Physical pain among family caregivers to older adults: A scoping review of the literature.

BACKGROUND AND OBJECTIVES: Scholarship on the health of family caregivers to older adults continues to expand. Although existing research suggests that many family caregivers experience pain, which impacts their ability to perform caregiving tasks and is associated with care recipients' unmet needs, the scope of research on family caregivers' pain remains poorly characterized. We conducted a scoping review of research on pain among family caregivers to older adults to characterize existing evidence and identify knowledge gaps. METHODS: We searched multiple databases spanning from January 2012 to July 2023, identified eligible studies using predefined inclusion/exclusion criteria, and extracted key data (e.g., study design/methodology, pain measurement, caregiver pain type, and major findings). RESULTS: We identified 46 eligible studies conducted in the United States (n = 19) and internationally (n = 27). Studies often focused on caregivers for older adults with specific health conditions, such as cancer (n = 11), dementia (n = 8), or stroke (n = 3). The most commonly employed pain measure was a single-item dichotomous question about pain (n = 16), followed by a visual numeric or visual analog scale (n = 11). Nine studies (five randomized controlled trials) reported on five caregiver pain management interventions, including yoga/exercise programs and caregiver education programs. DISCUSSION: Existing research on family caregivers' pain offers an important foundation. However, more robust research designs are necessary. We identify possibilities for future studies in addition to opportunities for systematic investigations to support the family caregivers being relied upon to care for the increasing number of older adults.

'With or without you': associations between noteworthy events and cognitive complaints across 100 days.

OBJECTIVES: Daily noteworthy events have implications for physical and mental health, but less is known about the role daily events have for self-reported cognition and whether the involvement of close social partners differentiates these associations. The current study examined how daily positive and negative noteworthy events relate to subjective memory and attentional difficulties and whether close social partners moderated associations. METHOD: We used data from a 100-day microlongitudinal web-based study of 104 older adults (Nobservations=7,051; Mage=63.13 years, SDage=7.81, 88.46% Female). Participants reported on exposure to and valence of noteworthy events, involvement of close social partners, and subjective cognitive complaints at the end of each day. RESULTS: Logistic multilevel models revealed that days with a negative event were associated with increased odds of forgetting something and trouble concentrating whereas days with positive events were associated with decreased odds of trouble concentrating. Close social partner involvement did not moderate within-person associations. CONCLUSION: Our results suggest that day-to-day events are correlates of cognitive complaints regardless of close social partner involvement in the events. Research should clarify the role of daily positive and negative events in personalized interventions and determine whether this person-centered approach to self-reported cognitive health helps inform diagnostic practices.

Loneliness dynamics and physical health symptomology among midlife adults in daily life.

OBJECTIVE: The current study examined how average daily loneliness (between-persons [BPs]), intraindividual variability in loneliness across days (within-persons [WPs]), and loneliness stability informed physical health symptomatology. METHOD: We utilized daily diary data from a national sample of 1,538 middle-aged adults (Mage = 51.02; 57.61% women) who completed eight end-of-day telephone interviews about daily experiences, including loneliness and physical health symptoms (e.g., headaches, nausea). Via multilevel modeling, we examined average daily loneliness (BPs), intraindividual variability in loneliness (WPs), stability in loneliness (individual mean-squared successive difference) in association with the number and average severity of daily physical health symptoms. RESULTS: When participants were less lonely on average, and on days when loneliness was lower than a person's average, they had fewer and less severe physical health symptoms. Additionally, participants who were more stable in loneliness across 8 days had less severe physical health symptoms. Further, there was a stronger association between instability in loneliness and more physical health symptoms for people who were lonelier on average. Finally, the increase in physical health symptom severity associated with WP loneliness was strongest for participants with low variability in loneliness. CONCLUSION: Loneliness is associated with physical health symptoms on a day-to-day basis, especially for people who are highly variable in loneliness. Considerations of multiple sources of variation in daily loneliness may be necessary to adequately address loneliness and promote health. Public health interventions addressing loneliness may be most effective if they support social connectedness in people's everyday lives in ways that promote stable, low levels of loneliness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence Estimates of Arthritis and Activity-Limiting Pain Among Family Caregivers to Older Adults.

BACKGROUND AND OBJECTIVES: Little is known about the prevalence of physical pain among family caregivers to older adults. We used national survey data to assess the relative prevalence of caregivers' arthritis and activity-limiting bothersome pain by caregiver and care-recipient characteristics to identify which caregivers may be at a higher risk for physical pain. RESEARCH DESIGN AND METHODS: We analyzed data collected from 1,930 caregivers who participated in the National Study on Caregiving (2017). We utilized modified Poisson models to estimate adjusted associations of caregiver and care-recipient characteristics with the relative prevalence of arthritis and bothersome pain. RESULTS: Forty percent of caregivers had a lifetime diagnosis of arthritis. Seventy-five percent of caregivers with arthritis reported bothersome pain, nearly 30% of whom endorsed bothersome pain that limited their activities on most or every day of the previous month (i.e., activity-limiting bothersome pain). Regardless of whether they had arthritis, 51% of the sample reported bothersome pain in the previous month, 24% of whom indicated activity-limiting bothersome pain. Caregivers who were older or more highly educated had a higher prevalence of arthritis. Black caregivers had a lower prevalence of arthritis and activity-limiting bothersome pain compared to White caregivers. Caregivers with physical difficulty providing care had a higher prevalence of arthritis and activity-limiting bothersome pain than caregivers without physical difficulty providing care. DISCUSSION AND IMPLICATIONS: Arthritis and activity-limiting bothersome pain are highly prevalent among caregivers. Given increased prevalence of pain among certain caregivers, it may be efficient to target these groups for pain management interventions.

The Role of Awareness of Age-Related Change in the Longitudinal Association between Pain and Physical Activity.

We examined how physical pain impacts the developmental construct of Awareness of Age-Related Change (AARC-gains and AARC-losses) and, in turn, how AARC mediates and moderates the association between pain and subsequent physical activity. We used longitudinal data from 434 participants of the UK PROTECT Study (mean age = 65.5 years; SD = 6.94 years). We found that pain in 2019 predicted higher AARC-losses (ß = .07; p = .036) and less physical activity (ß = -.13; p-value = .001) in 2020. Additionally, we found that AARC-losses partially mediated, but did not moderate, the association of pain in 2019 and physical activity in 2020. AARC-losses may explain physical inactivity in middle-aged and older adults experiencing pain. Incorporating developmental constructs such as AARC into theories and empirical studies on pain and pain management may be necessary to more fully capture people's responses to pain.

Physical and mental health conditions account for variability in awareness of age-related changes.

Background: The concept of Awareness of Age-Related Changes captures people's perceptions of the positive (AARC-gains) and negative (AARC-losses) age-related changes they experience in several life domains, including their health. We investigated the cross-sectional associations of number and type of physical and mental health conditions with AARC-gains and AARC-losses. Methods: The sample comprised 3,786 middle-aged and older adults (mean age = 67.04 years; SD = 6.88) participating to the UK PROTECT study. We used hierarchical regression models to analyze whether after having included sociodemographic variables (model 1), number of physical (model 2) and of mental (model 3) health conditions explained a significant additional amount of variance in AARC-gains and AARC-losses, and whether the association between number of conditions and AARC depended on participants' age. We used multiple regression models to analyze the associations of types of physical and mental health conditions with AARC-gains and AARC-losses. Results: A higher number of physical health conditions was associated with higher AARC-gains and higher AARC-losses, but the association did not depend on participant age. After controlling for the number of physical health conditions, a higher number of mental health conditions was associated with higher AARC-losses but not with AARC-gains, and the association was stronger among older participants. Small effects were found between greater AARC-gains and current cancer and between greater AARC-losses and diagnoses of mild cognitive impairment, Parkinson's disease, arthritic condition, cancer in full remission, osteoporosis, depression, anxiety disorders, and personality disorder. The remaining health conditions were either negligibly or non-statistically related to AARC-losses. Conclusion: Middle-aged and older adults having more physical health conditions and more mental health conditions may be at higher risk of negative views on their own aging. However, specific physical health conditions, such as arthritis, and certain mental health conditions, such as depression, may make adults particularly vulnerable to negative age-related perceptions.

Daily Caregiving Appraisals, Future Self-Views, and Physical Activity Goals Among Adult-Daughter Dementia Caregivers.

OBJECTIVES: Caregiving dynamics may shape caregivers' views on their own aging in ways that affect their (de)motivation to improve their current and future health and well-being. In this study, we investigated within-person associations of daily positive and negative caregiving appraisals, future self-views (physical functioning, cognitive, and overall health domains), and physical activity goal pursuit among adult-daughter dementia caregivers. METHODS: Data came from 33 middle-aged caregivers (M = 55.03) who participated in a 30-day microlongitudinal study of caregiving (N of occasions = 855). We used multilevel modeling to analyze within-person associations. RESULTS: Daily positive caregiving appraisals were not associated with daily future self-views. However, on days when caregivers reported higher negative caregiving appraisals, they thought more negatively about their future older selves in all domains. In turn, on days when caregivers thought more negatively about their future older selves in all domains, they reported lower physical activity goal pursuit. Future self-views in all domains mediated the association between negative caregiving appraisals and physical activity goal pursuit. Future self-views did not mediate the association between positive caregiving appraisals and physical activity goal pursuit. However, cognitive future self-views moderated the association between positive caregiving appraisals and physical activity goal pursuit. DISCUSSION: Results suggest that one pathway through which subjective caregiving experiences, especially negative caregiving appraisals, affect caregivers' physical activity goal pursuit is through future self-views. Thus, this study offers a deeper theoretical understanding of caregivers' self-regulatory health behavior and new empirical information on how caregiving might affect life-span developmental motivation.

How Do Marital Transitions Affect Self-Perceptions of Aging?

OBJECTIVES: We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging. METHOD: We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood. RESULTS: Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women. DISCUSSION: Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.

Validation of a Measure of Role Overload and Gains for End-of-Life Dementia Caregivers.

OBJECTIVES: Caregiving stress process models suggest that heterogeneous contexts differentially contribute to caregivers' experiences of role overload and gains. End-of-life (EOL) caregivers, especially EOL dementia caregivers, facing unique challenges and care tasks, may experience role overload and gains in different ways than other caregivers. This study evaluates measurement invariance of role overload and gains between EOL caregivers and non-EOL caregivers and between EOL dementia and EOL non-dementia caregivers. METHODS: We utilized role gains and overload data from 1,859 family caregivers who participated in Round 7 of the National Study of Caregiving. We ran confirmatory factor analyses to investigate the factorial structure across all caregivers and then examined the structure's configural, metric, and scalar invariance between (a) EOL caregivers and non-EOL caregivers and (b) EOL dementia and EOL non-dementia caregivers. RESULTS: Across the entire sample, the two-factor overload and gains model had good fit (χ 2(19) = 121.37, p < .0001; RMSEA = .053, 90% CI = [.044, .062]; CFI = .954; TLI = .932). Tests of invariance comparing EOL caregivers to non-EOL caregivers and EOL dementia caregivers to EOL non-dementia caregivers maintained configural, metric, and partial scalar invariance. Latent mean comparisons revealed that EOL caregivers had higher role overload (p = .0002), but no different role gains (p = .45), than non-EOL caregivers. Likewise, EOL dementia caregivers had higher role overload (p = .05), but no different role gains (p = .42), than EOL non-dementia caregivers. DISCUSSION: Results offer both a deeper theoretical understanding of end-of-life dementia caregivers' experiences of role overload and gains, and a practical tool to measure those experiences.

Intergenerational Programming Increases Solid Food Consumption for Adult Day Center Attendees.

We examined whether participation in intergenerational programming would impact daily food and liquid intake for adult day service center (ADSC) participants, many of whom are at risk for malnutrition and dehydration. Data came from 75 ADSC participants who, on average, attended the center for 472.32 days between 2007 and 2018. We analyzed daily data using multilevel modeling, nesting attending days within ADSC participants. On days when participants joined intergenerational programming, they consumed significantly more solid food (ß = 1.54, SD = .37, p < .001), but no different liquid (ß = -.16, SD = .09, p = .06), than their own average across all days they attended the ADSC. Intergenerational programming may be an effective way to support ADSCs participants' nutrition. Future research is needed to determine the longer-term health benefits of daily increases in food consumption and to explore why intergenerational programming may differentially impact eating and drinking.

Correlates of felt age in caregivers of people with dementia: findings from the IDEAL study.

Objective: Family relationships influence how people appraise their own aging and how their appraisals impact their health. We analyzed felt age (FA) among family caregivers of people with dementia. Methods and measures: We used a stratified sample of 1,020 spousal and 202 adult-child caregivers from the IDEAL study. We estimated cross-sectional associations and bidirectional influences between caregivers' FA and their health and wellbeing (depression, number of health conditions, stress, positive aspects of caregiving) over 2 years. Results: Among spousal caregivers, 25% had a younger FA and 36% had an older FA. Among adult-child caregivers, 21.8% had a younger FA and 36.1% had an older FA. In spousal and adult-child caregivers an older FA was cross-sectionally associated with higher depression, number of health conditions, and stress, and fewer positive aspects of caregiving. In spousal caregivers, hours of care per day moderated the association between FA and depression, and FA was associated with stress 1 year later. Conclusion: Caregiving may impact FA and its relationship with health. We urge continued research on the connections between caregiving and FA, and how interventions might support caregivers' positive views on their own aging, which will translate views on aging scholarship to meaningfully improve caregivers' lives.

Are Thoughts About the Future Associated With Perceptions in the Present?: Optimism, Possible Selves, and Self-Perceptions of Aging.

Despite much literature pointing to the saliency of self-perceptions of aging (SPA) to aging processes, limited research offers empirical analysis on what shapes SPA. In order to identify possible antecedents to SPA, we conducted an exploratory analysis to analyze whether two future-oriented constructs-optimism and self-efficacy associated with possible selves-were associated with SPA. We ran hierarchical linear regressions, with optimism and self-efficacy of possible selves predicting SPA among 244 middle-aged and older adults. Higher optimism, higher self-efficacy to achieve hoped-for selves, and higher self-efficacy to avoid feared selves were associated with higher overall SPA. Results from our study suggest that how someone appraises their future older self impacts how they perceive their current older self.

Program Practices Predict Intergenerational Interaction Among Children and Adults.

BACKGROUND AND OBJECTIVES: Intergenerational programs, those engaging youth and adults of nonadjacent generations in shared programming for mutual benefit, are attracting increasing attention from funders, policymakers, and practitioners for the range of goals they can support. The mechanisms by which these goals are achieved are rarely studied. To address this gap, we analyzed the associations between specific intergenerational implementation practices and younger and older participant outcomes. RESEARCH DESIGN AND METHODS: Activity leaders at 5 sites serving adults and preschoolers received training to implement 14 evidence-based practices during intergenerational activities involving 84 adults (M = 75.25 years; range = 55-98) and 105 preschool participants (M = 3.26 years; range = 2-5) over 4 years. Measures of activity leaders' implementation of these practices and participants' behavioral responses to programming were gathered. We utilized multilevel modeling to test whether variations in implementation of practices were associated with variations in participants' responses to programming on a session-by-session basis. RESULTS: For both preschool and adult participants, analyses revealed that the implementation of certain practices was associated with significantly more intergenerational interaction. When more practices were implemented reflecting factors of (a) participant pairing and (b) person-centered care, both child and adult intergenerational interactions were higher. DISCUSSION AND IMPLICATIONS: Practices used by intergenerational activity leaders during programming help to explain within-person responses of both child and adult participants. Intergenerational relationships may be a powerful means to achieve diverse goals; they depend on skillful practice by trained activity leaders.

Increasing the Power of Intergenerational Programs: Advancing an Evaluation Tool.

Intergenerational practitioners responding to a 2018 national survey identified a need for evidence-informed evaluation tools to measure program impact. The Best Practices (BP) Checklist, a 14-item (yes/no) measure assessing the extent to which an intergenerational program session maintained effective intergenerational strategies, may help meet this need. Yet, researchers have not validated the measure. In this study, we begin the empirical validation process by completing an exploratory factor analysis (EFA) of the BP Checklist to offer insight into possible item reduction and an underlying latent factor structure. Using BP Checklist data from 132 intergenerational activities, we found a 13-item, 3-factor structure, reflecting dimensions of: (a) pairing intergenerational participants, (b) person-centered strategies (e.g., selecting activities reflecting participants' interests), and (c) staff knowledge of participants. Our study represents a foundational step toward optimizing intergenerational program evaluation, thereby enhancing programming quality.

Self-Perceptions of Aging Moderate Associations of Within- and Between-Persons Perceived Stress and Physical Health Symptoms.

OBJECTIVES: To examine how self-perceptions of aging (SPA) moderated within- and between-persons perceived stress associations with physical health symptoms. METHODS: A community-dwelling sample of 103 adults (Meanage = 63, range = 52-88) participated in an online microlongitudinal study for 100 days (Noccasions = 7,064). Participants completed baseline surveys consisting of SPA, social connections, and demographics followed by 100 daily surveys including information about daily stress perceptions and physical health. Utilizing generalized multilevel models, we examined whether daily fluctuations and average levels of perceived stress over 100 days affected physical health symptoms and whether these associations varied by SPA. RESULTS: Adults who had higher perceived stress, on average across 100 days, reported significantly more physical health symptoms compared to individuals with lower perceived stress on average (p < .05). On days when individuals reported higher perceived stress than their own average, they had a higher likelihood of reporting more physical health symptoms compared to days when their perceived stress was lower than their own average (p < .05). Further, SPA significantly moderated associations between both within- and between-persons perceived stress and physical health symptoms (ps < .05). Individuals with more positive SPA were less affected by high levels of perceived stress-both on average and on days when perceived stress was higher than their own average. DISCUSSION: More positive SPA significantly dampened the impact of perceived stress, suggesting the importance of SPA as an individual characteristic within stress processes. Future work should examine how daily changes in SPA may exacerbate or mitigate the impacts of daily stress processes and health outcomes.

Women's Self-Relevant Goal Pursuit in the Presence of Physical Pain: An Intraindividual Variability Approach.

OBJECTIVES: Pursuing personal goals that are relevant to one's sense of self is important for adjusting to age-related changes. Experiences of physical pain, however, are thought to threaten both people's sense of self and their pursuit of personal goals. Although a majority of older women experience physical pain, little is known about their day-to-day regulation of their self-relevant goals in the presence of physical pain. The objectives of this study were to explore associations between physical pain and health goal pursuit on a daily basis for women who identified health as a part of their possible selves. METHODS: We took an intraindividual variability approach to analyze whether there were within- and between-person differences in associations between daily pain and daily health goal progress among 62 women who provided data over the course of 100 days, yielding 4,150 occasions of data. RESULTS: At the between-person level, women with higher pain on average had lower health goal pursuit on average. At the within-person level, days of higher-than-average pain were associated with lower same-day health goal progress. DISCUSSION: Our results suggest that pain interrupts regulation of a self-relevant goal at a within-person-not just between-person-daily level. Future work should consider how these daily, within-person, disruptions affect broader identity processes and overall well-being.

Self-Perceptions of Aging: Factorial Structure and Invariance by Gender.

BACKGROUND AND OBJECTIVES: Self-perceptions of aging (SPA)-the appraisals people place on their own aging processes-predict well-being in later life. Researchers are increasingly hypothesizing that the overarching construct of SPA is comprised of two factors-positive SPA and negative SPA-and that SPA are gendered. The purpose of this study was to empirically test the hypothesized two-factor structure of SPA and to analyze how the two-factor structure varies between men and women. RESEARCH DESIGN AND METHODS: Data come from the 2012 wave of the Health and Retirement Study (N = 7,029; Mage = 68.08), which includes an 8-item SPA scale. We used confirmatory factor analysis (CFA) to assess (i) the positive SPA and negative SPA two-factor solution for the 8-item scale and (ii) whether the two-factor solution had configural, strong, or weak invariance across men and women. RESULTS: CFAs indicated a two-factor latent structure of the 8-item scale, with SPA being comprised of both a positive SPA factor and a negative SPA factor. The latent structure was the same for both men and women. DISCUSSION AND IMPLICATIONS: Results suggest that SPA is a broader construct made up of positive and negative latent factors. Researchers should consider separating the SPA by positive and negative factors to analyze how each factor uniquely shapes health. Moreover, the two-factor solution was equivalent across men and women, possibly because of the generalized nature of the 8-item scale. Researchers can use the 8-item scale similarly for men and women and should continue to elucidate possible gender differences in SPA.

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity.

BACKGROUND AND OBJECTIVES: As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups. RESEARCH DESIGN AND METHODS: Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations. RESULTS: Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites. DISCUSSION AND IMPLICATIONS: Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.