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Due to advances made in medicine and health care, older adults (OAs) are living longer but enduring problems with physical functioning and health for longer periods of time. Also, the percentage of OAs with cognitive impairments is increasing. Caregiving duties which decades ago lasted months now last for years. The long-term stress of caring for an OA who is physically and/or cognitively impaired leads many caregivers (CGs) to feel frustrated, angry, overwhelmed and isolated. As a result of this stress many CGs resort to nursing home placement. The COPE Project was undertaken in a social service agency in northeastern Ohio in order to provide service options to participating CGs. It was hypothesized that these optional services would alleviate some of the debilitating stress associated with caregiving and postpone institutionalization. This program was geared to assist CGs of low income OAs (n=127) who had physical/cognitive disabilities. CGs were allotted $1200 in unrestricted vouchers to be used within a six month period to purchase new or additional services. This presentation will discuss baseline data obtained from the initial CG interview (e.g., physical and behavioral problems, activities of daily living and CG well-being) that predicted subsequent placement. Analyses revealed the predictors of placement to be: whether the OA had a problem with household tasks (b= -2.260, p=.006), whether the OA woke up the CG or other family members during the night (b= -1.522, p=.046,) and whether the CG felt she/he had been a good CG (b=. 1.465, p=.035). The implications of these findings for evaluation of service programs and the distribution of agency resources will be discussed.

This paper reports on the development and use of a scale that assesses values and preferences for everyday care of both family caregivers (CGs) and persons with cognitive impairments (PWCIs). Sample for the study included community-dwelling African American (n=66) and non African-American adults (n=45) with physical and/or cognitive impairments and their family caregivers. Results of factor analysis indicated that the 37-item Values and Preferences Scale (VPS) was best divided into four conceptual domains: autonomy (9 items, a=.76), burden (4 items a=.76), self-identity (10 items, a=.77), and family/social interactions (14 items, a=.81). Although no major differences were found across these four domains for African American vs. non African American CGs and PWCIs, differences were found at the item level. For example, PWCIs generally agreed on the importance of care values and preferences, while CGs were more likely to disagree on the importance of specific items. These and other findings will be discussed with an emphasis on how these differences are more likely attributable to SES or caregiver characteristics (e.g., daughters vs. wives) than to culture or ethnicity.

In this aging world, understanding the relationship between caregivers (CG) and care receivers (CR) becomes ever more important. For societies to meet the needs of this aging population, they must develop an understanding of the values and preferences for care of the people delivering and utilizing that care within informal caregiving networks. A sample of 111 dyads residing within the community was interviewed to examine the values and preferences of CRs and the CG's perceptions of the CR's values and preferences in a care-partnering situation. Correlations between CR Mini Mental State Examination and the Value and Preferences Scale domains (autonomy, burden, self-identity, and family/social interactions) indicated a statistically significant relationship for autonomy (r = .32, p < .01), self-identity (r = .19, p < .05), and family social/interactions (r = .22, p < .05) for care receivers. Autonomy (r = .44, p < .01) and self-identity (r = .21, p < .05) were reported by CGs as being more important for CRs who were more cognitively intact. Thus, impairment level is a good predictor of CR's care values and preferences as well as CG's perceptions of these values and preferences.

Many family caregivers (CGs) of person's with cognitive impairment (PWCIs) face the critical task of arranging for their relative's living arrangements, services, and activities. The potential stress CGs face surrounding decision-making for the PWCI centers on: 1) the CG's perceptions of the PWCI's preferences for care, and 2) how congruent the CG's perceptions are with the PWCI's preferences for care. This presentation examines dyadic congruence and its effect on CG strain in 111 CG-PWCI dyads. PWCIs were asked about their own preferences while CGs were asked about their perceptions of their relative's preferences on topics including decision-making, personal care, living arrangements, and use of f0t'tnal services. Dyadic congruence was measured using CG-PWCI difference scores for each question. Significant correlations between congruence and measures of CG strain indicate that as awareness of relative's care preferences increases, CGs' Quality of Life improves (r=.26, p=.010) and Financial Strain (r=-.30, p=.003) and Relationship Strain decrease (r=-.21, p=.025). These results suggest that increasing discussion of care preferences among dyads may be one method of alleviating caregiver strain.

Communicating about care preferences can improve the well-being of caregivers and care recipients. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings., Design: A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility., Methods: Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators., Results: Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members., Conclusion: Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months., Impact: This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting., Reporting Method: The authors have adhered to the EQUATOR STROBE Statement., Patient or Public Contribution: A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Purpose: This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities., Design and Methods: We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver depression., Results: Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident-caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors., Implications: These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes.

Purpose: This study examined the decision-making capacity of persons with cognitive impairment with respect to their everyday care preferences and choices. This is the first in a series of articles to report on findings from a larger study that examines choice, decision making, values, preferences, and practices in everyday care for community-dwelling persons with cognitive impairment and their family caregivers., Design and Methods: Fifty-one respondent pairs, or dyads, were interviewed, that is, persons with cognitive impairment (n = 51) and their family caregivers (n = 51). All persons with cognitive impairment were interviewed twice within a week using a parallel interview to determine stability and accuracy of responses. The family caregiver was interviewed once., Results: Persons with mild to moderate cognitive impairment (i.e., Mini-Mental State Exam scores 13-26) are able to respond consistently to questions about preferences, choices, and their own involvement in decisions about daily living, and to provide accurate and reliable responses to questions about demographics., Implications: Including the perspective of persons with cognitive impairment in both research and practice has the potential to enhance their autonomy and improve their quality of life.

This study examined the predictors of caregiver depression and "adaptation" over time in a sample of 202 family caregivers of cognitively impaired adults. By examining caregiver adaptation (i.e., a caregiver's ability to adjust psychologically to the demands of providing long-term in-home care), we were able to account for initial levels of depression, regression to the mean, and floor and ceiling effects. Results indicated that the strongest predictors of caregiver depression 1 year after baseline were initial levels of depression, worsening of caregiver subjective physical health status and burden, and short-term use of in-home respite assistance. These findings suggest that caregivers who experience deterioration in levels of physical health and burden and who use in-home respite on a short-term or sporadic basis may be especially vulnerable to the chronic stress of providing long-term in-home care.