Journal of Aging and Health current issue

Family Caregivers' Strains: Comparative Analysis of Cancer Caregiving With Dementia, Diabetes, and Frail Elderly Caregiving

Kim, Y., Schulz, R. — 2008-07-14

Objectives: This study aimed to investigate the impact of cancer from family caregivers' perspective, based on a comparative analysis of caregiving burden and distress, among four types of caregivers. Methods: The sample included caregivers of persons with cancer, dementia, diabetes, or frail elderly from a nationally representative sample of 606 caregivers. Results: Although the four different types of caregivers were comparable in most sociodemographic characteristics, caregiving involvement and caregiving outcomes differed among the caregiving groups. Both cancer and dementia caregivers reported greater levels of physical burden and psychological distress than other caregivers, after controlling for sociodemographic and caregiving involvement (i.e., level of burden and caregiving duration) factors. Discussion: The comparative analysis provided a systematic review of cancer caregiving in the context of three other types of caregiving. Given the high levels of burden and distress, greater emphasis should be placed on developing social service policy and practice for cancer caregivers.

The Association Between Low Vision and Function

Berger, S., Porell, F. — 2008-07-14

Objective: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability. Methods: Guided by the World Health Organization's International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study. Results: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities. Discussion: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

Personality and Defense Mechanisms in Late Adulthood

Yong Yu, , Chamorro-Premuzic, T., Honjo, S. — 2008-07-14

Objective: Current understanding of the use of psychological defense mechanisms (DMs) in older adults is limited. This study set out to examine individual differences in DMs and Cloninger's biosocial model of personality in two age groups (50—64, 65—93), as well as their influence on health. Methods: A Japanese community sample (N = 330) completed the Temperament and Character Inventory (TCI-125), the Defense Style Questionnaire (DSQ-40), and the General Health Questionnaire (GHQ-28). Results: Across age groups, psychological well-being was related to lower levels of harm avoidance and higher levels of self-directedness. In addition, older age was related to decreases in reward dependence, cooperativeness, and increases in self-transcendence, DMs of isolation, denial, and splitting. Discussion: An Age x Gender interaction revealed that men and women varied in their pattern of age differences for some specific DMs. Results further suggest that image-distortion defense may function to compensate resource loss.

Religion, Risk, and Medical Decision Making at the End of Life

Van Ness, P. H., Towle, V. R., O'Leary, J. R., Fried, T. R. — 2008-07-14

Objectives: The purpose of this study is to present empirical evidence about whether religious patients are more or less willing to undergo the risks associated with potentially life-sustaining treatment. Methods: At least every 4 months 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease were asked questions about several dimensions of religiousness and about their willingness to accept potentially life-sustaining treatment. Results: Results were mixed but persons who said that during their illness they grew closer to God (odds ratio [OR] = 1.79; 95% confidence intervals [CI] = 1.15, 2.78) or those grew spiritually (OR = 1.61; 95% CI = 1.03, 2.52) were more willing to accept risk associated with potentially life-sustaining treatment than were persons who did not report such growth. Discussion: Not all dimensions of religiousness have the same association with willingness to undergo potentially life-sustaining treatment. Seriously ill older, religious patients are not especially predisposed to avoid risk and resist treatment.

Parent Caregiving Choices of Middle-Generation Blacks and Whites in the United States

White-Means, S. I., Rubin, R. M. — 2008-07-14

Objective: This study compares how middle-generation caregivers and non-caregivers differ by race and explores racial differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and financial assistance that middle-generation caregivers provide for their parents. Method: Using 2000 Health and Retirement Study data, racially stratified descriptive analyses and logistic regression models for ADL, IADL, and financial assistance are presented. Results: Parental need and race influence support, with similar patterns of Black and White ADL support, but racial differences in IADL and financial support. Having more children motivates Whites to increase IADL support and reduce financial support; more children decreases Blacks' IADL support. Sibling caregiver networks influence IADL and financial support in ways that vary by race. The number employed is a key determinant for Blacks for all support, but only influences White ADL support. Discussion: The findings of this article indicate the importance of sample stratification by race and that employment or other subsidies may aid the expansion of caregiving by middle-generation adults.

Content of Advance Directives for Individuals With Advanced Dementia

2008-07-14

Objectives: To examine how people with end-stage dementia have conveyed their wishes for end-of-life care in advance directives. Method: The documents of 123 residents of three Maryland nursing homes, all with end-stage dementia, were reviewed. Results: More years of education and White race were significantly associated with having an advance directive. With the exceptions of comfort care and pain treatment, advance directives were used primarily to restrict, not request, many forms of care at the end of life. Decisions about care for end-stage conditions such as Alzheimer's dementia are less often addressed in these documents than for terminal conditions and persistent vegetative state. Discussion: For advance directives to better reflect a person's wishes, discussions with individuals and families about advance directives should include a range of care issues in the settings of terminal illness, persistent vegetative state or end-stage illness. These documents should be reviewed periodically to make certain that they convey accurately the person's treatment preferences.