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PURPOSE: This report describes the implementation of a novel, patient-driven approach to recruitment for a study of interpersonal communication in a primary care setting involving persons with Alzheimer's disease (AD), their family caregivers, and their primary care providers (PCPs). DATA SOURCES: Patients and caregivers were centrally recruited from a university-based memory clinic, followed by the recruitment of patient's individual PCPs. Recruitment tracking, naturalistic observation, and survey methods were used to evaluate recruitment success. CONCLUSIONS: About half of the patients and caregivers (n = 54; 51%) and most of the PCPs (n = 31; 76%) who we approached agreed to an audiorecording of the patient's next PCP visit. Characteristics of patient, caregiver, and PCP participants were compared to those of nonparticipants. Patient characteristics did not differ by participation status. Caregivers who volunteered for the study were more likely to be female and married than were those who declined to participate. Compared to nonparticipants, PCPs who agreed to the study were appraised slightly more favorably by patients' caregivers on a measure of satisfaction with care on the day of the visit. The vast majority of participating PCPs (95%) reported that the study had little or no impact on the flow of routine clinical operations. IMPLICATIONS FOR RESEARCH: Findings support the feasibility of a patient-driven approach to recruitment for studies involving multiple linked participants. Our discussion highlights possible advantages of such an approach, including the potential to empower patient participants while achieving maximum variability within the pool of clinician participants. [ABSTRACT FROM AUTHOR]

Inclusion of a close family member (e.g., the spouse) in psychosocial interventions for chronic illness may be more efficacious than focusing solely on the patient. This article reviews and synthesizes randomized, controlled studies designed to address this question (k=12) with various illness populations (heart disease, arthritis, chronic pain, and Type 2 diabetes). For patients, 5 out of 12 studies showed consistent evidence that a family-oriented approach was more beneficial than patient-oriented intervention, whereas 1 study showed that patient intervention provided an advantage over family intervention. In the remaining studies, the more efficacious approach depended on patient gender, the use of cognitive-behavioral intervention strategies, and the time of follow-up assessment. Benefits for family members were rarely assessed, with 1 study showing an advantage for couples intervention. Carefully designed studies are needed to evaluate the benefits of this psychosocial treatment approach, for both the patient and the family member. [ABSTRACT FROM AUTHOR]

We examined relationships between feelings of mastery and self-esteem in a given role (role adequacy) and caregivers' social and psychological well-being over time. Seventy-five women who occupied the roles of caregiver, mother and wife were assessed twice over a two month interval. Caregiver role adequacy predicted greater family cohesion and marital satisfaction, wife role adequacy predicted greater family cohesion, and mother role adequacy predicted less negative affect. Findings indicate that women can gain a sense of self- worth and mastery through caregiving, and underscore the importance of these role- specific resources to women's psychosocial well-being. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to examine the degree of individual change in structural indicators of social support (family network contact and close friend network contact) and functional indicators of social support (belonging, appraisal, and tangible support) during late life. METHODS: Using a large population-based sample of older adults, hierarchical linear modeling was applied to examine the extent of change in social contact and support as well as sociodemographic characteristics (age, race, gender, and education) that might explain individual variability in contact and support at baseline and over time. RESULTS: Consistent with predictions, small yet significant increases were observed in belonging support and tangible support. Contrary to predictions, no evidence was found for significant individual change in family network contact, close friend network contact, or appraisal support. Sociodemographic characteristics were more consistent predictors of variability in contact and support at baseline than variability over time. DISCUSSION: The findings of this study add to a growing literature suggesting that late life is not typically characterized by a decline in important social resources. [ABSTRACT FROM AUTHOR]

This study applied theory from the general work and family literature to the dual roles of work and caregiving, in order to examine whether level of satisfaction and time involvement in each of these roles moderate the effects of stress in the other role on well-being. Respondents were 118 employed women who were providing care to an impaired parent or parent-in-law. As predicted, greater time involvement in work was found to buffer women from the negative effects of caregiving stress. Satisfaction with caregiving and satisfaction with work were directly associated with better well-being, beyond the effects of stress in both roles. However, women who experienced high levels of caregiving stress and who were highly satisfied with work were especially vulnerable to depression. These findings illustrate the importance of examining the effects of caregiving stress on well-being in the context of work-related experiences. [ABSTRACT FROM AUTHOR]

A laboratory study of older adults with osteoarthritis and their spouses was conducted to examine the unique influence of exposure to suffering on caregivers' risk for impaired psychological and physical health. Spouses' blood pressure (BP) and heart rate (HR) were monitored during 2 tasks designed to capture their partners' suffering. First, spouses watched their partners (and a stranger) carry heavy logs across an 8-ft space for 3 min, a task that elicited pain expression. Second, spouses spoke about their partners' suffering (and also about a typical meal with their partners). Results showed that spouses' BP and HR increased when watching and talking about their partners' suffering, and exposure to a partner's suffering was more physiologically stressful than to a stranger's suffering. These findings suggest that heightened physiological stress caused by exposure to a loved one's suffering may be one pathway to caregivers' increased risk for cardiovascular disease. [ABSTRACT FROM AUTHOR]

This study examined interrole conflict experienced by 278 women who simultaneously occupied 4 roles: parent care provider, mother to children at home, wife, and employee. Compared with women who experienced no conflict between parent care and their other roles, women reporting parent care conflict tended to have fewer socio-economic resources, to have older children, and to be caring for parents with greater impairment. Women who reported conflicts between parent care and employment were older; had more education; had marriages of longer duration; and had older, more self-sufficient children than women who reported conflict between the parent care role and the mother role. Some evidence was found for the hypothesis that interrole conflict between parent care and other roles mediates the relationship between parent care stress and psychosocial well-being. Results suggest that one way parent care stress exerts its deleterious effects on the well-being of adult daughters is through the incompatible pressures of parent care and other roles. [ABSTRACT FROM AUTHOR]

Context: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative.Objective: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death.Design and Setting: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998.Participants: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52).Main Outcome Measures: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants.Results: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively).Conclusions: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss. [ABSTRACT FROM AUTHOR]