"One Size Doesn't Fit All" - Partners in Hospice Care, an Individualized Approach to Bereavement Intervention.

We concluded in a recent study that a "one size fits all" approach typical of group interventions often does not adequately accommodate the range of situations, life experiences, and current needs of participants. We describe how this limitation informed the design and implementation of an individually-delivered intervention format more specifically tailored to the unique needs of each bereaved person. The intervention comprises one of three interrelated studies within Partners in Hospice Care (PHC), which examines the trajectory from end-of-life care through bereavement among cancer caregivers using hospice. The PHC intervention employs an initial needs assessment in order to tailor the session content, delivery, and sequencing to the most pressing, yet highly diverse needs of the bereaved spouses/partners. Although an individually-delivered format has its own challenges, these can be effectively addressed through standardized interventionist training, regular communication among staff, as well as a flexible approach toward participants' preferences and circumstances.

Time for living and caring: an intervention to make respite more effective for caregivers.

This article presents the rationale for and description of a promising intervention, Time for Living and Caring (TLC), designed to enhance the effectiveness of respite services for family caregivers. It is guided by the theoretical principles of the Selective Optimization with Compensation (SOC) model, which individually coaches caregivers on how to assess their personal circumstances, identify their greatest needs and preferences, and engage in goal setting and attainment strategies to make better use of their respite time. Focusing on respite activities that match caregivers' unique needs is likely to result in improved well-being. We report on a pilot study examining TLC's feasibility and potential benefits and how caregivers viewed their participation. While additional research is needed to test and refine the intervention, we need to find more creative ways to enhance respite services.

Spousal Bereavement Following Cancer Death.

Loss due to cancer could predispose surviving spouses or partners to a variety of negative outcomes. Although a terminal prognosis may provide opportunities to prepare for the loss, existing evidence is inconclusive as to whether death expectedness buffers potentially negative bereavement outcomes. Using data from the Living After Loss study, we examined longitudinally outcomes of bereaved individuals whose spouses/partners died from cancer (n = 112) versus other causes (n = 213) while accounting for death expectedness. While most of the cancer deaths were expected, more than half of the non-cancer deaths were not. The lowest levels of depression, grief, and loneliness over time were among those whose spouses/partners died expectedly from causes other than cancer. Cancer-bereavement was as equally distressing as any unexpected death. Future efforts should focus on the mechanisms underlying these outcomes and develop effective and early interventions to those in greatest need.

Perceived self-competency among the recently bereaved.

In this study, the authors identified personal resources, features of the marital relationship, and death circumstances that affected perceived self-competency among recently bereaved older adults. Data came from 328 widowed persons who participated in the "Living After Loss" project. Results suggested that those who had more personal resources--namely, income and good health--were the most competent in daily life tasks. Surprisingly, neither death forewarning nor marital quality improved competency after widowhood. Higher competency was associated with more positive mental health outcomes, suggesting that grief is complicated by the need to enhance and/or restore daily life activities as well as the need to deal with the sadness associated with the loss.

Identifying themes regarding the benefits and limitations of caregiver support group conversations.

Support groups continue to be one of the most needed and desired forms of help for family caregivers to persons with dementia. Though the effects of caregiver support group participation have been examined, the benefits and limitations of the dynamics of support group conversations have been neglected. This study focuses on the perceived consequences of group dynamics. Three themes-balance, sameness, and individuality-emerged through analysis of open-ended interviews with support group members following observations of their meetings. The consequences of these themes are illustrated with a case study and the implications of these themes for practitioners are discussed.

Humor, laughter, and happiness in the daily lives of recently bereaved spouses.

The positive psychology movement has created more interest in examining the potential value of experiencing positive emotions (e.g., humor, laughter, and happiness) during the course of bereavement. This study of 292 recently widowed (5-24 weeks) men (39%) and women (61%) age 50 and over examined both the perceived importance of and actual experience of having positive emotions in their daily lives and how they might impact bereavement adjustments. We found that most of the bereaved spouses rated humor and happiness as being very important in their daily lives and that they were also experiencing these emotions at higher levels than expected. Experiencing humor, laughter, and happiness was strongly associated with favorable bereavement adjustments (lower grief and depression) regardless of the extent to which the bereaved person valued having these positive emotions.

Toward the development of an inventory of daily widowed life (IDWL): guided by the dual process model of coping with bereavement.

The Dual Process Model of Coping with Bereavement (M. Stroebe & H. Schut, 1999) suggests that the most effective adaptation involves oscillation between 2 coping processes: loss-orientation (LO) and restoration-orientation (RO). A 22-item Inventory of Daily Widowed Life (IDWL) was developed to measure these processes and the oscillation between them and assessed by examining 163 bereaved widow(er)s, ages 45-94 years. The LO and RO subscales produced alpha coefficients of .90 and .79, respectively. The more recently widowed demonstrated a high degree of oscillation balance between the two processes, while there was a greater emphasis on restoration-orientation among those bereaved longer. Both subscales generated significant relationships with the bereavement outcome measures used in this study. Furthermore, restoration-orientation was directly related to the level of self-care and daily living skills as well as personal growth. We identify six dimensions of oscillation that warrant further consideration and encourage others to help develop and refine all features of the IDWL and make it adaptable to other loss relationships.

Older adults' attitudes, concerns, and support for environmental issues in the "New West".

The natural environment has been a missing topic from education and public policy forums concerning an aging society. This study examines demographic trends and several socio-demographic influences on attitudes, concerns, and active support for environmental issues among older adults in a retirement "hot spot" in the New West. A sample of 394 older adults in southwestern Utah was obtained from questionnaires mailed to those randomly selected from a larger dataset, and through hand-distributed questionnaires at selected RV parks. We found a high degree of variability among respondents in regard to environmental attitudes and concerns. Despite a personal attitudinal desire to protect the environment, most older adults did not want to become involved in protective actions for the environment. We found that residency status and religious affiliation emerged as the strongest relationships with measures of attitudes and concerns, and willingness to support the environment. The most influential factors associated with willingness to take action in support of the environment were having higher levels of active/social concerns, and higher levels of awareness of environmental consequences. The New West is one of the fastest-growing areas for demographic aging, and the opinions and actions of older adults will play a significant role in the stewardship and sustainability of natural resources, particularly in retirement hot spots.