The Mediating Role of Proxy Respondents on the Relationship Between Cognitive Function and Self-Rated Health.

BACKGROUND AND OBJECTIVES: Proxy respondents are an important tool in survey research, especially among people with cognitive impairment. However, proxy respondents may be unable to accurately answer subjective survey instruments for cognitively impaired persons. This study investigates the mediating effect of proxy status on the relationship between cognitive impairment and subjectively rated health. RESEARCH DESIGN AND METHODS: Respondents from the 2018 wave of the Health and Retirement Study (N = 17,146) were included, and the Baron and Kenny method assessed the potential mediating role of having a proxy on subjectively rated health. Subjectively rated health and proxy status were dichotomously coded, and relationships between cognitive impairment, proxy status, and subjectively rated health were assessed using logistic regression. RESULTS: Findings indicate that cognitive impairment is inversely associated with subjectively rated health, and it is directly associated with having a proxy. They also indicate that having a proxy is inversely related to subjectively rated health. When including proxy status and cognitive impairment in the same model, cognitive impairment no longer predicted subjectively rated health. This indicates that proxy status perfectly mediated the relationship between cognitive impairment and subjectively rated health. DISCUSSION AND IMPLICATIONS: Measuring the experiences of people with cognitive impairment is challenging in survey research due to the limiting features of cognitive impairment. Although having a proxy respondent helps address attrition-related measurement challenges in survey research, findings indicate that proxies report worse subjectively rated health for people with cognitive impairment compared to individuals with comparable levels of cognitive impairment without a proxy. Future research may benefit from exploring optimal proxy-respondent characteristics.

Policies to Sustain Employment Among Family Caregivers: The Family Caregiver Perspective.

The work of caregiving can make it difficult to sustain employment. This study aimed to clarify what family caregivers themselves think is important in remaining employed, as part of work mandated under the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018. Data came from a Request for Information promulgated by the Administration for Community Living, resulting in 1147 family caregiver responses, and 12 focus groups. Findings support many goals identified by caregiver-advocates, such as expanding the Family and Medical Leave Act, and access to paid time off and sick leave; caregivers also value flexible work arrangements. However, the study further revealed a need for supportive work environments that protect caregivers against workplace discrimination and negative attitudes held by both managers and colleagues, and thus for employer education about the caregiving experience as well as caregivers' needs for workplace supports and benefits, and possibly anti-discrimination legislation.

Farmer Mental Health in the US Midwest: Key Informant Perspectives.

In this study, we seek to illuminate: (1) the ways farm service providers and mental health professionals understand the drivers of farm stress, (2) the strategies, challenges, and opportunities farm service providers and mental health professionals identify for supporting the mental health needs of farm families, and; (3) opportunities for future research and outreach to improve the mental health of farmers in the U.S. Midwest region. We obtained qualitative data from a series of semi-structured key informant interviews with 19 subject matter experts, using content analysis to identify themes across four domains: main challenges, unique impacts by subpopulation, coping strategies, and interventions and recommendations. The key informants we interviewed identified a variety of acute and chronic stressors, including several that are structural, rather than individual and interpersonal, and which lie outside of the control of farmers themselves. They also highlighted diversity within farm populations by socio-demographic and farm characteristics as well as positive and negative coping strategies, with negative being more common. For interventions and recommendations, they stressed the importance of education on mental health, improving access to care, and addressing root causes of stress. While farmer stress is well-documented, less is known about the perspectives of farm service professionals and mental health providers who care for them. The insights from this study add important information on how to best support the immediate and long-term mental health needs of farmers and farm families in the U.S. Midwest and beyond.