Future directions in family and professional caregiving for the elderly.

As the population ages and the expected wave of baby boomers settles into old age, there is a pressing need to examine the people and institutions that care for elders and the ways in which the system will need to adapt during the next 5-10 years to accommodate the needs of the elderly and of their caregivers. This paper examines future directions in this field, identifying the major issues from two perspectives: family caregiving and professional caregiving. Despite extensive research on caregiving, more attention to a series of methodological issues is needed, as is more extensive evaluation of promising intervention models in community and institutional settings. Effective strategies to lower caregiver distress and improve the quality of care can be implemented in efficient ways that manage costs, but the argument for innovations must be made based on efficacy.

Values and preferences of individuals with dementia: perceptions of family caregivers over time.

PURPOSE OF THE STUDY: Cross-sectional evidence indicates that family caregivers reporting on the importance of daily care values and preferences of individuals with mild-to-moderate dementia consistently report less importance than individuals with dementia (IWDs) self-report. Discrepancy is primarily associated with caregivers' beliefs about care. However, research has yet to address how caregivers' perceptions of IWDs' values and preferences change over time and how change is related to caregivers' well-being. DESIGN AND METHODS: The sample includes 198 dyads of an individual with mild-to-moderate dementia and a spouse or child providing assistance. Linear growth curve modeling was applied to investigate how caregivers' perceptions of importance of IWDs' values and preferences in daily care change over 4 years and the factors associated with change. RESULTS: Caregivers' perceived importance of IWDs' values and preferences significantly decreased over time, with significant between-person differences in level and slope. Between-person differences in level were associated with caregivers' beliefs about care, IWDs' self-reported importance of values and preferences at baseline, and kin relationship. Changes in caregivers' reports of importance covaried with caregivers' own quality of life over time. IMPLICATIONS: Findings suggest that caregivers increasingly de-emphasize the importance of values held by their IWDs. Although creating this emotional distance may be adaptive, caregivers may become increasingly unable to make decisions that effectively represent IWDs' own preferences.

Understanding discrepancy in perceptions of values: individuals with mild to moderate dementia and their family caregivers.

PURPOSE OF THE STUDY: We explore discrepancies in perceptions of values and care preferences between individuals with dementia (IWDs) and their family caregivers. DESIGN AND METHODS: We interviewed 266 dyads consisting of an individual with mild to moderate dementia and his or her family caregiver to determine IWDs' beliefs for 5 values related to care (autonomy, burden, control, family, and safety). We used multilevel modeling to investigate if there are dyadic level discrepancies in beliefs and what factors are associated with such discrepancies. RESULTS: Caregivers consistently underestimated the IWD's values for all five values. Discrepancies were associated primarily with caregivers' beliefs about the IWD's involvement in decision making. Race was also associated with the discrepancies for control and safety, whereas cognitive functioning of the IWD was associated with the discrepancy for burden. IMPLICATIONS: Many caregivers do not have an accurate depiction of the IWD's values, yet, caregivers will become the surrogate decision makers for IWDs as dementia progresses. These findings indicate the need for assessments of values and preferences in care and to develop programs that assess values, consider the caregiver's beliefs about care, and improve communication within the dyad in the early stages of dementia.

Communication about smoking between depressed adolescents and their parents.

INTRODUCTION: Better understanding of effective parent-adolescent communication regarding tobacco use could inform smoking cessation intervention. METHODS: Semistructured interviews related to communication about smoking were conducted with 15 depressed adolescent smokers and their parents, primarily from urban areas. This study, conducted in 2006-2008, was funded by the Pennsylvania Department of Health. Interview transcripts (N = 30) were coded in QSR N6. RESULTS: Quality of communication, rather than content, seemed to determine whether parental communication was effective. Parents reactivity to, or avoidance of, adolescent smoking presented a barrier to effective communication. In this sample, parents and adolescents were more concerned about problems, such as depression, than smoking. DISCUSSION: Involving parents in adolescent smoking cessation programs may be promising. Parental involvement may include teaching parent-child communication skills, building stronger relational bonds, or helping parents quit simultaneously. Further research is needed to explore whether coupling smoking cessation with depression treatment increases parent and adolescent treatment engagement and effectiveness.