Childhood abuse and adult relationships with perpetrating parents: impacts on depressive symptoms of caregivers of aging parents.

Objectives: Combining the stress process model of caregiving and life course perspective, this study examined the long-term associations among childhood abuse, relationships between perpetrating parents and adult children, and adult children's well-being in the context of caregiving for a perpetrating parent.Method: Using a sample of family caregivers from the Wisconsin Longitudinal Study, this study investigated (a) whether contact frequency and emotional closeness with an abusive parent mediated the longitudinal effects of parental childhood abuse on adult-child caregivers' depressive symptoms and (b) the moderating effects of self-acceptance and mastery on this mediational association.Results: Key findings indicated that in the caregivers of mothers, maternal childhood abuse was negatively associated with emotional closeness between an adult child caregiver and perpetrating mother care recipient. In turn, low emotional closeness was associated with higher depressive symptoms in the adult child caregiver. A lack of psychological resources such as self-acceptance and mastery strengthened the effect of maternal childhood abuse on depressive symptoms. In the caregivers of fathers, we did not find any significant indirect effect of parental childhood abuse on adult-child caregivers' depressive symptoms.Conclusion: Further research is needed to explore this phenomenon in light of the heterogeneity of contemporary families. Practitioners are encouraged to employ a trauma-informed approach when working with adults with a history of parental childhood abuse who are caregiving for their perpetrator to maximize the caregivers' health and well-being.

Adverse childhood experiences amplify the longitudinal associations of adult daily stress and health.

BACKGROUND AND OBJECTIVE: The long-term negative impact of Adverse Childhood Experiences (ACEs) is now well-recognized; however, little research has explored the link between ACEs and daily stress processes in adulthood. The current study aimed to examine the effect of ACEs in the association between daily stressor exposure and daily negative affect, and whether such associations would predict long-term health and well-being. METHODS: Using data from the National Study of Daily Experiences 2 (NSDE 2) and the Midlife in the United States (MIDUS) studies, multilevel moderated mediation analyses were conducted to account for daily measurements nested within individuals. We tested whether the indirect effect of daily stressor exposure on prospective chronic health conditions and prospective depressive symptoms through daily negative affect would differ by adults' levels of ACEs. RESULTS: We found significant positive associations between daily stressor exposure and daily negative affect at both the within- and between-person levels. Between-person daily negative affect was, in turn, associated with more chronic health conditions and higher depressive symptoms ten years later. This indirect effect was stronger for adults with high ACEs compared to those with low ACEs. CONCLUSIONS: The current study demonstrated that a history of ACEs may exacerbate the negative health effects of daily stress processes over time. Programs focusing on coping with daily stressors and resilience may benefit adults with ACEs and promote their health and well-being.

Caregiving for Parents Who Harmed You: A Conceptual Review.

Objectives: This paper aims to provide a conceptual review of prior research on the effect of a history of parental childhood maltreatment on the experiences and outcomes of adult-child caregivers who provide care to their perpetrating parents.Methods: We performed a search using several databases including PsycINFO, ScienceDirect, and Academic Search Premier (EBSCO) for relevant papers and reviewed reference sections of selected papers.Results: Histories of childhood maltreatment are associated with adverse psychological health in adult-child caregivers and reduced frequencies of providing support to their parents. The potential factors affecting the experiences and outcomes of such caregivers include contemporaneous relationships with perpetrating parents; caregivers' sense of choice about providing care; opportunities for posttraumatic growth; and participating in care through the end of life.Conclusions: Caregiving for perpetrating parents can be particularly challenging due to complex, intersecting factors; thus, healthcare practitioners' increased awareness of and knowledge about such caregivers are crucial to provide effective support.Clinical Implications: We highlighted the importance of ensuring caregivers' sense of choice and assessing their posttraumatic growth. In caregiving at the end of life, we noted the importance of using a trauma-informed approach when interacting with caregivers and their family members during illness and bereavement.

Palliative Care Leadership.

Palliative care is one of the newer health specialties and continues to mature. While there has been remarkable progression of clinical skills and education, there has been a lack of focus on palliative care interdisciplinary leadership or development of leadership skills. This article highlights the importance of interdisciplinary palliative leadership within the 5 realms of clinical practice, research, education, policy/advocacy, and administration. A definition of leadership is offered and discussion of successful leadership skills is described. A current review of leadership opportunities is provided.

Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review.

IMPORTANCE: Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE: To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. EVIDENCE REVIEW: Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). RESULTS: Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). CONCLUSIONS: Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.

Task force on Medicaid in Missouri: a community collaboration in gerontological social work education.

Master's level social work gerontology students formed a Task Force on Missouri Medicaid as the primary course project of the Social Policy and Aging class at George Warren Brown School of Social Work, Washington University in St. Louis. Led by students, the Task Force collaborated with community leaders to address issues with the escalating enrollment and cost of Missouri's Medicaid program, resulting in a widely disseminated policy brief. Students identified multiple professional skills gained through this assignment and community leaders determined the issue brief to be a significant contribution to Missouri's Medicaid policy debate.