the children s changes in attitudes toward the elderly participants remained significant. Improvements in intergenerational attitude...

Issues in Dementia Caregiving: Effects on Mental and Physical Health, Intervention Strategies, and Research Needs

In 2005, Vitaliano et al.1 called in the American Journal of Geriatric Psychiatry for more caregiver research in geriatric psychiatry. Since 2005, caregiver outcomes have been addressed in more than 800 studies and reviews. This great outpouring of research reflects the perceived need for caregiver support that will inevitably accompany the vast increase in size of the older adult population in coming decades. As well, it reflects growing understanding of the complex determinants of adverse health outcomes of caregiver burden, and therefore the study of approaches to its mitigation. This issue of the Journal adds three studies to this growing and increasingly sophisticated literature. One by Gaugler et al.2 highlights the important role that caregiver burden plays in mediating the oft-noted relationship between patient behavioral disturbance and nursing home admission. Two others report on results of multifaceted interventions tested in randomized controlled trials. Bakker et al.3 show that an intervention with multiple components assembled to meet the specific needs of an individual older adult and their caregiver resulted in caregiver assessments of significantly reduced neuropsychiatric symptoms and perceived burden. Examining implementation of care in a “real world” community context, Spijker et al.4 tested whether training of health professionals in the delivery of an intervention designed to support caregivers’ effectiveness reduced the need for institutional care. Revealing no significant impact, the findings provide helpful insights into the program and provider characteristics that may influence an intervention’s effectiveness, and which require additional study. Together, the studies build on an increasingly robust body of evidence to guide development and implementation of interventions to reduce caregiver burden and its related costs. We will attempt to place them in context by combining the Stress Process Model5 and the Appraisal Model6 into one heuristic conceptual framework (Figure 1). The models suggest that caregivers appraise caregiving events and then respond with particular behaviors. Emotional, psychological, and health outcomes follow these behaviors. FIGURE 1