Social isolation and outcomes post stroke.

OBJECTIVE: To assess the relationship between social isolation and stroke outcomes in a multiethnic cohort. METHODS: As part of the Northern Manhattan Stroke Study, the authors prospectively followed a cohort of patients with stroke for 5 years. Baseline data including social isolation were collected. At follow-up, the authors documented outcome events as defined by the first occurrence of myocardial infarction (MI), stroke recurrence, or death. Cox hazard models were used to calculate the hazard ratio (HR, 95% CI) for prestroke predictors of post stroke outcomes. RESULTS: The authors followed 655 ischemic stroke cases for a mean of 5 years. The cohort was 55% women; 17% white, 27% African American, 54% Hispanic; mean age 69 +/- 12 years. There were 265 first outcome events. In univariate analysis, coronary artery disease (OR 1.3, 1.0 to 1.7), age > 70 years (OR 1.9, 1.5 to 2.5), atrial fibrillation (AF) (OR 1.8, 1.3 to 2.5), race-ethnicity (white vs Hispanic) (OR 1.7, 1.1 to 2.9), physical inactivity (OR 1.3, 1.1 to 2.6), help at home (OR 1.8, 1.4 to 2.4), and social isolation (OR 1.4, 1.2 to 1.6) were associated with increased risk of an outcome event. No association was seen for hypertension, diabetes, education, sex, insurance, occupation, marital status, or primary care physician. In the multivariable model controlling for age, AF (OR 1.9, 1.5 to 2.5), help at home (OR 1.5, 1.1 to 2.0), and social isolation (OR 1.4, 1.1 to 1.8) predicted outcome events. CONCLUSION: Prestroke social isolation is a predictor of outcome events post stroke. Lack of social support may contribute to poorer outcomes due to poor compliance, depression, and stress.

Factors influencing participation in weekly support groups among women completing an HIV/STD intervention program.

Over the past three decades, the influence and importance of social support has been well documented and the findings have suggested a beneficial effect on stress-related situations, mental and physical health, and social functioning. More recently, small group/skills training behavioral interventions have demonstrated success in changing behaviors which affect the transmission of sexually transmitted diseases, including HIV among populations at risk for these diseases. Studies of support groups to date have been conducted exclusively in research settings where women are offered financial incentives for participation. Little is known about the willingness of women to participate in ongoing support groups after successfully completing a skills training intervention. The present study examines the factors that may influence participation among women in a weekly support group after completing a structured, six session HIV/STD intervention. Both quantitative and qualitative data are collected from 265 women in the intervention arm of a multi-site randomized controlled behavioral intervention trial. Results reveal that less than a quarter (22%) of women participated in at least one support group. Participation varied significantly by site, ranging from 34% to 15% (p = .008). Participation was also strongly linked to recent use of domestic violence services. Qualitative data indicated that although monetary incentives play some role in the woman's decision to participate, other factors are also important. These include program outreach, support group size, salience of the group content, consistency of group leadership from the intervention to the support group, and use of peer leaders along with professional facilitators. Implications for design of post-intervention support groups programs are discussed.

Caregiver burden and coping strategies used by informal caregivers of minority women living with HIV/AIDS.

The incidence of HIV/AIDS among minority women has been reported in record numbers in inner cities. In considering the shift toward community-based care, these minority women living with HIV/AIDS (MWLWHA) are receiving care from informal caregivers in their communities. As caregivers strive to meet the needs of these women, understanding the impact on these caregivers of providing support is critical. In this qualitative study, caregiver burden and coping strategies used by informal caregivers of minority women living with HIV/AIDS were studied. Thirty-one caregivers were interviewed. Data analyses included the constant comparative method consistent with the grounded theory approach. Two caregiver groups emerged, male companion and relative/girlfriend caregivers. All caregivers reported the emotional burden of not revealing the HIV/AIDS diagnoses. Relative/girlfriend caregivers had similar burdens related to the children of the women; their social networks, health and finances. Maintaining a physical exercise regimen and a spiritual focus were coping strategies use by all caregivers. Implications and recommendations are discussed.

Caregiver characteristics and types of assistance provided by caregivers to minority women living with HIV/AIDS.

The incidence of HIV/AIDS has escalated among African American and Hispanic women in the United States and particularly in urban centers such as New York City. As a chronic illness, it is important to understand to whom minority women living with HIV/AIDS turn to for assistance and support. The purpose of this exploratory qualitative study was to identify the characteristics of informal caregivers and the types of assistance that they provide to minority women living with the HIV virus. Thirty one caregivers were interviewed using semi-structured and opened ended questions. Data analyses included the constant comparative method consistent with the grounded theory approach. A topology of two caregiver groups were identified, male companions and relative/girlfriend caregivers. Caregiving activities are described within each group in the areas of emotional support, child care, personal advisement, social welfare and financial assistance. Implications for practice and recommendations for further study are discussed.

Mental health services for rural elderly: innovative service strategies.

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.

Choosing optimal support groups: a review and reformulation.

There is considerable empirical research on the division of supportive and caregiving services among different network members. Yet the principles that govern the configuration of social support networks are still not well understood. Cantor's (1979) and Shanas' (1979) hierarchical-compensatory model and Litwak's (1985) task-specific model are among the more prominent formulations for explaining the choice of support groups. We propose that the former model is a special case of the latter one. The major conceptual features of both models are summarized here, followed by a qualitative review of 16 key empirical studies coupled with a meta-analysis to demonstrate the broader application of the task-specific model.

A task-specific typology of intergenerational family structure in later life.

We tested a typology of intergenerational social support structure with data from 910 dyads of older adults and their primary child helpers. Logistic regression was used to identify variables that differentiate dyads with distinct support configurations. Household support provided to elderly parents was more sensitive to physical and social deficits and geographic distance, whereas social-emotional support was more sensitive to norms and personal affinity.

Migration patterns among the elderly: a developmental perspective.

PIP: The elderly tend to make 3 kinds of moves when they migrate: 1) When they retire, 2) When they experience moderate forms of disability, and 3) when they have major forms of chronic disability. In the 1st type of move, the migrant's support needs do not require nearness of kin. These migrants tend to be younger, healthier, wealthier, and more often have intact marriages than migrants in the counter streams. The 2nd type of move is typically compounded when deficits from widowhood and disability are combined. They generally move nearer to their children. Older persons moving to retirement destinations like Florida should typify the 1st move, whereas those moving from Florida to northern urban areas should typify the 2nd and 3rd moves. Those moving from northern states to Florida tend to be younger than those moving from Florida to northern states. 15.5% of those moving to Florida are over 75 years old whereas 40.6% of those moving north from Florida are over 75. 47.8% of those moving north are widowed, but only 17% of those moving to Florida are widowed. Limited kin resources is the motive for the 3rd move. Most 3rd-stage moves are local rather than long distance. There are 2 groups who do not follow the same migration pattern despite facing similar social pressures to make the 3 basic moves: 1) those moving between metropolitan and non-metropolitan places and 2) migrants from abroad who join their families. Migrants from abroad tend to live with their children more and live independently less frequently than any of the migration comparison groups. They also have the highest proportion of persons receiving welfare income.^ieng

Complementary roles for formal and informal support groups: a study of nursing homes and mortality rates.

Organizational theorists have argued that formal and informal support systems cannot exist in strong form in the same society. In this article, the author argues that such theories fail to consider the complementary of these two systems and the necessity of both for the completion of most tasks. A study of tasks performed for nursing home residents found that the formal organization assumed those tasks that could be standardized and deemed legitimate for Medicaid funding, while the others were either maintained by informal support groups or lost altogether. A study of the influence of informal support groups on mortality rates found that such groups played an important role in reducing death in older persons resulting from causes associated with nontechnical matters. In conclusion, the author finds that formal groups can best manage tasks that require technical knowledge or that can be reduced to simpler, routine components, whereas informal groups can better manage tasks requiring everyday knowledge and characterized by many contingencies or unpredictability. The author stresses that both formal and informal support must be provided when serviing older people.