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Mutuality, the positive quality of the relationship between the family caregiver and care receiver, is an important variable in family care for frail older adults. It has been shown to be associated with lower levels of caregiver strain and higher levels of caregiving rewards. However, the concept and measure of mutuality were developed with non-Hispanic White samples. The purpose of this article is to describe the development of an instrument-the Spanish Version of the Mutuality Scale. We determined for Mexican American families: (a) the functional equivalence of mutuality, (b) a comparative descriptive framework for mutuality, and (c) the language equivalence of the Mutuality Scale and the Spanish Version of the Mutuality Scale. Evaluating mutuality levels for Mexican American older adults and caregivers, especially in view of their strong cultural norm of familism, is essential.

In this validity study, using factor analysis, the authors identified three dimensions (affection, skill, and attentiveness) of the Care Receiver View of Caregiver Role Enactment Scale, a self-report measure designed to elicit an elderly care receiver's evaluation of how well their family member carried out the role of caregiver. The scale is a revision of the Satisfaction With Caregiving Scale. This study was a secondary analysis of data from PREP: Family-based Care for Frail Older Persons. Care receiver mutuality was the variable most highly correlated with caregiver role enactment. Other variables related to good quality care were higher care receiver positive affect, better caregiver physical health, and lower caregiver role strain; husband caregivers were rated as giving poorer quality care.

Purpose: To describe the concepts of role strain and role satisfaction (renamed ease in decision-making following analysis) experienced by family caregivers when making decisions to withdraw or withhold life support for elderly relatives in a variety of settings., Methods: Semi-structured interviews were conducted with 17 family caregivers to obtain descriptions of their experiences when making decisions about life support for elderly relatives. Content analysis was used to analyze the data., Findings: Role strain was complex, dynamic, and multidimensional, and it evolved over time before, during, and after decision-making about life support. Role satisfaction, the concept name used at the beginning of the study, did not match descriptions or the experience of family caregivers, and a revised name, ease in decision-making, was selected., Conclusions: The concepts of role strain and ease in decision-making have not previously been used in studies of decisions about life support. Both role strain and ease in decision-making augment the existing literature on role strain in family care by providing a more complete picture of caregivers' responses during their experience of making life-support decisions. Research focused on the measurement of strain and ease in decision-making is needed to understand their interrelationship as well as their association with such variables as caregiver grief and health.

The purpose of this pilot study was to refine and evaluate methods of measuring costs of an innovative home-health nursing intervention designed to support frail, older persons and their family caregivers. We evaluated a multifaceted strategy to collect a detailed utilization profile from 22 caregiver/care receiver dyads for hospital, ambulatory, home health, nursing home, and community services. The strategy was feasible for most participants, maximized accuracy of cost data, and minimized research burden on study participants. Lower overall costs were found in the intervention group, but the difference was not significant. Approaches to the measurement of costs in this study can serve as models for evaluating other innovations in nursing, home care, and long-term care.

Interview and observational data obtained from caregiver-care recipient dyads were analyzed in developing a theory of enrichment that explains how some families use pleasurable or meaningful experiences in their caregiving to frail elders. The personal history and frailty trajectory of both caregiver and care recipient, the quality of the dyadic relationship, and the caregiving situation are antecedents to enrichment processes. Core elements influencing the nature of enriching events include acquiring symbolic meaning, performing activity, and fine tuning. Categories of enrichment events are customary routines and innovative routine breakers. Consequences of enrichment are relationship and identity sustenance for both caregiver and care recipient, comfort for the care recipient, and rewards of meaning for the caregiver.

1. The concepts of local and cosmopolitan knowledge may be used by gerontological nurses in creating partnerships with family caregivers to frail older people. 2. Local knowledge is the understanding and skills that the family brings to the caregiving situation; cosmopolitan knowledge is the understanding and skills that the gerontological nurse brings to the situation. 3. Four nursing interventions are guided by the conceptualization of local and cosmopolitan knowledge: acknowledging and affirming local knowledge when it is adequate; developing or enhancing local knowledge when it is inadequate; assisting family caregivers to apply local knowledge to problem solving; and blending local and cosmopolitan knowledge.

Data from 78 older persons and their family caregivers were obtained at 6 weeks and 9 months after hospital discharge. Hierarchical multiple regression was used to determine whether mutuality and preparedness for caregiving were related to lower levels of caregiver role strain. The results indicated that, after controlling for five other variables commonly found to be related to caregiver role strain, mutuality and preparedness ameliorated some but not all aspects of role strain.