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
Decision-Making for Persons with Cognitive Impairment and Their Family Caregivers Despite the large number of persons affected by cognitive impairment, very little is known about how they and their families make choices and decisions about everyday living and long-term care. Moreover, few studies have examined the concept of consumer direction, particularly the ability of cognitively impaired persons to delegate decision-making to other persons. This study explored decision-making through personal interviews with 51 respondent pairs, or dyads (i.e., the cognitively impaired person and the family caregiver). Results suggest that persons with mild to moderate cognitive impairment are able to answer questions about their preferences for daily care and to choose a person, usually a spouse or adult child, to make a variety of decisions on their behalf. By recognizing both voices—those of the care receiver and the family caregiver—we can enhance future research and practice, foster the development of consumer direction in long-term care, and advance public policy to support caregiving families. Read more
Case Management for Caregivers This article originally was prepared as a resource guide to assist the nation's Area Agencies on Aging as they begin developing or expanding services for the caregivers of older adults. A seminal question they face is how to provide case management service for this particular target population. The article reviews the literature on case management service generally, including its goals, functions, models, and outcomes. Its primary purpose, however, is to explicate the specific issues for providers to consider when planning and implementing case management service for caregivers. The article concludes with recommendations based on the results of evaluation research to maximize the benefits of caregiver services. Read more
Caregiving as a Dyadic Process Perspectives from Caregiver and Receiver Most family caregiving research has relied on the perspective of the caregiver but has not systematically examined the views and opinions of the elder who is receiving care. The present study examined 63 caregiving dyads to determine how the responses of each member had an impact on the well-being of the other member of the dyad. Caregiver relationship strain predicted his or her own depression and negative health, but no significant association was found between caregiver and care recipient outcomes. Multilevel modeling was used to assess the level of dyadic discrepancy over the care recipient’s needs and appraisal of caregiving difficulties. Results indicate that there is little disagreement over the care recipient’s needs, but a significant amount of variation in how much the care recipient and caregiver agree on their appraisals of caregiving difficulties. Relationship strain perceived by the caregiver, but not the care recipient, was significantly associated with this disagreement. Read more
