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Purpose: Specific stressors associated with caregiving in Mexican American (MA) families are not well documented, yet caregiving issues are paramount because informal care for parents is central to their culture. Although MA families who band together to provide care for one member are not unique, the literature does not describe the phenomenon of collective caregiving, which may be widespread but unrecognized. This article describes these understudied families who are poorly served by contemporary health systems because their characteristics are unknown., Design: Descriptive, multisite, longitudinal mixed-methods study of MA caregiving families., Findings: We identified three types of collective caregivers: those providing care for multiple family members simultaneously, those providing care successively to several family members, and/or those needing care themselves during their caregiving of others., Discussion and Conclusions: Collective caregiving of MA elders warrants further investigation., Implications for Practice: Exploration of collective caregiving may provide a foundation for tailored family interventions.

Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the "point of reckoning" in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver. Ninety-three of 116 caregivers recognized and spontaneously reported a "reckoning point" that initiated the caregiving trajectory, while eight cited "gradual decline" into caregiving for elders in their homes. This "reckoning point," which marks the assumption of this role, may afford a fertile opportunity for referral to community resources or initiation of formal PEOLC, thereby improving the quality of life for these older individuals and their families., (© The Author(s) 2016.)

La familia drives elder care in Mexican-American (MA) families, but nursing home placement can result from day-to-day caregiving demands that increase caregiver difficulty with activities of daily living (ADLs). Using life course perspective, this article describes the initial data wave of 31 MA caregivers from a descriptive, longitudinal, mixed-methods study of 110 MA caregivers and care recipients over 15 months in their caregiving trajectories. Fifteen of 31 caregivers consistently indicated "no help needed" on the Katz ADL, whereas all but one reported "help needed" during semistructured interviews with cultural brokers. In addition to the discrepancy between results on the Katz ADL and interviews, findings include consideration of nursing home placement by moderately acculturated caregivers and minimization of their illnesses by caregivers. Additional methods of MA caregiver assessment may be needed due to the questionable accuracy of the Katz ADL; additional research should explore minimization and acculturation in MA caregivers.

Family caregivers of older adults with significant cognitive and/or physical impairment are at increased risk for both psychiatric and physical morbidity. This article examines the research literature dedicated to the development of effective interventions to reduce distress and enhance well-being for these caregivers. Using a recent empirically based treatment (EBT) review of the literature as a backdrop, 3 overarching types of interventions were described as effective: psychoeducational skill building, psychotherapy (cognitive-behavioral in focus), and multicomponent (using a combination of at least 2 approaches such as education, family meetings, and skill building). Suggestions are made to facilitate future caregiver intervention research and translation of EBTs into the community including the need to expand rigorous research with caregivers of older adults facing problems other than dementia, including older patients with psychiatric problems; develop and test interventions designed for transitions into and out of the caregiving roles, as well as interventions designed to improve physical health outcomes and promote health behaviors; create linkages between interventions at multiple levels of delivery; extend caregiver intervention work with underrepresented ethnic and racial populations; and investigate the cost-effectiveness of caregiver interventions.

The primary purpose of this study was to examine the synchronous and temporal relations between engagement in activities and the two primary dimensions of affect--namely, positive and negative affect--using an intensive time-series design called concomitant time series analysis (CTSA). Twenty-four dementia caregivers completed 56 diary measures (4 times per day for 2 weeks) assessing their experience of positive and negative affect as well as engagement in a variety of activities. Total number of activities was significantly correlated with positive affect (r=.40), but not negative affect (r=-.12). Obtained pleasure from activities was significantly correlated with both positive (r=.42) and negative affect (r=-.17). These results may help further develop behavioral models of depression by suggesting that behavioral or self-reinforcing activities are associated primarily (or more saliently) with one's experience of positive affect. Future research examining the effect of behavioral interventions on both positive and negative affect is suggested, as is the examination of factors that may be more strongly associated with negative affect.

Objectives: To examine the cost-effectiveness of a randomized, clinical trial of a home-based intervention for caregivers of people with dementia., Design: This cost-effectiveness analysis examined Resources for Enhancing Alzheimer's Caregivers Health (REACH II), a multisite, randomized, clinical trial, from June 2002 through December 2004, funded by the National Institute on Aging and the National Institute of Nursing Research, of a behavioral intervention to decrease caregivers' stress and improve management of care recipient behavioral problems., Setting: Community-dwelling dementia caregiving dyads from the Memphis REACH II site., Participants: Of Memphis' random sample of 55 intervention and 57 control black and white dyads, 46 in each arm completed without death or discontinuation. Family caregivers were aged 21 and older, lived with the care recipient, and had provided 4 or more hours of care per day for 6 months or longer. Care recipients were cognitively and functionally impaired., Intervention(s): Twelve individual sessions (9 home sessions and 3 telephone sessions) supplemented by five telephone support-group sessions. Control caregivers received two "check in" phone calls., Measurements: Incremental cost-effectiveness ratio (ICER), the additional cost to bring about one additional unit of benefit (hours per day of providing care)., Results: At 6 months, there was a significant difference between intervention caregivers and control caregivers in hours providing care (P=.01). The ICER showed that intervention caregivers had 1 extra hour per day not spent in caregiving, at a cost of $5 per day., Conclusion: The intervention provided that most scarce of caregiver commodities--time. The emotional and physical costs of dementia caregiving are enormous, and this intervention was able to alleviate some of that cost.

Thirteen percent of Hispanic households provide care to an adult aged 50 or older, but given their dramatic population growth, an increasingly large number of families will soon be placed in a caregiving role. The purpose of this study was to determine whether Hispanic caregivers could be accessed through local provider groups, with the goal of generating interventions to decrease caregiver burden. Study findings raise Anglo nurses' awareness of the need for staff who share the values and language of diverse subgroups. Second, they confirm the presence of male caregivers, sons who alone provide personal care to a parent. Lastly, the effect of empathetic, informal interactions and personal stories in communication with Hispanics cannot be overstated. We believe that our findings are of interest to clinicians who help Hispanic families access community care agencies and, conversely, will help community agencies identify families who need assistance and clinical researchers who are seeking study participants.

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery., (((c) 2007 APA, all rights reserved).)

This study performed moderator analyses to determine if self-efficacy predicted differential outcome in a randomized trial comparing a cognitive behavior psychoeducational intervention and an enhanced support group (ESG). The four key outcomes were depression, anxiety, social support, and coping. Low baseline self-efficacy scores were hypothesized to be more predictive of positive response in the psychoeducational intervention than in the support group. Change from pre- to posttreatment (baseline to three months) for 213 female caregivers of older adult relatives with dementia (122 Anglos and 91 Latinos) are presented. Caregivers were randomly assigned to either the coping with caregiving class (CWC), a skill-building, small group intervention designed to reduce caregiving stress, or to an enhanced support group (ESG), which used guided discussion and empathic listening to develop within-group reciprocal support. The findings showed that low baseline self-efficacy scores better predicted positive response to treatment in the CWC intervention than in the ESG intervention. This study supports the use of self-efficacy as a screening tool for appropriate caregiver intervention assignment.

Background: Psychosocial and behavioral interventions trials targeting a broad range of complex social and behavioral problems such as smoking, obesity and family caregiving have proliferated in the past 30 years. At the same time the use of Data and Safety Monitoring Boards (DSMBs) to monitor the progress and quality of intervention trials and the safety of study participants has increased substantially. Most of the existing literature and guidelines for safety monitoring and reporting of adverse events focuses on medical interventions. Consequently, there is little guidance for investigators conducting social and behavior trials., Purpose: This paper summarizes how issues associated with safety monitoring and adverse event reporting were handled in the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) program, a multi-site randomized clinical trial, funded by the National Institutes on Aging (NIA) and the National Institutes of Nursing Research (NINR), that tested the efficacy of a multicomponent social/behavioral intervention for caregivers of persons with Alzheimer's disease., Methods: A task force was formed to define adverse events for the trial and protocols for reporting and resolving events that occurred. The task force conducted a review of existing polices and protocols for data and safety monitoring and adverse event reporting and identified potential risks particular to the study population. An informal survey regarding data and safety monitoring procedures with investigators on psychosocial intervention trials was also conducted., Results: Two categories of events were defined for both caregivers and patients; adverse events and safety alerts. A distinction was also made between events detected at baseline assessment and those detected post-randomization. Standardized protocols were also developed for the reporting and resolution of events that occurred and training of study personnel. Results from the informal survey indicated wide variability in practices for data safety and monitoring across psychosocial intervention trials., Conclusions: Overall, the REACH II experience demonstrates that existing guidelines regarding safety monitoring and adverse event reporting pose unique challenges for social/behavioral intervention trials. Challenges encountered in the REACH II program included defining and classifying adverse events, defining "resolution" of adverse events and attributing causes for events that occurred. These challenges are highlighted and recommendations for addressing them in future studies are discussed.

Objective: Latino family caregivers of older people with memory problems are a rapidly growing group. However, their participation in intervention research is disproportionately low. The authors compared the participant retention rates of three different recruitment strategies in a sample of Latino and Caucasian family caregivers., Methods: A total of 310 caregivers (195 Latino and 105 Caucasian) were screened for participation in one of two clinical intervention trials. Potential participants were recruited from one of three sources: 1) non-professional (e.g., health fairs); 2) professional (e.g., community agencies); and 3) advertisements. Reasons for non-participation were also obtained., Results: Caucasians were significantly more likely to be successfully retained across all recruitment strategies (52% versus 31%, respectively). However, logistic regression revealed a recruitment strategy-by-ethnicity interaction: Latinos were highly similar in retention rates to Caucasians when recruited through professional referrals, and far less likely to participate with other strategies. Descriptive analyses also revealed ethnic differences for non-participation., Conclusion: Partnership of Latino family caregivers with community agencies may result in the highest recruitment rates among this group. Latino cultural values likely play a role in the success of these partnerships in participant recruitment.

This study used a geographically diverse sample to estimate the total cost of informal care and formal services for community-residing Alzheimer's disease (AD) care recipients. Baseline data were used for 1200 family caregivers from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study, a multisite intervention trial. The replacement-wage-rate approach estimated informal cost. Formal services were assigned a cost based on secondary sources. Annual cost per care recipient amounted to 23,436 dollars for informal care and 8064 dollars for formal services. Variation in informal cost was almost entirely due to instrumental activities of daily living (IADLs) assistance. Cross-site differences in cost persisted after controlling for caregiver and care-recipient characteristics. Geographic variation may suggest regional preferences or ethnic/cultural values. Further study is needed to determine whether this reflects differences in access or availability or how including a control group for care recipients with nondementia diagnoses might have affected these findings.

Objectives: To compare rates of institutionalization of dementia patients cared for by Latina and Caucasian female caregivers and to explore which caregiver and care-recipient characteristics predicted institutionalization., Design: Longitudinal., Setting: San Francisco Bay area, California., Participants: Two hundred sixty-four female caregivers of dementia patients (154 Caucasian women, 110 Latinas) who participated in an intervention project designed to reduce caregiver stress and may represent a sample that is more stressed and motivated than a general sample of caregivers., Measurements: Number of days between baseline interview and institutionalization was recorded over an 18-month period. Kaplan-Meier survival analysis with the log rank statistic was used to test for ethnic differences in time to institutionalization. Cox regression analyses were conducted to determine whether care-recipient or caregiver characteristics (e.g., care-recipient age and memory and behavior problems; caregiver depression, years of education, income, and views of the caregiving role) significantly interacted with ethnicity to explain time to institutionalization., Results: Latinas delayed institutionalization significantly longer than their Caucasian counterparts; care-recipient characteristics or caregiver demographics did not explain these results, although Latinas who identified greater benefits or more-positive aspects of the caregiving process at baseline were less likely to institutionalize their loved one than those who reported fewer benefits of caregiving. Less-acculturated Latinas were significantly more likely to identify positive aspects of caregiving than more-acculturated Latinas., Conclusion: Latina dementia caregivers delay institutionalization significantly longer than female Caucasian caregivers. In addition, Latino cultural values and positive views of the caregiving role are important factors that may significantly influence their decision to institutionalize loved ones with dementia.

Objective: The long-term effect of counseling and support on symptoms of depression was examined in spouse-caregivers of patients with Alzheimer's disease., Method: The participants were 406 spouse-caregivers of Alzheimer's disease patients who lived at home at baseline. The caregivers were randomly assigned to either a group receiving enhanced counseling and support treatment or a group receiving usual care (control group). Caregivers in the enhanced treatment group were provided with six sessions of individual and family counseling, agreed to join support groups 4 months after enrollment, and received ongoing ad hoc counseling. The Geriatric Depression Scale was administered at baseline and at regular follow-up intervals for as long as the caregiver participated in the study., Results: After baseline differences were controlled for, caregivers in the enhanced treatment group had significantly fewer depressive symptoms after the intervention than did the control subjects. These effects were sustained for 3.1 years after baseline, similar across gender and patient severity level, and sustained after nursing home placement or death of the patient., Conclusions: Counseling and support lead to sustained benefits in reducing depressive symptoms in spouse-caregivers of Alzheimer's disease patients and should be widely available to provide effective, evidence-based intervention for family caregivers.

Purpose: This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers, and it also examines the role of specific moderator and mediator variables on caregiver outcomes., Design and Methods: Female participants (N = 169) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were randomly assigned to one of three treatment interventions: anger management, depression management, or a wait-list control group. These interventions took place over a 3- to 4-month period. The primary outcomes examined were anger or hostile mood, depressed mood, frequency of use of positive and negative coping strategies, and perceived caregiving self-efficacy., Results: Significant main effects in the expected direction were found for changes in most of these measures. Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group. Use of positive cognitive coping strategies increased in the anger management group only. Self-efficacy significantly increased for participants in both intervention groups, and it was also demonstrated to function as a mediator of intervention effects. Pretreatment levels of depressive symptoms and anger expression style (Anger Expression-Out) moderated the relative effects of the two interventions on mood and coping., Implications: These data are consistent with a growing body of evidence supporting the effectiveness of skills training, in small groups, to improve both the affective states and the type of coping strategies used by caregivers. In addition, this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals.

The Resources for Enhancing Alzheimer's Cargiver Health (REACH) project was designed to test promising interventions for enhancing family caregiving for persons with dementia. The purpose of this article is to describe the research design, interventions, and outcome measures used in REACH and to characterize the sample recruited for the study. Nine interventions and 2 control conditions were implemented at 6 sites; 1,222 dyads were randomly assigned to an intervention or a control condition. The caregiver sample was 18.6% male with an average age of 62.3 years (56% Caucasian, 24% Black, and 19% Hispanic). Caregivers reported high levels of depressive symptoms and moderate burden. Care recipients were older, with a mean age of 79, and were moderately to severely impaired with mean Mini-Mental State Exam scores of 13/30.

Purpose: Few empirical studies have compared the efficacy between psychoeducational (skill-building) approaches for reducing caregivers' psychological distress and interventions modeled after typical community-based support groups. We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia., Design and Methods: The change from preassessment to postassessment (baseline to 3 months) for 213 female caregivers (122 Anglo and 91 Latino) is presented. They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program (instruction and practice in small groups to learn specific cognitive and behavioral skills) or in the Enhanced Support Group condition (guided discussion and empathic listening to develop reciprocal support within the group). Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers, and they were delivered in either English or Spanish by trained interventionists., Results: Overall, participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms, increased use of adaptive coping strategies, and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition. Results were similar for both ethnic groups: there were no main effects for ethnicity, and no significant ethnicity by treatment interaction effects., Implications: This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone. We find it very encouraging that the Latino caregivers responded well on key outcome variables, suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs.

This article reports on the measurement properties of Caregiver Vigilance, a four-item caregiver self-report of perceived oversight demand for Alzheimer's disease and related disorders family caregiving. The self-report uses data from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project, a multisite National Institutes of Health (NIH) sponsored study of over 1,200 family caregivers. Results indicate that the items were clearly understood by the racially/ethnically diverse respondents; and, when responses were transformed into a summary scale and analyzed, unidimensionality was evident and internal consistency reliability favorably demonstrated. We suggest using the Caregiver Vigilance Scale in conjunction with traditional burden measures to systematically include the caregiving time associated with protectively watching over care recipients and the daily duration of this responsibility. We also highlight the practical utility of selected items for potential use in the caregiver assessment process.

Purpose: This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers, and it also examines the role of specific moderator and mediator variables on caregiver outcomes. Design and Methods: Female participants (N = 169) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were randomly assigned to one of three treatment interventions: anger management, depression management, or a wait-list control group. These interventions took place over a 3- to 4-month period. The primary outcomes examined were anger or hostile mood, depressed mood, frequency of use of positive and negative coping strategies, and perceived caregiving self-efficacy. Results: Significant main effects in the expected direction were found for changes in most of these measures. Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group. Use of positive cognitive coping strategies increased in the anger management group only. Self-efficacy significantly increased for participants in both intervention groups, and it was also demonstrated to function as a mediator of intervention effects. Pretreatment levels of depressive symptoms and anger expression style (Anger Expression-Out) moderated the relative effects of the two interventions on mood and coping. Implications: These data are consistent with a growing body of evidence supporting the effectiveness of skills training, in small groups, to improve both the affective states and the type of coping strategies used by caregivers. In addition, this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals.

Purpose: Few empirical studies have compared the efficacy between psychoeducational (skill-building) approaches for reducing caregivers' psychological distress and interventions modeled after typical community-based support groups. We compare the impact of two distinct interventions on Anglo and Latino caregivers of elderly relatives with dementia. Design and Methods: The change from preassessment to postassessment (baseline to 3 months) for 213 female caregivers (122 Anglo and 91 Latino) is presented. They were seen weekly for 10 weeks in either the Coping With Caregiving psychoeducational program (instruction and practice in small groups to learn specific cognitive and behavioral skills) or in the Enhanced Support Group condition (guided discussion and empathic listening to develop reciprocal support within the group). Both programs were tailored to be sensitive to the cultural concerns of Anglo and Latino caregivers, and they were delivered in either English or Spanish by trained interventionists. Results: Overall, participants in the Coping With Caregiving condition reported a significant reduction in depressive symptoms, increased use of adaptive coping strategies, and a trend toward decreased use of negative coping strategies when compared with those in the Enhanced Support Group condition. Results were similar for both ethnic groups: there were no main effects for ethnicity, and no significant ethnicity by treatment interaction effects. Implications: This study provides empirical support that female caregivers benefit more from a skill-building approach to managing their distress than from support group membership alone. We find it very encouraging that the Latino caregivers responded well on key outcome variables, suggesting that Latinos will participate in clinical research and will benefit from their involvement when services are provided to meet their specific needs.

ObjectiveMethodsResultsConclusionsClinical ImplicationsTo evaluate the feasibility and acceptability of a virtually delivered psychoeducational skill-building intervention for ADRD caregivers.A single-arm, pre-posttest pilot study design was employed to evaluate the intervention. Four 90-min group-based weekly sessions were combined with four individual coaching sessions via Zoom. Intervention components covered topics designed to reduce caregiver stress and distress, and a VR experience to help caregivers understand dementia. Data was gathered via REDCap pre- and post-intervention and through post-intervention interviews via Zoom.Results (N = 20) from individual interviews, surveys, and treatment implementation strategies suggest strong feasibility and acceptability. Key change exploration indicated medium effect sizes and statistical significance in preparedness for caregiving (t(19) = 2.69, p = .015, d = 63), communication (t(19) = 2.45, p = .024, d = 0.55), and a medium effect size for the mindful attention awareness scale (t(19) = 0.48, p = (0.637, d = 0.54). Further, participants reported their perceptions of improvement in outcomes such as the ability to care, increased understanding of memory loss, and confidence.Through Alzheimer’s Eyes is a feasible and acceptable intervention that blends technology with skill-building strategies to help caregivers manage their stress and distress regardless of their location.There is potential for interventions including VR to assist family caregivers in managing caregiving challenges and improve well-being. [ABSTRACT FROM AUTHOR]

The Internet of Health Things (technologies for exchanging data) is crucial in helping promote health and wellbeing. Family caregivers of people with Alzheimer's can significantly benefit from the Internet of Health Things by enabling caregivers to participate in programs from home to help manage their stress and distress in their caregiver role. This paper reports the results of a techno-economic analysis and a life cycle assessment comparing a video-communication delivered intervention designed to decrease the stress and distress of caregivers of people with Alzheimer's and related dementias to a hypothetical in-person delivery of the same intervention. Results indicated that the virtual intervention, compared to the hypothetical in-person intervention, was associated with lower participant costs yet, potentially more expensive from an organizational/provider perspective. Environmentally, the virtual intervention had lower carbon emissions than the hypothetical in-person delivery of the intervention. Furthermore, video-communication delivery of the intervention has the potential to reduce some of the hassles of looking for respite to attend caregiving interventions and allow caregivers to join from their preferred location across the country. [ABSTRACT FROM AUTHOR]

Only recently has research focused on families and social support systems of lesbian, gay, bisexual, and transgender (LGBT) older adults; to date, this research is limited. This article highlights new findings and insights on the changing American family, with an emphasis on LGBT families and caregiving, and explores the importance of recognizing the diversity in family types and roles-- especially when considering the care provided by and for LGBT individuals. [ABSTRACT FROM AUTHOR]

This report extends knowledge about the informal caregiving trajectory in Mexican American (MA) families, constituting the second known empirical study of the emerging phenomenon of personal care by (MA) sons for their aging mothers, previously reported by our research team. It uses life course perspective (LCP) to compare caregiving patterns over time through case-based comparative-historical methods. “Historical” within-case analysis searches for themes, while “comparative” cross-case analysis allows exploration of themes across multiple cases, enabling examination of eight cases of caregiving MA sons who were currently providing personal care or confronting the imminent need to do so. We used the comparative-historical technique of pattern matching to determine the worth of LCP for exploration of MA family caregiving, test data-derived theoretical propositions, and function as a template for combining multiple methods. Qualitative findings were buttressed in this sub-analysis of a parent study by results from a battery of variable-oriented scales. [ABSTRACT FROM AUTHOR]

This mixed methods, multi-site, National Institute of Nursing Research (NINR)-funded, interdisciplinary, descriptive study aimed to identify expressions of worry in qualitative data obtained from caregiving Mexican American (MA) families assisting older adults. The purpose of this portion of the inquiry was to determine how worry is expressed, what happens to caregivers when they worry, and what adaptive strategies they used. We examined semi-structured interviews completed during six in-home visits with 116 caregivers. We identified 366 worry quotations from 639 primary documents in ATLAS.ti, entered them into matrices, and organized findings under thematic statements. Caregivers expressed cultural and contextual worries, worried about transitions and turning points in care, and identified adaptive strategies. Despite these strategies, worry persisted. Constant worry may be an allied, important aspect of caregiver burden. We need additional longitudinal research to better understand the experience of MA caregivers for older adults and to provide empirically supported interventions, programs, and services that reduce worry. [ABSTRACT FROM AUTHOR]

Family caregiving for people with dementia and grandparents raising grandchildren both remain critical issues for our increasingly diverse and aging society. Very little research has focused on the role of resilience in either of these caregiving literatures, thereby creating opportunities for researchers, practitioners, and policy makers to drive future agendas including the development, evaluation, and dissemination of caregiver interventions grounded in resilience frameworks. This chapter reviews key issues related to caregiver resilience and makes several recommendations to help move its study and application forward, including the use of mixed-methods and prospective longitudinal designs, the application and evaluation of relevant theoretical frameworks, and the examination of interventions at different levels that target both mental and physical health outcomes with diverse populations. [ABSTRACT FROM AUTHOR]

LGBTcaregiving for midlife and older adults facing chronic illness or disability as well as the development and evaluation of interventions targeting LGBT caregivers remains fundamentally unexplored. Caregivers regardless of their sexual orientation or gender identity often juggle multiple roles and responsibilities leading to increased stress and distress. However, largely due to discrimination and discriminatory policies, many LGBT caregivers face barriers at multiple levels of service provision that can exacerbate stress and negatively impact caregiver and care recipient quality of life. This article highlights many of these obstacles and provides examples of intervention strategies designed to assist LGBT caregivers ranging from interventions aimed at the individual and interpersonal levels of service provision to changes needed at the social policy level. As an example of an individual or interpersonal level of intervention designed to assist LGBT caregivers, the SURE 2framework is presented and more thoroughly discussed. Given the diversity of the LGBT community, the article ends with ways to extend or adapt SURE 2 as well as suggesting that the time has come to develop and test a variety of interventions for LGBT caregivers. [ABSTRACT FROM AUTHOR]

The Northern California Chronic Care Network for Dementia brings together Northern California's major providers of managed care, community-based care, consumer education, and advocacy in new partnerships to improve the care of persons with dementia enrolled in managed care plans and their family caregivers. These partnerships are part of a national initiative entitled the Chronic Care Network for Alzheimer's Disease (CCN/AD) sponsored by the National Chronic Care Consortium and the Alzheimer's Association. This initiative selected eight promising provider-consumer partnerships across the country to implement and evaluate a new model of coordinated care for people with dementia and their families. This paper describes the Northern California network's partnerships and its intervention and challenges. The intervention is grounded in the key components of the CCN/AD model: “identification of patients with possible dementia, diagnostic assessment, care management and family caregiver information and support.” These components, in turn, are translated into protocols and pathways designed to create timely, comprehensive, appropriate, and effective systems of care services that address the unique needs of dementia patients and their caregivers over the course of the disease. [ABSTRACT FROM AUTHOR]

A modified version of the Revised Memory and Behavior Problems Checklist (RMBPC; L. Teri et al., 1992) was administered across 6 different sites to 1,229 family caregivers of community-dwelling adults with dementia. The total sample was divided randomly into 2 subsamples. Principal components analyses on occurrence responses and reaction ratings from the first subsample resulted in a 3-factor solution that closely resembled the originally proposed dimensions (memory-related problems, disruptive behaviors, and depression). Confirmatory factor analyses on data from the second subsample indicated adequate fit for the 3-factor model. Correlations with other caregiver and care-recipient measures supported the convergent and discriminant validity of the RMBPC measures. In addition, female caregivers and White caregivers reported more problems, on average, than male caregivers and African American caregivers, respectively. [ABSTRACT FROM AUTHOR]