Predictors of grief in bereaved family caregivers of person's with Alzheimer's disease: a prospective study.

The purpose of this prospective study was to identify factors in 66 spouses and adult child caregivers of person's with Alzheimer's disease prior to the death that predicted higher levels of grief in bereavement. A hierarchical regression model was tested. Predeath grief, dysfunctional coping, depression, social support, and decreased positive states of mind explained 54.7% of the variance in postdeath grief. Factors that contributed significantly to postdeath grief included predeath grief and depression. Results from this study indicate that risk factors for postdeath grief can be predicted prior to the death.

"Easing the way" for spouse caregivers of individuals with dementia: a pilot feasibility study of a grief intervention.

A multicomponent intervention targeting grief symptoms in spouse caregivers of individuals with dementia was pilot tested in this feasibility study. Twenty spouse caregivers completed the study within the 5-month protocol. The five-component intervention, deduced from Meuser, Marwit, and Sanders' Dementia Caregiver Grief Model and tailored to participants' grief, mental health, and learning needs, included supportive grief counseling, emotional support, education, skill building, and referral to community resources. Significant changes were found from baseline to intervention completion for the measures of grief, depression, anxiety, positive states of mind, and self-efficacy, resulting in a moderate effect size of -0.43 for grief to a large effect size of -2.40 for anxiety. Increases in quality of life and decreases in grief persisted at the 8-month follow up for caregivers who continued to provide care in the home. The Easing the Way intervention protocol is a promising caregiver program that warrants further testing in a randomized controlled study.

The experience of high levels of grief in caregivers of persons with Alzheimer's disease and related dementia.

An abundance of literature on caregivers of individuals with dementia has been written since the mid-1980s. However, most of this literature focused on the experience of stress, burden, and depression in caregivers, thus excluding the grief experience that also accompanies the caregiving experience. The purpose of this multimethod study is to describe the lived experience of 44 spouses and adult children who are caregivers of persons with Alzheimer's disease and related dementias (ADRD) and scored high on the Marwit and Meuser Caregiver Grief Inventory, Short Form (MM-CGI-SF). This study presents qualitative results from a mixed-methods descriptive study (N = 201). Seven themes emerged from the qualitative data that detailed the caregiving experience of the individuals with high grief: (a) yearning for the past, (b) regret and guilt, (c) isolation, (d) restricted freedom, (e) life stressors, (f) systemic issues, and (g) coping strategies. The first 2 themes reflect grief reactions, whereas isolation, restricted freedom, life stressors, and systemic issues possessed elements of both grief and caregiver burden and stress. Coping strategies used by this group of caregivers included spiritual faith, social supports, and pets. Quantitative analysis confirmed that these themes are unique to individuals with high levels of grief compared with those with moderate/low levels of grief, except for the coping strategies of social support and spiritual faith. Caregivers with high levels of grief may benefit from supportive interventions that are based on reducing feelings of isolation, lack of freedom, and increased guilt and regret, while also addressing feelings of loss. Interventions that facilitate building a supportive network are suggested. Using a screening tool such as the MM-CGI-SF will help in identifying caregivers with high levels of grief who may be in need of additional support.

Spousal bereavement in older adults: common, resilient, and chronic grief with defining characteristics.

The purpose of this study was to identify empirically patterns of grief among 141 older bereaved spouses. A longitudinal hierarchical cluster procedure with the Ward agglomeration method was used to identify distinct clusters based on grief scores. Three clusters were identified: common (49%), resilient (34%), and chronic (17%) grief. Members of the common grief cluster experienced elevated levels of grief and depressive symptoms that decreased over time. Members of the resilient cluster experienced the lowest levels of grief and depression and the highest quality of life. The chronic grief cluster experienced the highest levels of grief and depression, more sudden deaths, the lowest self-esteem, and the highest marital dependency. The majority in this chronic cluster also met proposed criteria for a diagnosis of complicated grief. Five out of every six bereaved spouses adjusted well over time, and about a third of these showed considerable resilience without negative consequences. One out of six experienced a chronic grief syndrome. Early identification of this syndrome can lead to referral to newly emergent treatments specific for grief.

Grief and personal growth experience of spouses and adult-child caregivers of individuals with Alzheimer's disease and related dementias.

PURPOSE: The purpose of this study was to describe the grief and personal growth experience of spouses and adult children of individuals with Alzheimer's disease and related dementias and the factors contributing to these experiences. DESIGN AND METHODS: We used a modification of the Marwit-Meuser-Sanders Caregiver Grief model to examine the factors that contribute to grief and personal growth. We used chi-square tests, t tests, multivariate analyses of variance, correlations, and hierarchical regression analyses in a cross-sectional analysis of 201 spouses and adult children caregivers at various stages of the disease trajectory. RESULTS: Grief increased as the severity of the disease increased. When the spouse with Alzheimer's disease lived out of the home, spouse caregivers experienced more sadness and longing, worry and isolation, and personal sacrifice burden than did adult children caregivers. Different factors influence grief and personal growth for caregivers of individuals with Alzheimer's disease. The majority of caregivers experienced personal growth, with more growth experienced by adult children. IMPLICATIONS: Health care providers should consider using the Marwit and Meuser Caregiver Grief Inventory to screen for high levels of grief in caregivers of individuals with Alzheimer's disease. Supportive services targeted for those with high levels of grief are suggested.

Smoking-related health behaviors of employees and readiness to quit: basis for health promotion interventions.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

Development and validation of the College Tobacco Survey.

The authors report on the development and assessment of an instrument to measure baseline campus cigarette use and outcomes from prevention programs, including those using a social norms approach combined with environmental policy change. They administered the 37-item College Tobacco Survey (CTS) to a convenience sample of 1,279 college students in freshmen-level classes at a large urban university. Factor analysis of 15 belief items revealed 3 factors: Peer Environment, Personal Effects, and Campus Policy Endorsement. The findings support the survey's reliability and validity. The authors discuss potential uses of the survey in terms of social norms and environmental prevention programs.

The impact of an urban outreach teaching project: developing cultural competence.

The purpose of this study was to explore the development of cultural competence in a group of university nursing students in the context of an interactive substance abuse prevention project attached to a health promotion course with 414 racially diverse high school students. The project provided opportunities for contact, interaction, and reflection. A descriptive approach was utilized to elicit the meaning attached to the experience. Data included written content from an exit survey, field notes from onsite debriefings, transcriptions of a focus group interview, and an analysis of theoretical papers. Findings indicate that when university students participate in an urban teaching project under conditions of diminishing anxiety and are given opportunities for reflection, they not only increase cultural competence but they also develop a sense of advocacy. Recommendations are made for building community partnerships to enhance cultural competence.

A collaborative student affairs and faculty health assessment and intervention initiative.

The authors describe a collaborative partnership forged between faculty and student affairs staff to improve student health at a large urban university. They examine skills and reward structures of each constituency and the stages of the collaboration in the context of 2 theoretical models. A comprehensive data collection and dissemination process in the campus community provided goals for the initial stage of the partnership, leading to implementation of campus initiatives that use the reciprocal skills of each stakeholder. Outcomes of the collaboration included (1) a working relationship between faculty and student affairs staff, (2) increased dialogue with high-level administrators, (3) more coordinated campus efforts to decrease high-risk drinking, (4) use of outcome measures for implementing and evaluating health programs, and (5) an opportunity for interdisciplinary research. The authors offer suggestions for implementing the process on other campuses.

The impact of complicated grief on mental and physical health at various points in the bereavement process.

The purpose of this cohort sequential study was to determine whether the presence of complicated grief (CG) measured at various points in the spousal bereavement process is associated with an increase in mental and physical health problems 18 months later. One hundred twelve participants provided data at four points in time. CG was measured with the Inventory of Complicated Grief (ICG), and mental health was measured with the Integra Outpatient Tracking Assessment, Mental Health Index (MHI), and illnesses by self-report. Twenty-nine participants were identified as experiencing CG. Beginning at 6 months after the death, MHI scores were significantly lower for the CG group and those results were persistent. The CG group experienced more additional life stressors, perceived less social support, and achieved less clinically significant change in MHI than the NCG group. Identification of CG at any point at 6 months or later in bereavement indicates a need for professional intervention. Implications for establishing CG as a DSM diagnosis are discussed.

Social norms marketing: a prevention strategy to decrease high-risk drinking among college students.

We describe a social-norms marketing approach to moderating college student drinking behaviors and correcting student misperceptions about campus drinking. The intervention has the potential to be applied to other health behaviors where misperceptions abound, such as those related to cigarette smoking, eating disorders, sexual health, and sexual assault. Even though nurses are actively working on alcohol and other drug (AOD) prevention efforts on college campuses, little data based research have been published. Collaborative efforts between faculty from different disciplines, including nursing and nurse health educators, can be an effective combination for preventing alcohol abuse and for initiating sound research-based campus prevention programs.

Patterns of change in mental health status during the first two years of spousal bereavement.

Patterns of change in mental health were identified for 118 recently widowed participants using the Integra Outpatient Tracking Assessment, Mental Health Index. Change was measured 4 times over the first 2 years of bereavement using a cohort sequential design. It was hypothesized that application of the psychotherapy phase model would have some use in understanding the various ways in which people grieve. The overall pattern of change in mental health was similar to that of the psychotherapy dosage and psychotherapy phase models and indicated a dramatic change in overall mental health, well-being, and symptoms during the beginning phases of bereavement followed by a plateau. At 24 months after the death, participants had not attained the same level of mental health as the general population. Within limitations of the design and sample, 2 conclusions were reached: (a) the overall pattern of change in bereavement was similar to that of distressed patients receiving outpatient mental health services, and (b) the patterns of change for individuals vary, making it important to consider clinical characteristics that might account for individual differences. These findings help establish an empirical model of grief that has use for clinical interventions.