Stress among Family Caregivers of Older Persons in Singapore

It is projected that, in the 21st century, the majority of the world’s older people will be living in Asia. After Japan, Singapore is the most rapidly aging country in Asia. With an increasing life expectancy, many older persons will require health and instrumental care during later life stages. In Singapore, close to 95% of older people co-reside with family members, highlighting the importance of community support for family caregivers. Using a study of 61 principal family caregivers in Singapore, this article highlights the nature of and relationship between caregivers’ stress and gender, patients’ activities of daily living (ADL) and instrumental ADL dependency, and caregivers’ attitudes. Findings from the study suggest that female caregivers tended to be more stressed than male caregivers. Results also showed a significant inverse relationship between the level of stress experienced by caregivers and the ADL and instrumental ADL dependency of patients. Caregivers looking after patients suffering from dementia, Parkinson’s disease, and hypertension were more likely to be stressed than those caring for persons with stroke, depression, and other illnesses. This article concludes by describing some implications of this research for social worker practice and for informal as well as formal support programs for family caregivers.     

Sleep–Wake Disturbances and Frailty in Community-Living Older Persons

OBJECTIVES: To evaluate the association between sleep–wake disturbances and frailty.
DESIGN: Cross-sectional.
SETTING: New Haven, Connecticut.
PARTICIPANTS: Three hundred seventy-four community-living persons aged 78 and older.
MEASUREMENTS: Frailty was based on the Fried phenotype, and sleep–wake disturbances were defined as daytime drowsiness, based on an Epworth Sleepiness Scale (ESS) score of 10 or greater, and as subthreshold and clinical insomnia, based on Insomnia Severity Index (ISI) scores of 8 to 14 and greater than 14, respectively.
RESULTS: Mean age was 84.3; 87 (23.8%) participants were drowsy, 122 (32.8%) had subthreshold insomnia, 38 (10.2%) had clinical insomnia, and 154 (41.2%) were frail. There was a significant association between drowsiness and frailty, with unadjusted and adjusted odds ratios (ORs) of 3.79 (95% confidence interval (CI)=2.29–6.29) and 3.67 (95% CI=2.03–6.61), respectively. In contrast, clinical insomnia was significantly associated with frailty in the unadjusted analysis (OR=2.77, 95% CI=1.36–5.67) but not the adjusted analysis (OR=1.93, 95% CI=0.81–4.61)), and subthreshold insomnia was not associated with frailty in the unadjusted or adjusted analysis.
CONCLUSION: In older persons, sleep–wake disturbances that present with daytime drowsiness, but not insomnia, are independently associated with frailty. Because drowsiness is potentially remediable, future studies should determine whether there is a temporal relationship between drowsiness and frailty, with the ultimate goal of informing interventions to reverse or prevent the progression of frailty.     

Validation of Minimum Data Set for Nursing Home in Hong Kong Chinese Elders

Abstract

The objective of this study was to validate the Chinese version of the Minimum Data Set-Resident Assessment Instrument (MDS-RAI) in Hong Kong Chinese elders. The respondents were 83 people aged 65 years or older who lived at a care and attention home in Hong Kong. Firstly, test-retest reliabilities of four Resident Assessment Protocol (RAP) scales (including cognitive loss/dementia, communication, activities of daily living/rehabilitation potential, and mood symptoms) were examined and we found acceptable test-retest reliability. Secondly, inter-rater reliability of these four RAPs was found to be acceptable. Concurrent validity was also obtained for these four areas in MDS-RAI and most associations were in the range from 0.4 to 0.6. Results suggest that the Chinese version of MDS-RAI is a reliable and valid assessment tool for elderly Chinese residents in a long-term care facility in Hong Kong.     

The Composition and Structure of Depressive Symptomatology among Young and Older Caregivers of Persons with Dementia

Informal caregivers of persons with dementia (PWD) experience higher rates of clinical depression relative to general populations of older adults. Because caregivers range considerably in age (e.g., older spouses as compared to adult children or grandchildren), the need exists to evaluate the psychometric properties of depression screening measures to ascertain if cohort differences exist. The current study was conducted to determine whether responses to the Center for Epidemiological Studies–Depression (CES-D) Scale are equivalent between older (range 66 to 93 years; n?=?542) and younger PWD caregivers (range 21 to 65; n?=?884). Only responses to the interpersonal affect factor differ between the two. We contend that this pattern of consistency is due to similarity of role demands which may cause depressive symptoms to present more uniformly among PWD caregivers in contrast to heterogeneous groups of young and older adults. Overall, our findings support the higher-order factor structure of CES-D responses within a population at elevated risk for depression.     

The Plight of Older Persons as Caregivers to People Infected/Affected by HIV/AIDS: Evidence from Uganda

This paper describes the challenges faced by elderly persons (50 years and above) in Uganda, as parents and/or relatives of persons infected by HIV and as caregivers of the infected relatives and their uninfected children. Little is known regarding these indirect impacts of HIV/AIDS on the elderly in sub-Saharan Africa. Yet, the elderly are most often the main caregivers of HIV-infected persons and their families. Data used in this study were obtained from focus group discussions and in-depth interviews conducted among elderly respondents in 10 rural and urban communities within two Ugandan districts, Luwero and Kamuli. Findings indicate that the elderly do provide care to patients with AIDS at the terminal stage of the illness-when patients most need constant care. In most cases, the challenge of caring for the sick patients is compounded by the responsibility to care for the children affected by HIV/AIDS, which also starts when their parents are still living, not when the children become orphans. This demanding work was reported to negatively affect the elderly in various dimensions (economic, emotional, physical, and nutritional), all of which impacts their health and well-being. The responsibility for day-to-day patient care is borne primarily by elderly females, who reported a higher rate of physical ailments than male respondents-perhaps an indication of their disproportionate contribution to the care responsibilities. Most of the elderly respondents interviewed have a lot of anxiety about their future health and well-being, which they attributed in most part to the HIV/AIDS epidemic. These challenges do appear to exacerbate the aging process of the elderly whose health and well-being are already affected by the poor resource base and weak health infrastructure in this setting.     

Validity and responsiveness of the Minimum Data Set.

OBJECTIVE: To determine the criterion validity and responsiveness to change over time of the Minimum Data Set (MDS). DESIGN: Cross sectional analysis comparing prospectively collected research data with MDS data reported from nursing homes on identical subjects. Longitudinal follow-up of subjects allowed for calculation of responsiveness to change over time. PARTICIPANTS: Subjects (n = 140) participating in epidemiological research on the natural history of Alzheimer's disease in the University of Washington Group Health Cooperative Alzheimer's Disease Patient Registry (ADPR) who entered nursing homes in Washington State from January 1990 through March 1996. MAIN OUTCOME MEASUREMENTS: Spearman's correlation coefficients to compare MDS cognitive performance scale scores with Mini-Mental State Examinations (MMSE), MDS behavior domain scores with ADPR Physician Behavior checklist scores, and MDS activities of daily living (ADL) functioning scores with Dementia Rating Scale scores for ADLs. Partial correlations were used to control for the number of days between MDS and ADPR assessments, age, and function in the other two MDS ratings of ADL, cognition, or behavior. We determined responsiveness by using the mean change in an effect size (ES) calculation for each domain of interest. RESULTS: MDS measures in all three domains were correlated modestly to the analogous ADPR research instruments, with correlation coefficients 0.45 for cognition, 0.50 for behavior, and 0.59 for ADL functioning. Controlling for age, time between ADPR and MDS assessments, and the MDS ratings of the other two MDS domains did not improve the correlations significantly. In a subgroup of 60 subjects followed for an average of 636 days, the Cognitive performance scale of the MDS had a slightly larger effect size (ES = 0.60) than the Folstein Mini-Mental Status Exam (ES = 0.39) used by the ADPR. However, the Dementia Rating Scale (ES = 0.77) used by the ADPR researchers reflected more change over time than the ADL domain of the MDS (ES = 0.02). The MDS behavior domain (ES = 0.058) was comparable to the research behavior checklist (ES = 0.065). CONCLUSIONS: These data demonstrate reasonable criterion validity of the MDS and the MMSE, ADL, and behavior rating scales and suggest that the MDS data is of adequate validity for research purposes in these areas. The MDS was less able to capture dementia-related change in ADLs in this population of patients with dementia even though the same nursing home staff completing the MDS often supplied the information for completing the research scales. As a result, the MDS may be limited as an outcome assessment instrument.     

Understanding Aging in a Middle Eastern Context: The SHARE-Israel Survey of Persons Aged 50 and Older

This article describes the development of SHARE-Israel, the survey of persons aged 50 and older in Israel, and preliminary results from an early data release. The introduction of an HRS-inspired computer-based survey into a Middle East country required linguistic and cultural adaptations of the survey mechanisms that had not been previously experienced in other countries. Preliminary findings showed that the majority group of veteran Jewish-Israelis aged 50 and over is in a favorable position in terms of health, employment status and household income compared to Arab-Israelis and to new immigrants to Israel from the Former Soviet Union. Arab-Israelis aged 50 and over are at greater risk due to greater disability and lower incomes. Recent immigrants from the former Soviet Union are at greatest risk. They report having the highest degree of depression, long term problems and activity limitation, the fewest children, low rates of home ownership and low incomes. Comparing the older Israeli population with their European counterparts revealed that Israelis are more depressed; more Israeli women are employed, and fewer Israeli men are retired; and household income in Israel is lower, but rises relatively when correcting for purchasing power parity. These trends point to several areas that will require attention in the formulation of public policy on behalf of the aging population in Israel.

Measurement sensitivity and the Minimum Data Set depression quality indicator

PURPOSE: The purpose of this study was to determine the accuracy of the prevalence rating of depression in nursing homes as flagged on the Minimum Data Set (MDS) quality indicator report. DESIGN AND METHODS: Research Staff measured depression symptoms and compared the results with the prevalence of disturbed mood symptoms documented by nursing home (NH) staff on the MDS in two samples of residents living in different NHs. The homes had been flagged on the nationally mandated MDS quality indicator report as having unusually low (Site 1) or high (Site 2) prevalence rates of depression. RESULTS: The percentages of residents determined by research staff interview assessments to have probable depression in the two resident samples were not significantly different (49% vs. 55%, respectively) between homes. The staff in the home flagged on the MDS quality indicator report as having a high depression prevalence rate identified significantly more residents who also had scores indicative of probable depression on the resident interviews for follow-up mood assessments than did the home with a low quality indicator prevalence rate (78% vs. 25%, respectively). IMPLICATIONS: The prevalence of the depression quality indicator may be more reflective of measurement processes than of depression outcomes. Factors that may affect the difference in detection rates are discussed.     

Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

BACKGROUND  

Prognostic information is becoming increasingly important for clinical decision-making.     

Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set

OBJECTIVES: To develop a Nursing Home Confusion Assessment Method (NH-CAM) for diagnosing delirium using items found on the Minimum Data Set (MDS) and to compare its performance with that of the delirium Resident Assessment Protocol (RAP) trigger and to an additive score of six of the RAP items. DESIGN: Retrospective cohort study using MDS and Medicare claims data. SETTING: Free-standing NHs in urban markets in the 48 contiguous U.S. states. PARTICIPANTS: Long-stay residents who returned to their NHs after acute hospitalizations between April and September 2000 (N=35,721). MEASUREMENTS: Mortality and rehospitalization rates within 90 days of readmission to the NH from the hospital. RESULTS: Almost one-third (31.8%) of the residents were identified as having delirium according to the RAP; 1.4% had full delirium, 13.2% had Subsyndromal II delirium, and 17.2% had Subsyndromal I delirium. More-severe NH-CAM scores were associated with greater risks of mortality and rehospitalization. NH-CAM levels were strong independent risk factors for survival and rehospitalization in a Cox model (hazard ratios ranging from 1.5 to 1.9 for mortality and 1.1 to 1.3 for rehospitalization) adjusting for cognitive and physical function, diagnoses, inpatient care parameters, care preferences, and sociodemographic factors. CONCLUSION: The NH-CAM successfully stratified NH residents' risk of mortality and rehospitalization. If validated clinically, the NH-CAM may be useful in care planning and in further research on the determinants and consequences of delirium in the NH.