Caregiver cognitive status and potentially harmful caregiver behavior.

The association between caregiver cognitive status and potentially harmful caregiver behavior was assessed in a sample of 180 caregiver-care recipient dyads. Compromised cognitive status was identified in 39% of these informal caregivers. Beyond variance explained by demographic factors, amount of care provided, care recipient cognitive status, and caregiver depressed affect, care recipients reported more frequently being subjected to potentially harmful caregiver behavior when their caregivers evidenced compromised cognitive status. While preliminary, critical areas of caregiver cognition appeared to be deficits in language comprehension and memory. Results indicate that compromised cognitive status is common among informal caregivers of impaired elders and that this may adversely influence the quality of care they provide.

Relationship quality and potentially harmful behaviors by spousal caregivers: how we were then, how we are now. The Family Relationships in Late Life Project.

Structured interview data from 142 caregivers (98 wives, 44 husbands) indicate that more depressed caregivers are more likely to treat their spouses in potentially harmful ways. However, consistent with hypotheses derived from communal relationships theory, when the preillness relationship between caregiver and care recipient was characterized by mutual responsiveness to each other's needs (i.e., was more communal), caregivers were less depressed and less frequently engaged in potentially harmful behaviors. These effects were not attributable to demographic factors, amount of care provided, care recipient dementia status, or length of time in the caregiving role. Rather, multivariate analyses suggest that the extent to which premorbid relationships were communal in nature determines whether caregivers perceive their current relationships as rewarding, which, in turn, predicts caregiver depression and potentially harmful behaviors.

Extending the activity restriction model of depressed affect: evidence from a sample of breast cancer patients.

Survey data from 95 women with Stage 1 (n = 36), Stage 2 (n = 49), or Stage 3 (n = 10) breast cancer both confirm and extend prior research indicating that restriction of normal activities is an important factor in depressed affect. Illness severity was directly related to more restricted routine activities, and more activity restriction was associated with higher public self-consciousness and less social support. Beyond the effects of age, self-consciousness, illness severity, and social support, activity restriction explained significant additional variance in symptoms of depression. Moreover, activity restriction mediated the impact of pain, public self-consciousness, and social support on depressed affect, which implies that these factors foster symptoms of depression by disrupting normal activities.

Activity restriction and prior relationship history as contributors to mental health outcomes among middle-aged and older spousal caregivers.

In a sample of cancer patients (n = 75) and spousal caregivers (24 men and 51 women), restriction in caregiver routine activities mediated associations between caregiving stress (patient symptom severity) and caregiver depressed affect and resentment. Moreover, the antecedents and affective consequences of caregiver activity restriction were consistent with the theory of communal relationships (e.g., M. S. Clark & J. Mills, 1979, 1993). If a relationship had been communal in the past (i.e., characterized by mutual concern for and responsiveness to one another's needs), activity restriction was predicted by intimacy and affectional loss (rather than by the severity of patient symptoms) and in turn predicted caregiver depressed affect. Among caregivers in less communal relationships, activity restriction was predicted by severity of patient symptoms (rather than by intimacy and affectional loss) and in turn predicted resentment of care recipients and the caregiving role.

Social ecology and entitlements involved in battering by heterosexual college males: contributions of family and peers.

This study examined how the social ecological factors of family history and relationships with peers were associated with 193 college men's partner violence and attitudes regarding battering. Multivariate (path) analyses revealed that witnessing paternal battering in childhood was both directly and indirectly (through male peer variables and attitudes concerning battering) related to a man's violence toward female partners. Specifically, those men who reported witnessing paternal domestic violence as a child were more likely to associate with male peers who are abusive and who provide informational support for relationship violence. Associating with abusive male peers and receiving male peer informational support for battering were also related to perpetrating relationship violence. Of particular interest were the findings that after controlling for witnessing paternal battering, male peer informational support exerted a direct effect on the increased likelihood of using violence against female partners, and that, in the path model predicting battering ever, witnessing battering ceased to be a significant predictor of men's violence when peer and attitudinal variables were considered. Male peer-related variables also predicted men's increased beliefs of entitlement to abuse female partners, and the belief that battering is justified directly affected partner violence perpetrated. These results support the inclusion of the broader social ecology of the batterer in examinations of male partner violence.

The measurement of caregiver outcomes in Alzheimer disease research.

The focus of this paper is on the measurement of outcomes for caregivers of patients with Alzheimer disease and related disorders. The discussion addresses theory-based and proven measures and seven major measurement domains: health effects, caregiver characteristics and contextual measures, service utilization, burden, positive aspects of caregiving, quality of care provided, and measures related to normative caregiver transitions such as institutionalization and death of the care recipient. Also provided are a brief summary of existing measurement approaches for assessing caregiver outcomes and general recommendations regarding the measurement of caregiver outcomes.

Pessimism, age, and cancer mortality.

Cancer patients (N = 238) receiving palliative radiation treatment were followed for 8 months; 70 patients had died by the 8-month follow-up. Controlling for site of cancer and level of symptomatology at baseline, the authors studied the independent effects on mortality of pessimism, optimism, and depression. The findings show that the endorsement of a pessimistic life orientation is an important risk factor for mortality, but only among younger patients (ages 30-59). Attempts to replicate this finding with conceptually related constructs such as depression or optimism did not yield significant associations for either younger or older patients, suggesting that negative expectations about the future may contribute to mortality in unique ways. The authors conclude that attempts to link psychosocial factors to mortality should focus on specific psychological constructs instead of diffuse, global measures that cover many psychological phenomena and that the role of psychological processes in mortality may vary dramatically depending on age.

Activity restriction mediates the association between pain and depressed affect: a study of younger and older adult cancer patients.

Associations are reported frequently among pain, functional disability, and symptoms of depression. The purpose of this longitudinal study was to further clarify relations among these variables. In 268 younger (ages 30-64) and older (ages 65-90) cancer outpatients, cross-sectional analyses replicated previous findings showing that effects of pain on symptoms of depression are mediated by functional disability. Longitudinal analyses revealed that as pain increased over time, so did activity restriction, which in turn predicted increases in depressed affect. Comparative analyses indicate that restriction of routine activities that are due to illness and pain may be more distressing to individuals less than 65 years of age than to those 65 years of age or older. The results suggest that older persons are less distressed by restricted activities because of lower expectations about functional status and more experience with illness and disability.

Coping with specific stressors in Alzheimer's disease caregiving.

Strategies used to cope with specific caregiving stressors were examined in a sample of 170 Alzheimer's disease (AD) caregivers. The most commonly identified stressors were memory deficits, loss of ability to communicate, and gradual decline of a loved one. Wishfulness was related to more depressed affect, regardless of stressor type. Other strategies related to more depressed affect included taking direct action when coping with patient memory deficits and stoicism in response to decline of a loved one. Strategies related to less depressed affect included relaxation in response to memory deficits, acceptance in dealing with communication impairments and decline of a loved one, and seeking social support in coping with decline of a loved one.

Psychosocial and behavioral dimensions of physical frailty.

Findings from a decade of research on physical frailty in diverse elderly populations are summarized and integrated. While much of the literature focuses on the physical and functional consequences of chronic and acute illness, we emphasize the psychosocial and behavioral aspects of physical frailty. The underlying assumption of our approach is that the psychological representation of illness and disability, as well as the social contexts in which they occur, are important determinants of their impact on patients and family members. We focus on both patients and their primary support persons and on the comparative analysis of different disabling conditions. A patient and family caregiver impact model is used to summarize major findings of our research program and to make recommendations for intervention research.

Pain, activity restriction, and symptoms of depression among community-residing elderly adults.

Relations among physical illness, functional disability, pain, and symptoms of depression were investigated in a sample of community-residing elderly outpatients. As expected, physical illness, functional disability, and pain were correlated with depressive symptomatology. It was further hypothesized that functional disability (but not physical illness per se) would attenuate the relation between depressed affect and pain. The data supported these predictions by showing that functional disability (but not physical illness) accounted for differences in reported pain between nondepressed subjects and those at risk for developing clinical depression. Additional analyses revealed that functional disability mediated relations between pain and depressed affect and also between illness and depressed affect. These results indicate that both pain and illness are important contributors to functional disability, which in turn contributes to symptoms of depression. Secondary analyses revealed that restriction of certain activities associated with physical mobility and independence were strong individual factors in attenuating the relation between pain and depressed affect. An important implication of this research is that neither pain nor activity restriction should be treated in isolation. Maximal effects are likely to be achieved when both are targeted simultaneously.

Physical illness and symptoms of depression among elderly outpatients.

Elderly outpatients were assessed to clarify relations between symptoms of depression and physical illness, disability, pain, and selected psychosocial variables. Three types of assessments were made: (a) medical evaluations by physicians, (b) self-reported symptoms of depression and physical health, and (c) demographic and psychosocial data relating to participants' life circumstances. Both objective (physician-rated illness symptoms) and subjective (self-reported health, activity restriction, and use of pain medications) indicators of health accounted for independent variance in symptoms of depression. After controlling for these factors, additional variance was explained by health-related concerns (e.g., health care expenses, service needs), social support, and "other worries" (e.g., feeling useless, becoming a burden to others).

A 2-year longitudinal study of depression among Alzheimer's caregivers.

Results from a 2-year (4 waves) longitudinal study show strong evidence for patient decline and high levels of depressive symptomatology among caregivers. Female caregivers reported high, stable rates of depressive symptomatology throughout the study, whereas male caregivers exhibited significant increases in depression over time. Cross-sectional multivariate analyses revealed significant positive relationships between depression and number of patient problem behaviors, negative social support, and concern about financial resources; negative relationships were found between depression and social support, quality of prior relationship, and satisfaction with social contacts. Three significant independent predictors of change in depression were found: Lower depression scores at Time 1 were related to increases in depression over time; men were more likely than women to experience increases; and a decline in social support resulted in increased depression.

Stress and infectious disease in humans.

This article reviews research on the role of stress in infectious disease as measured either by illness behaviors (symptoms and use of health services) or by verified pathology. Substantial evidence was found for an association between stress and increased illness behavior, and less convincing but provocative evidence was found for a similar association between stress and infectious pathology. Introverts, isolates, and persons lacking social skills may also be at increased risk for both illness behaviors and pathology. Psychobiological models of how stress could influence the onset and progression of infectious disease and a psychological model of how stress could influence illness behaviors are proposed.

Relationship orientation, quality of prior relationship, and distress among caregivers of Alzheimer's patients.

Communal orientation and closeness of the caregiver-patient relationship were investigated as predictors of distress among caregivers of Alzheimer's patients. Persons high in communal orientation were less depressed than those low in communal orientation. Caregivers reporting a close relationship with the patient before illness onset felt less burdened than those whose relationship had not been close. Communal orientation interacted with closeness when data were analyzed separately for men and women. Among men, being low in communal orientation and having a relatively poor prior relationship were associated with the highest levels of depression, levels that put them at risk for clinical depression. Among women low in communal orientation, higher levels of depression were related to having a close prior relationship with the patient.

Psychiatric and physical morbidity effects of caregiving.

Existing empirical literature on the prolonged or cumulative consequences of exposure to the stresses of caregiving is reviewed. Specific goals are to identify psychiatric and physical morbidity effects, report the magnitude of those effects, evaluate research and analytic methods used to assess morbidity, and make recommendations for future research. Overall, the literature indicates increases in self-report psychiatric symptomatology and increases in psychiatric illness among most caregivers when compared to population norms or appropriate control groups. However, there is little information on the population prevalence or incidence of clinically significant psychiatric conditions attributable to caregiving. Studies of physical health effects as assessed by self-report, health care utilization, and immune function are less conclusive but, nevertheless, suggest increased vulnerability to physical illness among caregivers. We conclude with a discussion of why morbidity effects are difficult to obtain in caregiver studies and with recommendations for future research.

Providing help and desired relationship type as determinants of changes in moods and self-evaluations.

Observed in 2 initial studies was converging evidence that helping improves the helpers' moods and self-evaluations. In these studies Ss induced to help showed improved moods and self-evaluations relative to Ss not given an opportunity to help. A 3rd study examined the moderating effects of desired relationship type on reactions to having helped. In this study Ss were led to desire either a communal or an exchange relationship with another. They then helped the other or were not allowed to help. Among Ss led to desire a communal relationship, but not among those led to desire an exchange relationship, helping was associated with greater improvements in moods than not helping. Helping tended to improve self-evaluations regardless of desired relationship type. However, this effect reached statistical significance only among subjects led to desire a communal relationship.

Factors influencing the susceptibility of Candida albicans to the polyenoic antibiotics nystatin and amphotericin B.

Factors influencing the interaction between Candida albicans and the polyenoic antibiotics nystatin and amphotericin B have been investigated using a K+-specific electrode to measure polyene-mediated efflux of cellular K+. In batch cultures, sensitivity was a function of culture age. Using continuous (chemostat) cultures, the influence of growth-limiting substrate, specific growth rate, growth temperature and growth pH were examined. Carbon-limited cultures showed the highest sensitivity of those substrates tested, and susceptibility increased with growth rate. Within the range 22 to 42 degrees C, growth at lower temperatures resulted in increased sensitivity, whilst a similar trend was observed when the growth pH of cultures was reduced. Further, under the conditions tested, there were considerable variations in free intracellular K+ concentrations.

The antiviral activity of the isoquinolines famotine and memotine in respiratory infections in man.

A period of direct contact with a concentration of 20 mug/ml or less of either famotine (1-(p-chlorophenoxymethyl)-3,4-dihydroisoquinoline hydrochloride) or memotine (1-(p-methoxyphenoxymethyl)-3,4-dihydroisoquinoline hydrochloride) inactivates myxoviruses and paramyxoviruses. This activity has been confirmed in organ culture prepared from dog trachea and infected with an influenza A2 virus.Consistent protection of mice infected intranasally with influenza A/PR/8 has not been obtained. Other viruses causing respiratory disease in man, in particular some rhinoviruses, are susceptible during replication to the action of these compounds. Both compounds are of low toxicity and well tolerated by man.Trials in man have embraced challenge, prophylactic and therapeutic studies with both oral and local administration. Challenge studies with influenza A2 and B viruses have demonstrated that with some strains there is in the drug-treated groups a reduction in the incidence of evidence of infection, sometimes significantly, and also a reduction of clinical symptoms, the effect towards influenza B virus being the greater. Nasal instillation of famotine reduced the incidence of clinical symptoms only following challenge with influenza B virus and rhinovirus type 2. Oral prophylactic trials have been inconclusive, although the nasal instillation of famotine did reduce somewhat the incidence of symptoms in a small outbreak of influenza A2/Hong Kong/68. The number of therapeutic trials has been too few and too small to evaluate conclusively the role of these agents in therapy of acute respiratory illness.