Caregiving appraisal and interventions based on the progressively lowered stress threshold model.

The purpose of this article is to describe the impact of a theoretically driven, psychoeducational intervention based on the Progressively Lowered Stress Threshold (PLST) model on caregiving appraisal among community-based caregivers of persons with Alzheimer's disease and related disorders. A total of 241 subjects completed the year-long study in four sites in Iowa, Minnesota, Indiana, and Arizona. Caregiving appraisal was measured using the four factors of the Philadelphia Geriatric Center Caregiving Appraisal Scale: mastery, burden, satisfaction, and impact. Analysis of trends over time showed that the intervention positively affected impact, burden, and satisfaction but had no effect on mastery when measured against the comparison group. The PLST model was influential in increasing positive appraisal and decreasing negative appraisal of the caregiving situation.

The experience of caring for a family member with Alzheimer's disease.

The purpose of this phenomenological study was to describe the experience of caring for a family member with Alzheimer's disease or related disorder (ADRD) living at home among a diverse sample of 103 family caregivers. The study involved secondary analysis of in-depth transcribed interview data using van Kaam's rigorous four phase, 12-step psychophenomenological method. A total of 2,115 descriptive expressions were categorized into 38 preliminary structural elements. Eight essential structural elements emerged from an analysis of the preliminary structural elements. The eight elements were then synthesized to form the following synthetic structural definition: Caring for a family member living at home with ADRD was experienced as "being immersed in caregiving; enduring stress and frustration; suffering through the losses; integrating ADRD into our lives and preserving integrity; gathering support; moving with continuous change; and finding meaning and joy."

What's a nice girl like you doing in a place like that? The role of a nurse in the Office of the Provost.

This article describes an uncommon role for a senior nursing administrator, that of associate provost for health sciences. Key interdisciplinary interactions and responsibilities in this position are outlined, as well as particular competencies needed to be successful in this multifaceted job. The author's professional development as a clinician and academician is summarized, noting that she did not orchestrate her career for an administrative role. However, aspects of her development as a psychiatric mental health nurse and researcher contributed skills that have proved to be invaluable in her current administrative position.

The Iowa Model of Evidence-Based Practice to Promote Quality Care.

The UIHC Department of Nursing is nationally known for its work on use of research to improve patient care. This reputation is attributable to staff members who continue to question "how can we improve practice?" or "what does the latest evidence tell us about this patient problem?" and to administrators who support, value, and reward EBP. The revisions made in the original Iowa Model are based on suggestions from staff at UIHC and other practitioners across the country who have implemented the model. We value their feedback and have set forth this revised model for evaluation and adoption by others.

The biological basis of behavioral symptoms in dementia.

This article describes the pathophysiology of dementia and differentiates between cognitive and noncognitive symptoms that characterize this devastating illness. Relationships between brain anatomic and neurochemical systems and behavioral symptoms of dementia are discussed. An overview of the etiologies and neuro-pathologies of dementia are presented as they relate to impairments in memory and intellectual abilities, personality changes, and behavioral symptoms. Recent genetic and molecular discoveries that have advanced our understanding of this complex spectrum of disorders and their treatment(s) are also highlighted.

Use of multidimensional assessment to provide testimony on behalf of residents in a life-care home.

City administrators challenged a life-care home's tax-exempt status. A successful, empirically-based case was made based on data collected by gerontological nurses using the Iowa Self-Assessment Inventory (ISAI) and related instruments (Mini-Mental State Examination [MMSE], Instrumental Activities of Daily Living Scale [IADLS], and Physical Self-Maintenance Scale [PSMS]) to describe the life-care population. Testimony by gerontological nurses included comparisons between these life-care residents and statewide data on elderly individuals currently residing in nursing homes and in the community. The data they presented showed not only that this life-care home provided a high quality of life, but also saved society substantial amounts of money in government-funded services that would otherwise be provided to residents of this home. The judge ruled in favor of continuing tax-exempt status for this life-care home because credible evidence clearly demonstrated that taxpayer savings from the services provided to life-care home residents and the life-care commitment dramatically outweighed the taxpayer costs associated with lost tax revenues.

Life stress, mood disturbance, and elevated interleukin-6 in healthy older women.

BACKGROUND: Although adverse effects of severe chronic stress on immunocompetence and physical well-being in older adults have been reported, the immune response to less severe life stress among healthy older adults, particularly among women, is not well understood. Interleukin-6 (IL-6) has been considered a good overall indicator of immune functioning in older adults because of its contribution to the pathogenesis of several age-related conditions such as osteoporosis. Regulation of IL-6 is impaired in elderly adults, and levels of IL-6 increase with stress and depression. This research cross-sectionally examined levels of IL-6 in three groups of healthy older women with varying levels of life stress and mood disturbance and a healthy group of young women. METHODS: Subjects included 18 caregivers of Alzheimer's patients, 17 older women assessed one month before relocation of their residence, 15 nonmoving and noncaregiving older women, and 20 younger women. Subjects completed the Profile of Mood States (POMS) and had early morning blood draws. RESULTS: Alzheimer's caregivers reported significantly greater distress than women of all other groups. IL-6 levels in caregivers were significantly higher than those of all other women. The older women had significantly higher IL-6 than young controls, but there were no significant differences in IL-6 between movers and older controls. Among all women, greater depression and distress were related to higher levels of IL-6. CONCLUSIONS: These findings suggest that in older women, chronic stressors are associated with significant elevations in IL-6 over and above the elevations associated with normal aging, but that moderate stressors may not be related to appreciable elevations in IL-6.

Emotional and physical health of spouse caregivers of persons with Alzheimer's disease and stroke.

Providing care for a cognitively impaired spouse can adversely affect caregivers' health. It is not known how early in the caregiver's 'career' emotional and physical health deteriorates. The progressive deterioration associated with Alzheimer's disease (AD) may have different effects on caregivers' health when compared with the potential recovery following a stroke. An exploratory study was conducted with 42 couples, equally divided among early phase AD, ischaemic stroke after hospital discharge, and well controls. Couples were evaluated at baseline (time 1), 6 months (time 2) and 1 year (time 3). At time 1, depression was significantly higher in AD and stroke caregivers when compared to controls. Over time, depression increased significantly for AD caregivers with 21% evidencing moderate to severe depression at time 1 and 50% at time 3. For stroke caregivers there was a significant interaction effect with race: white stroke caregivers' depression increased over time while African American stroke caregivers' depression decreased. Physical health was not significantly different for the three groups and remained stable over time. Cognitive and functional impairment levels of care recipients were significantly related to stroke caregivers' but not AD caregivers' depression. Long-term counselling and support to family caregivers is advocated.

Well siblings living with schizophrenia. Impact of associated behaviors.

As a result of the ongoing hallucinations and delusions, life at home became "anxious and chaotic" with "lots of stress." Because there was no on-site crisis intervention by professionals, well siblings were sometimes called upon to control the violent behavior and were vigilant and fearful regarding the potential for abuse. Negative symptoms were the most disturbing to well siblings. Siblings need help to understand that social isolation and lack of motivation are symptoms of the illness--not due to "laziness."

Pastoral care for the person with dementia.

We discuss the various stages of Alzheimer's disease and related disorders (ADRD) and present a psychosocial model which spiritual caregivers can use in their ministry, the Progressively Lowered Stress Threshold (PLST) model. We argue that religious activities are very important to these patients and that spiritual caregivers can make an important contribution.

A nursing intervention to decrease depression in family caregivers of persons with dementia.

The goal of this study was to evaluate a community-based psychoeducational-nursing intervention designed to teach home caregivers to manage behavioral problems of persons with Alzheimer's disease and related dementias (ADRD) using the Progressively Lowered Stress Threshold (PLST) model, and to compare this intervention with routine information and referrals for case management, community-based services, and support groups. Previous caregiver studies have overwhelmingly pointed to the adverse effects of caregiving on the caregivers' physical and mental health, and high prevalence rates of depression among caregivers of persons with ADRD have consistently been reported. Therefore, a primary aim was to evaluate the impact of the intervention on caregivers' affective responses, especially depression. Data from both the Profile of Moods States and the Geriatric Depression Rating Scale support the effectiveness of this intervention in decreasing depression among caregivers who received the experimental training. Additional analysis of factors associated with caregiver depression are also reported. The pivotal role of psychiatric nurses in the assessment and treatment of depression among caregivers of persons with ADRD is discussed.

Utilization of mental health services among rural elderly.

Rural elders are an undeserved and vulnerable population with compromised access to health and human services leading to premature institutionalization. Even though elders living in rural areas have psychiatric illnesses that would prompt them to use mental health services, their use of these services remains low. This study developed predictive models of psychiatric hospitalization, use of mental health services, and use of crisis intervention by rural elders participating in an outreach case-management program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression. Being married and having supplemental insurance in addition to Medicare predicted 23% of the variance for utilization of psychiatric hospitalization. Only one variable, Medicaid, predicted 14% of the variance for use of mental health services. Type of caregiver, marital status, household composition, and Medicaid insurance accounted for 23% of the variance in utilization of crisis intervention by rural elders. Overall, the two variables that most likely predicted use of psychiatric mental health services were marital status and type of insurance.

Access to health care resources for family caregivers of elderly persons with dementia.

Concerns about the "elder care crisis" and changes in the provision of health care are fostering expectations that families should be responsible for taking care of their elderly members. The assumptions that families (1) are not providing enough care, (2) know how to provide care, and (3) have access to resources for the provision of care are embedded in the social expectation of family care for elderly persons with dementia. However, research shows that these assumptions are not based on fact.