Beyond the Chi-Square Caregivers Are More Than Just Faceless Statistics A multitude of research studies have examined family caregiver stress and burden. For the most part. Results from these projects describe group characteristics in quantitative statistical terms. In many cases, this method of evaluation may diminish the intense emotional and physical toll caregiving has on the lives of individual caregivers and care receivers. Far fewer articles are devoted to the stories behind the numbers to focus on the individual mental and physical strain caregivers endure. This article translates statistical research into Benrose, realistic portrayals of the daily lives of overburdened caregivers. These illustrations can be utilized by case managers to provide more unique. Flexible, innovative, and diverse solutions to alleviate the intense emotional and physical stress experienced by caregivers. The development and reporting of research studies must achieve a balance between quantitative and qualitative methodology and provide an application for practical use. Read more
Accuracy and Consistency of Responses From Persons With Cognitive Impairment This study examines the ability of persons with cognitive impairment (n = 111) to provide consistent and accurate responses to questions about demographic characteristics and basic preferences. Persons with cognitive impairment were interviewed twice within a week using a parallel interview to determine stability and accuracy of responses. Family caregivers were interviewed once within the same time period. In general persons with mild to moderate cognitive impairment (i.e. MMSE scores from 13–26) were accurate and reliable in their ability to respond to questions about demographics and basic preferences. These results add further support to past findings that persons with cognitive impairment can be active participants in both research and practice. Read more
Successful Aging in the Face of Chronic Disease Successful aging represents a positive development in gerontological theorizing, for it has shifted the focus away from viewing older adults as a dependent group whose problems tax the resources of society to considering the contributing potential of older adults. This shift has been labeled as a move from dependency to autonomy or agency-based models of aging (Midlarsky & Kahana, 1994). The emphasis on successful aging or aging well helps dispel negative stereotypes and removes some of the stigma associated with being an aged person. Models of successful aging have sought to understand the resources and behaviors that facilitate aging well and typically point to the maintenance of healthy lifestyles as deterrents to chronic illness and attendant impairments (Rowe & Kahn, 1998). Behind the optimistic message of these models of successful aging, however, there lies an exclusionary orientation, whereby chronically ill and disabled older adults do not have a place at the table of successful aging. This chapter articulates a model of successful aging we developed (Kahana & Kahana, 1996; 2003; Kahana, Kahana, & Kercher, in press), which allows for understanding criteria of successful aging that are based on human agency and are particularly salient for the many older persons facing the challenges of chronic illness. It is particularly important to study how older people can cope with chronic disease, because over 100 million Americans have chronic health problems (Robert Wood Johnson Foundation, 1996), with rates of chronic disease increasing with age. The prevalence of chronic health problems will continue to grow as people live longer and as the large cohort of baby boomers ages in upcoming years. Chronic health problems have negative consequences for both individuals and society. Chronic disease can lead to disability, additional health problems, and reduced quality of life (Jette, 1996; National Center for Chronic Disease Prevention and Health Promotion, 2002). Of those who have a chronic health problem, one third of those ages 65-74 and 45% of those ages 75 and older are limited in their activities because of health problems (National Academy on an Aging Societ Read more
Outcomes for Patients with Dementia from the Cleveland Alzheimer’s Managed Care Demonstration This investigation evaluates effects of care consultation delivered within a partnership between a managed health care system and Alzheimer’s Association chapter. Care consultation is a multi-component telephone intervention in which Association staff work with patients and caregivers to identify personal strengths and resources within the family, health plan, and community. The primary hypothesis is that care consultation will decrease utilization of managed care services and improve psychosocial outcomes. A secondary modifying-effects hypothesis posits benefits will be greater for patients with more severe memory impairment. The sample is composed of managed care patients whose medical records indicate a diagnosis of dementia or memory loss. Patients were randomly assigned to an intervention group, which was offered care consultation in addition to usual managed care services, or to a control group, which was offered only usual managed care services. Data come from two in-person interviews with patients, and medical and administrative records. Results supporting the primary hypothesis show intervention group patients feel less embarrassed and isolated because of their memory problems and report less difficulty coping. Findings consistent with the modifying-effects hypothesis show intervention group patients with more severe impairment have fewer physician visits, are less likely to have an emergency department visit or hospital admission, are more satisfied with managed care services, and have decreased depression and strain. Read more
Planning for the Future Together in Culturally Diverse Families Making Everyday Care Decisions The stress of providing long-term care to a relative with a cognitive impairment (eg. dementia) is often compounded by the difficulties encountered when making care decisions on behalf of the individual (ie. care receiver). This article describes research within culturally diverse families that explores decision making in everyday care from the perspective of both the caregiver and the care receiver. Our findings suggest that persons with cognitive impairments are able to express preferences for care, and that there are more similarities than differences across culturally diverse families. Read more
Circumstances Leading to Placement A Difficult Caregiving Decision Due to advances made in medicine and healthcare, older adults are living longer but enduring problems with physical functioning and health over longer periods of time. In addition, the percentage of older adults with cognitive impairments is increasing. Caregiving duties, which decades ago lasted for months, now last for years. This long-term strain of caring for an older adult who is physically and/or cognitively impaired may lead many caregivers to feel frustrated, angry, overwhelmed, and isolated. As a result of this stress many caregivers resort to nursing home placement. The Caregiver Options Program and Evaluation research project was undertaken to provide service options to participating caregivers to alleviate some of the debilitating stress associated with caregiving and postpone institutionalization. Results of logistic regression indicate the predictors of nursing home placement were whether the caregiver felt she/he had provided good care, and whether the elder had a problem with household tasks and/or woke the caregiver or other family members up during the night. Findings suggest that elderly care receivers who are predominately low-to-middle income have a physical and/or cognitive impairment, along with their caregivers, need to be especially targeted for help by case managers early in the caregiving process before placement becomes the only alternative. Read more
The Cleveland Alzheimer’s Managed Care Demonstration Outcomes After 12 Months of Implementation Read more
Impact of Family Members on Nurse Assistants What Helps, What Hurts This qualitative study focuses on nurse assistant reports of both positive and negative behaviors exhibited by family members of cognitively impaired residents. The information reported is obtained from in-person interviews with 114 nurse assistants in 5 skilled nursing facilities (3 philanthropic, 2 proprietary) in Greater Cleveland, Ohio. Nurse assistants were predominantly female (89 percent), white (60 percent), with a mean age of 33, and had been caring for cognitively impaired nursing home residents for an average of five years. Content analyses of nurse assistants’ responses reveal five categories of family members’ positive behaviors and four categories of negative behaviors. This article focuses on these themes and suggests topics for educational interventions for family members and nurse assistants who care for cognitively impaired nursing home residents. Topics include coping with family members’ feelings of guilt and related behaviors, understanding longstanding family relationship issues, and understanding possible reasons for decisions family members make regarding care of their relatives. Read more
