Adherence to immunosuppression: a prospective diary study.

Immunosuppression adherence among kidney transplant recipients is essential for graft survival. However, nonadherence is common, jeopardizing graft survival. Besides skipping dosages, little is known about other forms of medication nonadherence and their underlying reasons. This study sought to examine patients' extent of medication adherence over time and reasons for nonadherence. Thirty-nine new kidney transplant recipients were asked to complete a month-long medication-taking diary that included reporting medication nonadherence such as skipped medications, medications taken early or late, taking dosages greater or less than prescribed, and the reason for each occurrence of nonadherence. Of the 20 (51%) patients who completed the diary, 11 (55%) reported at least 1 form of nonadherence. Eleven patients reported taking their immunosuppression at least 1 hour later than the prescribed time, 1 patient reported skipping medication, but no patients reported changing the dosage on their own. Immunosuppression was taken on average 1.5 hours after the prescribed time. Of those patients who took their medications late, there were on average 3.1 occasions of taking it late. The most common reasons for this behavior included health care-related issues, followed by oversleeping, being away from home, work-related barriers, and forgetting. The majority of kidney transplant recipients took medications later than prescribed during 1 month. Future research should determine the clinical impact on graft function of late administration of immunosuppression. Interventions should be designed to better assist kidney recipients with taking medications on time, especially when they are away from home.

Gender and race differences in the predictors of daily health practices among older adults.

Preventive health behaviors are crucial for older adults' well-being. This study examined the factors that influence the practice of positive daily health behaviors over time in a sample of older adults (N = 1266) and investigated whether explanatory factors differ by health behavior, gender or race. Physical activity, weight maintenance, smoking, alcohol consumption and sleep patterns were examined as dependent variables. Independent variables included demographic characteristics, baseline health behavior, health status variables, psychological factors and social network characteristics. Results indicate that age and health status are important predictors of preventive health behaviors. However, the factors that predict preventive health behaviors vary by behavior, gender and race. The independent variables included in this study were most successful in explaining cigarette smoking and weight maintenance, and least successful in explaining amount of sleep. In addition, results suggest that social network variables are particularly influential for women's health behaviors, while health status is more influential among men. Greater education predicts better health behaviors among whites, while formal social integration seems particularly important for the health behaviors of older black women. These results indicate that examining older adults' health behaviors by race and gender leads to a fuller understanding of these behaviors.

The costs of caring: impact of dementia on family caregivers.

With the aging of the population, an increasing number of older adults are diagnosed with Alzheimer's disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experience a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dementing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role.

Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses.

This study describes the health behaviors (alcohol consumption, exercise, sleep patterns, smoking, and weight maintenance) of a sample of older adult spouse caregivers (N = 233) and investigates the predictors of decreased self-care since caregiving began. Multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform a greater number of activities of daily living (ADL) tasks in caregiving and spend more hours in a day providing care, and who have lower self-efficacy for both self-care and spouse care are at greater risk for negative health behavior change. Results have implications for the identification of caregivers who may be particularly vulnerable to the negative health impact of caregiving.

Spouse caregivers' attitudes toward obtaining a diagnosis of a dementing illness.

OBJECTIVES: To examine attitudes of spouse caregivers about the process of obtaining a diagnosis of a dementing illness, including perceived benefits and obstacles to obtaining a diagnosis and suggestions for improving the process. DESIGN: A mail survey of spouse caregivers of dementia patients followed by the Michigan Alzheimer's Disease Research Center. PARTICIPANTS: The 233 spouse caregivers of dementia patients who returned a completed questionnaire. RESULTS: More than three-fourths of the sample rated the following benefits of obtaining a diagnosis as very or extremely important: ruling out other causes of memory or behavior problems, allowing family members to get information about dementia, may qualify my spouse for drug treatment, and will allow me to plan for the future. Primary obstacles included the time required to obtain a diagnosis, the cost of procedures, lack of access to physicians trained to diagnose dementing illnesses, and not receiving a referral from a primary care physician (41.6%, 41.0%, 40.8%, and 24.1% of the sample, respectively, agreed or strongly agreed that the factor posed a barrier to obtaining a diagnosis). Content analysis of responses to two open-ended questions identified problematic or stressful aspects of obtaining a diagnosis and suggestions for making the process easier for the patient and family. CONCLUSION: Results suggest the need to provide an orientation to the diagnosis and assessment process for patients and family members, develop a training session for physicians to better prepare them to address the emotional needs of patients and families and to disclose the diagnosis in an informative and compassionate manner, and provide outreach education to primary care physicians to increase knowledge and awareness of dementing illnesses and to increase referrals to community-based services and health professionals able to address the concerns of family members.

Measurement of social interaction in change of health behavior.

A social network approach to measuring social interaction related to change of health behavior required 460 participants in a health promotion program to nominate up to five network members and to rate the supportiveness of each person in changing health behavior during the previous year. Exploratory factor analysis of intercorrelations of the eight items suggested two factors representing supportive and negative interaction with internal consistency reliability of .89 and .61, respectively.

Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes.

Tested was a model of social support and cognitive appraisal of self-efficacy, outcome expectancies, and illness threat on depression. Study participants were community-dwelling adults with diabetes who completed a mailed questionnaire (N = 362). Results of structural equation modeling indicated that 52% of the variance in depression was explained by the model--largely by the direct effects of physical functioning, the perceived availability of social support, and the perceived threat of diabetes as well as the indirect paths from perceived support to perceived threat and from physical functioning to perceived support and perceived threat of diabetes. Diabetes-specific social support, self-efficacy, and outcome expectancies were not significant predictors of depression.

Health beliefs and practices of kenyan primary school students.

A study of 224 primary school students in Kenya was conducted to determine if health belief model variables predicted their health behavior, specifically, using safe drinking water. One health belief model construct, belief in benefits, was associated with the behavior (p = .05). Living in an urban environment (p = .01), and proximity to a tap (p = .004) were also significant predictors of safe water use. Implications for further research and health education programs are discussed.