William S. Shaw

ACCELERATED RISK OF HYPERTENSIVE BLOOD PRESSURE RECORDINGS AMONG ALZHEIMER CAREGIVERS

The purpose of this study was to determine whether the stress of caregiving for the Alzheimers disease (AD) patient accelerates the likelihood of exceeding hypertensive blood pressure (BP) criteria in periodic longitudinal home assessments. In this cohort study, participants consisted of spousal caregivers of AD patients (n = 144) and demographically equivalent non-caregiving controls (n = 47). Thirty percent of caregivers and 33% of controls were receiving antihypertensive treatment at study entry. Supine systolic and diastolic blood pressure (SBP and DBP) was assessed by semi-automated recordings taken in the home every 6 months for 2 to 6 years. Survival analyses (Cox proportional hazards models) were used to determine whether the hazard for developing hypertension (DBP>140, SBP>90) was greater in caregivers than in controls, and whether increased hazards were related to background characteristics or the extent of caregiving demands. Based on periodic 6-month assessments of BP over 6 years, the hazards of meeting criteria for borderline hypertension were greater for caregivers than for controls (Cox Proportional Hazards, chi2 [1, N = 174] = 4.86, p = 0.03). This difference remained statistically significant (p<0.05) after controlling for age, gender, education, socioeconomic status, body mass index, and use of antihypertensive medications. Increased risk of hypertension was not related to the extent of daily living assistance provided, patient problem behaviors, or caregiver distress. The chronic stress of caring for an AD spouse may have adverse effects on blood pressure; however, the mechanism for this relationship remains unclear.

Longitudinal analysis of multiple indicators of health decline among spousal caregivers

The hazards for experiencing major health events were studied longitudinally among 150 spousal caregivers of Alzheimer’s disease (AD) patients and 46 married control participants. Based on longitudinal assessments from one to six years, the hazards of reaching any of three health events (extended physical illness or disability >1 month, unhealthy medical rating from a nurse interview, or hospitalization) were not significantly different in a group comparison of caregivers to controls (Cox proportional hazards assumption,p>.05). However, there was a trend [X2(1,N=107)=3.13,p=.08] for caregivers to have a greater hazard for serious illness. Among caregivers only, a greater hazard for reaching at least one of these health events was associated with providing more activities of daily living (ADL) assistance [X2(1, N=125)=3.83,p=.05] but not with problem behaviors of the AD patient (p>.05). These results suggest that providing extensive ADL assistance may have health implications for spousal AD caregivers, while caregiving, per se, does not. Furthermore, these physical health impacts of caregiving may be best characterized using multidimensional assessments. Contrary to our guiding hypothesis, caregivers encountering more problem behaviors of their AD spouse were less likely to be hospitalized, X2(1, N=145)=5.88, p=.02. This finding may reflect a reluctance by caregivers to schedule necessary medical care when their spouses are most problematic, and this may have further long-term health implications for caregivers.

Relationship of psychosocial factors to HIV disease progression.

Based on the existing empirical evidence that psychosocial variables may predict the course of human immunodeficiency virus (HIV) illness, disease progression (described by advance in symptoms, decline in CD4+ cell count, and mortality) in 414 HIV-positive (HIV+) males was studied using Cox Proportional Hazards Models (survival analysis). Depressive symptoms predicted shorter longevity after controlling for symptoms and CD4+ cell count. Large social network sizes predicted longevity among those with acquired immune deficiency syndrome (AIDS)-defining symptoms at baseline, but not among other subjects. Therefore, psychosocial variables and affective states may be related to disease outcome only during later stages of HIV disease. Although the results provide support for psychoneuroimmunologic effects in HIV, other confounding explanations may still apply.

Health-related quality of life in older patients with schizophrenia and other psychoses: relationships among psychosocial and psychiatric factors.

Objective. Few multivariate studies relating psychosocial factors to symptoms of psychosis among older patients exist. We assessed environmental stressors, satisfaction with emotional support, coping responses and psychiatric symptoms, and sought to relate these factors to quality of well‐being among older patients with schizophrenia and other psychoses.

Predictors of attrition in health intervention research among older subjects with osteoarthritis.

Attrition in an experimental osteoarthritis intervention was studied among 364 (130 male) volunteers (ages 60-87). Subjects were randomly assigned to control, social support, education, or combined treatment groups. A series of discriminant function analyses showed that the final intervention groups were more homogeneous than the original samples. The most robust predictor of attrition was having either high or very low depression scores. Social support variables were predictors of poor attendance in the social support group, indicating possible attrition bias in evaluating this treatment. The results indicate that psychosocial variables may be the best predictors of attrition in health intervention research among older subjects, and that variables related to attrition can be related to the content of the intervention.

The Social Networks of Older Schizophrenia Patients

There is a paucity of research that examines the role of family members and friends in the lives of older schizophrenia patients. This study compared 66 middle-aged and elderly outpatients with 31 normal comparison subjects. Five dimensions of social network were assessed: (a) family composition, geographic proximity, and frequency of contact; (b) instrumental support; (c) emotional support and interpersonal difficulties; (d) role of friends; and (e) use of formal service providers as sources of support and assistance. As compared with normal subjects, the schizophrenia patients were less likely to be married, less likely to have children, more likely to live alone, and had fewer friendships. The patients were, however, similar to comparison subjects on the following family-relationship variables: frequency of contact, instrumental support received, presence of a family confidant, and extent of interpersonal difficulties. These findings do not support the stereotype of older schizophrenia patients as being estranged from family members. The need for developing interventions that use key family members to interface with service providers and to monitor treatment compliance and continuity of care is discussed.

Self-perceived interpersonal competence in older schizophrenia patients: the role of patient characteristics and psychosocial factors

Semple SJ, Patterson TL, Shaw WS, Grant I, Moscona S, Jeste DV. Self‐perceived interpersonal competence in older schizophrenia patients: the role of patient characteristics and psychosocial factors. Acta Psychiatr Scand 1999: 100: 126–135.

Disclosure of HIV seropositivity to sexual partners : An application of social cognitive theory

The present study used social cognitive theory to examine self-disclosure of HIV seropositivity to sexual partners in a sample of 223 HIV-positive individuals. Participants were primarily male, Caucasian, gay or bisexual, with an average age of 36 years. Eighty-two percent of the sample disclosed their serostatus to at least one sexual partner in the past 4 months; however, disclosure rates varied by gender, partner type, and number of partners. Multiple regression analyses predicting disclosure behavior on the basis of social cognitive variables revealed the significance of self-efficacy and outcome expectancies. These findings suggest the clinical importance of focusing on the enhancement of self-efficacy and positive outcome expectancies as techniques to assist clients with self-disclosure of HIV serostatus to sexual partners.

HIV-Seropositive Parents: Parental Role Strain and Depressive Symptoms

There is a paucity of studies that examine the impact of parenting strain on the mental health of HIV positive parents. This study compared HIV+ mothers and fathers on five dimensions of parenting strain, and examined sex differences in the effects of parenting strains on depressive symptoms. HIV+ mothers reported significantly more emotional/behavioral problems of children, more child physical health problems, and more child-related financial strain as compared to HIV+ fathers. The groups did not differ on mean levels of intrapsychic strain or interpersonal strain related to children. Increased parental role strain was associated with increased depressive symptoms, irrespective of the sex of the parent. Future research should assess the extent to which these findings are attributable to HIV serostatus.

Health and Well-Being in Retirement

To consider the topic of retirement as a special clinical issue in this book alongside the comparatively severe Stressors of chronic pain, elder abuse, caregiving, and bereavement may seem unwarranted to some. Retirement is now a normative process for most older workers, and available pension and savings plans have greatly eased the financial burdens of retirement. Yet, for many individuals, retirement may represent the single largest lifestyle transition since early adulthood. Therefore, this period of social development and its mental and physical health implications have continued to be a subject of theoretical speculation and empirical study. Retirement may alter family dynamics and social networks, challenge one’s sense of self-worth and accomplishment, and prompt reprioritization of personal values and interests. The decision to retire may also be influenced by a complex set of variables, including physical health, occupational attitudes, personal values, and secular trends. By studying the antecedents and consequences of retirement, social scientists have sought to identify factors that contribute to a successful and healthful retirement process.