Positive Aspects of Family Caregiving for Older Adults at End-of-Life: A Qualitative Examination.

Family caregivers of older adults with dementia have significant challenges across many domains. While this role has been found to be burdensome on the caregiver, increasingly, though, there are also significant positive aspects reported by caregivers (known as the positive aspects of caregiving-PAC). This participatory qualitative study of 30 United States caregivers of family members age 65 and older who died with a dementia-related diagnoses used in-depth qualitative interviews and directed content analysis to understand the data. The study addressed a gap in the research literature and asked about caregiver's positive experiences during their family members' last weeks of life and investigated what this meant for the caregiver. Three primary themes were identified: (1) The Importance and Impact of Family Traditions/Celebrations, (2) Use of Humor in Living and the Difficult Experiences at End-of-Life, and (3) "The Gift of Caregiving." These findings are explored and reviewed in light of other research looking at the positive aspects of caregiving for caregivers taking care of persons living with dementia, finding concurrence and some uniqueness across the results. Implications of the findings for families and social work professionals are reviewed.

Dying With Dementia: Caregiver Observations of Their Family Members' Physical Decline and Behavioral or Psychological Changes During Their Last Days.

Family caregivers of older persons with dementia have significant challenges across many domains. These reported problems encountered over their caregiving time are for many reasons, but what makes the caretaking difficult is complicated by both the unknown nature of the dementia disease and the dying trajectory. While there are studies, primarily from health-care professionals, of this dying process and the last few weeks of life for older persons with dementia, much less is known directly from the family caregivers' perspectives and experiences. This qualitative study of 30 caregivers of family members aged 65 years and older who died with dementia-related diagnoses used in-depth qualitative interviews conducted over a 12-month period and directed content analysis to understand the data. The study asked what physical, behavioral, and psychological changes they observed and experienced during their family members' last weeks of life. Three primary themes were identified around behavioral and psychological changes: (a) they become different people, (b) did not recognize caregiver, and (c) wandering and getting lost; and two primary themes identified physical decline: (a) system started shutting down and (b) drastically diminished self-sufficiency. Implications for families and professionals are reviewed and discussed.

Family caregivers for older persons with dementia offer recommendations to current caregivers: a qualitative investigation.

BACKGROUND AND AIMS: Family members who care for older adults with dementia encounter significant difficulties across many domains. There is limited research in this area; thus, the aim here is to share the actual experiences of 30 family caregivers to other family caregivers and to show how these experiences can provide help and recommendations. METHODS: This qualitative study of 30 family caregivers of family members aged 65 and older who died with dementia-related diagnoses used in-depth qualitative interviews conducted over a 12-month period for data collection and content analysis to understand the data. The study asked what they learned and what subsequent recommendations these caregivers had for other family caregivers taking care of an older person with dementia. RESULTS: Four primary themes emerged from the content data analysis and included the following: (1) "do not do it alone"; (2) patience, love, and kindness; (3) "first of all, take care of yourself"; and (4) "get educated." CONCLUSIONS: This study is unique in asking directly of family caregivers of older persons who died of dementia what they learned and what they want to share and recommend to ongoing and future family caregivers.

From Juvenile Offender Institutions to Residential Treatment Centers: Evidence of the Shifting Paradigm to Improved Youth and Community Outcomes.

Hundreds of thousands of youth are held every year in U.S. juvenile justice detention centers and incarceration facilities. Increasingly it is known that these facility placements are at best ineffective and at worst lead to additional youth recidivism outcomes. What is most concerning, though, is that a majority of these incarcerated youth have one or more mental health/substance abuse disorders, special education disabilities, or maltreatment victimization histories-comorbid situations that negatively impact their involvement with the juvenile courts. In this article the authors summarize the epidemiology of these youth problems within the juvenile justice system. The authors then compare the outcome evidence for the youth placed in juvenile justice facilities with those placed in residential treatment centers, finding significant advantages to addressing the problems through rehabilitative efforts. Recognizing that there are a small number of serious youthful offenders who will need placement, their analysis finds that the juvenile courts must continue (or in many instances begin) reshaping their detention and incarceration facilities reliance on punishment toward a rehabilitative residential model.

Comorbid Adolescent Difficulties: Social Work Prevention of Delinquency and Serious Youthful Offending.

A majority of adolescents who are formally involved with the juvenile courts and detained or incarcerated are dealing with past or present maltreatment victimization, learning disabilities, and/or mental health/substance abuse difficulties. Addressing these problems and traumas is an integral part of preventing delinquency and breaking a youthful offender's recidivist cycle, a pattern that often predicts adult offending and incarceration. Fortunately, there are effective programs across the social work profession that decrease or may even eliminate delinquent behaviors, both for low-level and more serious youthful offenders. Unfortunately, the use of these social work preventative programs is not consistent or extensive within the juvenile justice system.

Association between mental health disorders and juveniles' detention for a personal crime.

BACKGROUND: Youth involved with juvenile courts often suffer from mental health difficulties and disorders, and these mental health disorders have often been a factor leading to the youth's delinquent behaviours and activities. METHOD: The present study of a sample population (N = 341), randomly drawn from one urban US county's juvenile court delinquent population, investigated which specific mental health disorders predicted detention for committing a personal crime. RESULTS: Youth with attention-deficit hyperactivity disorder and conduct disorder diagnoses were significantly less likely to commit personal crimes and experience subsequent detention, while youth with bipolar diagnoses were significantly more likely. CONCLUSION: Co-ordinated youth policy efforts leading to early identification and treatment of bipolar disorder symptoms may be necessary.

Predicting juvenile delinquency: the nexus of childhood maltreatment, depression and bipolar disorder.

BACKGROUND: It is important to identify and provide preventative interventions for youth who are most at risk for offending behaviour, but the connection between early childhood or adolescent experiences and later delinquency adjudication is complicated. AIM: To test for associations between specified mental disorders or maltreatment and later delinquency adjudication. METHOD: Participants were a random sample of youth before the juvenile courts in two Northeast Ohio counties in the USA (n = 555) over a 4-year time frame (2003 to 2006). RESULTS: Logistic regression analysis identified a lifetime diagnosis of depression and/or bipolar disorder to be predictive of later youth delinquency adjudication, but found that childhood maltreatment (or involvement with the child welfare system) made delinquency outcomes less likely. IMPLICATIONS: Study implications are discussed as they relate to professionals working in the fields of child welfare, social work, mental health and juvenile justice. Awareness of risks associated with maltreatment may have led to effective interventions, while there may be less awareness of risks from depression in young people; however, studies tend not to take account of intervention variables.

Behaviorally-based disorders: the historical social construction of youths' most prevalent psychiatric diagnoses.

Psychiatry in the USA controls the definitions of mental health disorders and diagnosis through required practice utilization of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and fiscal reimbursement using it. The present sociohistorical research paper presents and critically examines the Manual's systemic and diagnostic development of today's most prevalent youth mental health diagnoses (conduct and oppositional defiant disorders). Through a social construction theoretical paradigm, this research identified diagnostic classification systems, nosology changes, critical time periods, conducive social and cultural conditions, and key individuals involved in the development of these youth behaviorally-based disorders within two distinct historical time frames: 1880 to 1968 and 1969 to 2000. It also identified patterns of nosology system and diagnostic category changes based upon very limited empiricism, inordinately influenced by a limited number of individuals, and understood through a socially constructed framework.