Comparative analysis of a moderating and mediating model of stress, appraisal, and coping in Hispanic and non-Hispanic Alzheimer's disease caregivers

This dissertation utilizes a cross-sectional study to examine the phenomenon of caregiving within a theoretically grounded stress, appraisal, and coping model. Hispanic and non-Hispanic caregivers were studied to examine the factors associated with variance in caregiver appraisal, coping, and outcomes of caregiving strain (depression and somatic complaints) and caregiving gain (life satisfaction, mastery, and personal gain). A purposive sampling strategy was used to recruit 204 Alzheimer's disease caregivers in South Florida. A self-report questionnaire was used to collect demographic data, and to measure stress, appraisal, coping, and psychological well-being of caregivers. Regression equations were developed to compare moderating and mediating models of appraisal and coping. Emotion-focused coping skills were found to significantly moderate the effects of stress (F [1,195] = 4.62, p < .05), explaining approximately 21% of the variance in satisfaction was found to moderate the effects of stress (F [1,195] = 7.09; p < .05), explaining approximately 27% of the variance in personal gain and approximately 8% of the variance in life satisfaction (F [1,195] = 4.14; p < .05). Appraisal of Burden was found to significantly mediate the effects of stress, explaining approximately 30% of the variance in somatic complaints (F [1,196] = 31.60; p < .001) and 32% of the variance in depression (F [1,196] = 38.18; p < .001). The results of the analyses indicate that appraisal and coping skills are important variables in the stress process. The results of this study underscore the importance of accounting for positive and negative outcomes in providing a fuller understanding of the stress, appraisal and coping process of Alzheimer's Disease caregivers. ^

Correlations among Coping Skills and Life Satisfaction in Ethnic Older Caregivers

The purpose of the present study is to extend our current understanding of the effects of caregiver burden on life satisfaction by examining whether or not there are ethnic differences in coping strategies used to manage caregiving. Several specific hypotheses were tested in order to determine the linkages among age, gender, ethnicity (i.e., familism, filial piety), caregiver burden, coping with caregiving, and life satisfaction. A total of 103 Hispanic and Non-Hispanic White participants ages 60 and older were included in this study (mean age was 67.42; 16.5% male; 83.5 % female; 52.4% Hispanic; 47.6% Non-Hispanic White). The results suggest that demographics and certain coping skills can influence levels of life satisfaction and burden experienced by caregivers. The findings from this study shed light on how to structure effective psychoeducational interventions, facilitate adaptive coping, reduce burden, and improve life satisfaction for older adult caregivers.

Coping with a diagnosis of Alzheimer's disease: A client and caregiver perspective

The purpose of this study was to examine how individuals and their caregivers cope with a diagnosis of Alzheimer's disease. The sample size consisted of six patients with Alzheimer's disease and seven caregivers. The caregivers included spouses and adult children. The study was conducted at an academic medical center in the South Florida area. Using a phenomenological approach, data were collected by audiotaped interviews. Data were analyzed following the seven steps of Colaizzi (1978).^ The results of the study indicated that clients experienced fear, social withdrawal, decreased self-esteem and a need for love and support. Caregivers experienced psychological strain, burden, lifestyle adjustments and sacrifice. Both clients and caregivers identified numerous strategies for coping with Alzheimer's disease. The findings reflect the need for a holistic approach to promoting the quality of life for patients and caregivers. ^

Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

The relationship between coping strategies and level of depression among spousal caregivers of elders with dementia

Caregivers are often under a great deal of stress while caring for their spouses with dementia. It is when the stress builds up and becomes overwhelming that the caregiver is at risk for developing depression. The primary objective of this study was to determine which cognitive and behavioral coping strategies are associated with lower levels of depression; once these strategies are identified, interventions can be established to educate these caregivers. Thirty-two spousal caregivers participated in this study. They each filled out a questionnaire, which contained three sections. The first section asked them for demographic information about themselves and their spouses; the second section consisted of a coping strategies scale; and, the third section contained a depression scale. Results of this study indicate that problem-focused coping strategies were associated with a lesser degree of depressive symptomatology, whereas most of the emotion-focused strategies were associated with a greater degree of depressive symptomatology among the present sample of spousal caregivers. In addition, no relationship was found between the length of time providing care to their spouses and their level of depression.