Dementia Caregiving Outcomes: The Impact of Caregiving Onset, Cognitive Impairment and Behavioral Problems.

With a projected increase in the prevalence of Alzheimer's disease (AD) and related dementias, family caregiving is steadily increasing. Caring for an individual with AD is characterized as a "career," and within this career are a number of key transitions, including the onset of caregiving. Research reveals a number of negative emotional health outcomes for AD caregivers, including depression and role overload, but less research has examined the influence of key transitions on the emotional adaptation of caregivers. The purpose of this study is to examine how different patterns of caregiving onset (gradual and abrupt) impact emotional health outcomes for AD caregivers. This study also explores how care-recipient cognitive impairment and behavioral problems moderate these relationships. Cross-sectional, quantitative data from 100 caregivers completing self-administered surveys were used. A series of one-way ANOVAs and multiple regression analyses were conducted to address study aims. Results indicate that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and emotional health outcomes for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering different onset transitions and moderating factors within the caregiving career to target clinical interventions. Implications for social work practice are discussed.

Age Differences in Information Use While Making Decisions: Resource Limitations or Processing Differences?

Recent research on the decision-making abilities of older adults has shown that they use less information than young adults. One explanation ascribes this age difference to reductions in cognitive abilities with age. The article includes three experimental studies that focused on determining the conditions in which older and young adults would display dissimilar information processing characteristics. Findings from Studies 1 and 2 demonstrated that older adults are not necessarily at greater disadvantage than young adults in decision contexts that demand more information processing resources. Findings from Study 3 indicated that older adults when faced with decisions that require greater processing are likely to use a strategy that reduces the amount of information needed, whereas younger adults rely on strategies that utilize more resources. Combined the findings indicate that older adults change their decision-making strategies based on the context and information provided. Furthermore, support is provided for processing difference.

A comprehensive symptom diary intervention to improve outcomes in patients with HF: a pilot study.

BACKGROUND: Patients with heart failure must monitor for and recognize escalating symptoms to take action to relieve symptoms and decrease hospitalizations. However, symptom monitoring is not commonly performed. One way to promote patients' engagement in symptom monitoring is by providing a symptom diary. PURPOSE: The aim of this study was to test the effect of a comprehensive daily symptom diary intervention on event-free survival and health-related quality of life (HRQOL). METHODS: Patients were randomized into either intervention (n = 23) or usual-care groups (n = 21). The intervention group received a symptom diary with self-care education and counseling at baseline with 5 follow-up calls for 3 months. All patients were interviewed to obtain survival data at 1 month and 3 months. HRQOL was measured at baseline, 1 month, and 3 months. Kaplan-Meier curves with the log-rank test were used to compare group differences in time to first event. Linear mixed models were conducted to examine the relationship between groups and changes in HRQOL over 3 months. RESULTS: The intervention group had longer event-free survival than the usual-care group (P = .03). There were no differences in changes in HRQOL scores between the groups over 3 months. CONCLUSIONS: Positive effects of the intervention on survival were found. However, there was no significant difference in changes in HRQOL.

Predicting positive well-being in older men and women.

The purpose of this study was to examine the effects of background, psychological, and social variables on older adults' well-being, and how this may differ for men and women. Participants included 800 adults from the 2002 Health and Retirement Study (HRS), aged 60 to 101 years old (M = 71.22, SD = 8.46), who completed the optional positive well-being module. Gender-based regression models revealed that for men, marital status, self-rated health, and depression were significant predictors and accounted for 32% of the variability in positive well-being. Similar to men, self-rated health and depression were significant predictors of well-being for women. Additional significant predictors for women included age, the importance of religion, and volunteer work. Combined, these variables explained 35% of the variance in women's positive well-being. These results can help us understand which variables are important to target when developing interventions to improve the well-being of older men and women.

Gender differences in psychosocial responses to lung cancer.

BACKGROUND: Although biologically based sex differences in the smoking patterns, epidemiology, biomedical markers, and survival rates associated with lung cancer are well documented, examinations of psychosocial gender differences are scarce. OBJECTIVE: This cross-sectional study examined gender differences in psychosocial factors that are important in the medical management of lung cancer. METHODS: A convenience sample of patients who were attending a multidisciplinary lung cancer treatment center (Markey Cancer Center, Lexington, Kentucky) were invited to complete a psychosocial needs assessment. Eligibility criteria included primary diagnosis of lung cancer, age > or =18 years, and being cognitively intact. Measures focused on psychosocial resources, treatment decision-making, social consequences of treatments, and treatment outcomes. Data were collected between the fall of 2005 and the summer of 2006. RESULTS: A total of 47 women and 53 men (mean [SD] age, 62.81 [12.01] years; 95% white) completed the needs assessment. Gender was not found to be associated with demographic characteristics, time until diagnosis, treatment, or survival rate. Smoking histories differed significantly in the proportion of women and men who smoked or were former smokers (P = 0.01) as well as the age when they began to smoke (P = 0.02). There were no significant gender differences in social support networks, general coping, information needs, treatment decision satisfaction, functional health, life satisfaction, financial impact, or service needs. However, significant gender differences did indicate that women favored spiritual practices (P = 0.02) and religious coping (P = 0.04), and were more likely to endorse having a life mission (P = 0.03) and being part of a divine plan (P = 0.01). CONCLUSIONS: Previous research has found that religiousness and spirituality improved depressive symptoms and may ease end-of-life despair. In the present study of patients with lung cancer, gender differences in religiousness and spirituality suggest that this may be especially true for women, and that interventions should be directed toward their religious practices and coping.

Older adults' perceptions of mentally ill older adults.

OBJECTIVES: Many mentally ill older adults are stigmatized, which reduces quality of life and discourages help-seeking. This study's goal was to identify factors associated with stigma. METHODS: Community-dwelling older adults (N = 101) were asked to indicate their attitudes toward and reactions to three hypothetical older women with depression, anxiety, or schizophrenia. RESULTS: The results suggest that schizophrenic persons are viewed as most dangerous and dependent, while anxious persons are seen as most responsible for their illness. Age, gender, and educational level of participants were associated with desired social distance and differing perceptions of the hypothetical persons. CONCLUSION: These findings can be used to improve educational efforts that seek to reduce the stigma associated with mental illness in older adults.

The relationship between lung cancer patients' educational level and evaluation of their treatment information needs.

BACKGROUND: Understanding the information needs of lung cancer patients is critical to developing interventions to assist them with treatment decisions. The present study examined how educational level is related to lung cancer patients' perceptions of the importance of having their information needs met and how well those needs were met. METHODS: Lung cancer patients completed a needs assessment that evaluated treatment information needs, treatment decision satisfaction, coping, and life satisfaction. RESULTS: Results indicated that education did influence the importance ratings of information needs and influenced coping skills. CONCLUSIONS: Findings have implication for how doctors interact with well- and less-educated patients.

Diabetes self-care among a multiethnic sample of older adults.

Type 2 diabetes constitutes a leading and increasing cause of morbidity and mortality among older adults, particularly African Americans, Native Americans, Mexican Americans, and rural dwellers. To understand diabetes self-care, an essential determinant of diabetic and overall health outcomes, 80 middle aged and older adults from these four disproportionately affected racial/ethnic/residential groups engaged in in-depth interviews, focusing on approaches to and explanations for diabetes self-care. Certain self-care activities (medication-taking, diet, foot care) were performed regularly while others (blood glucose monitoring, exercise) were practiced less frequently. Despite research suggestions to the contrary, only one in four elders used unconventional diabetes therapies, and only one-third listed someone other than a health care provider as a primary information source. Few self-care differences emerged according to race/ethnicity/residence, perhaps because of the influential and common circumstance of low income. Thematic analyses suggest that inadequate resources, perceived efficacy of medication, great respect for biomedical authority, and lack of familiarity with and concerns about unconventional therapies are influential in establishing these patterns of self-care. We discuss the similarity of self-care practices and perspectives irrespective of race/ethnicity/residence and the predominance of biomedical acceptability.

Confronting death: perceptions of a good death in adults with lung cancer.

Investigations regarding patients' concerns about death have focused on the importance of autonomy, resolution of concerns, family relationships, and religiosity, and relied on data from physicians, nurses, family members, and healthy older adults. Few studies have focused on patients with diseases that have short-term survival rates. This study examined lung cancer patients' perceptions of a good death. One hundred lung cancer patients answered open-ended questions about what a good death was and completed measures assessing coping, spirituality, religious coping, and life satisfaction. Content analysis revealed 4 themes describing a good death: (a) during sleep, (b) pain-free, (c) peaceful, and (d) quick. These findings have implications for those caring for terminally ill patients as the 4 themes differ from those derived from studies of more heterogeneous patients, their families, and health care providers.

Gender differences in predictors of late-life health insurance knowledge.

For many older adults having access to affordable health care is a major concern. The present study's goal was to examine what factors were related to individuals' knowledge of late-life health insurance. A total of 131 women and 116 men (all aged 55-71) answered questions about private, Medicare, Medigap, and long-term care insurances. In addition, they answered demographic, personality, and health status questions. Results revealed that different factors are related to men's and women's knowledge of late-life health insurance options implying genderspecific educational interventions would be more effective than current educational interventions.

Goal clarity and financial planning activities as determinants of retirement savings contributions.

Retirement counselors, financial service professionals, and retirement intervention specialists routinely emphasize the importance of developing clear goals for the future; however, few empirical studies have focused on the benefits of retirement goal setting. In the present study, the extent to which goal clarity and financial planning activities predict retirement savings practices was examined among 100 working adults. Path analysis techniques were used to test two competing models, both of which were designed to predict savings contributions. Findings provide support for the model in which retirement goal clarity is a significant predictor of planning practices, and planning, in turn, predicts savings tendencies. Two demographic variables-income and age-were also revealed to be important elements of the model, with income accounting for roughly half of the explained variance in savings contributions. The results of this study have implications for the development of age-based models of planning, as well as implications for retirement counselors and financial planners who advise workers on long-term saving strategies.

Gender differences in factors that influence time spent planning for retirement.

Retirement research has shown that planning activities are influenced by a variety of demographic and psychological variables. However, few investigations have focused on how demographic and psychological factors influence the time and effort men and women allocate to retirement preparation. In the present study, 184 individuals completed a survey designed to assess future time perspective (FTP), worry about retirement, age, and income level. Hierarchical regression techniques were used to examine how these variables influenced the amount of time men and women spent planning for and thinking about retirement. Results revealed that women spent less time thinking about retirement than men, and gender was differentially related to the factors predictive of this activity. From an applied perspective, these findings suggest that separate retirement intervention programs are warranted that meet the unique needs of working men and women.

Influences of age and gender on workers' goals for retirement.

Having clear goals for retirement is a critical determinant of life satisfaction and adjustment during the post-employment transition period. The purpose of the present study was to explore individuals' goals for retirement and determine whether age and gender differences exist among those goals. A sample of 55 working adults (aged 20-67) were asked to list their retirement goals. Items contained on respondents' lists were then classified into a taxonomy of retirement goals adapted from the work of LaPierre, Bastin, and Bouffard (1997). Both age and gender differences were identified in the concreteness of individuals' goals. Additionally, the number of retirement goals individuals hold decreased across the lifespan. Results also revealed patterns of age and gender differences across the various coding categories in the goal taxonomy. Findings are discussed in terms of the applied benefits of understanding the retirement goals of American workers.