The stress process in family caregivers of persons receiving chemotherapy

The purpose of this analysis was to explore strain and depression among family caregivers of persons receiving chemotherapy for cancer using the Pearlin Stress Process Model. Seventy-five family caregivers of persons receiving chemotherapy participated, completing the Caregiver Strain Index and the Depression Subscale of the Profile of Mood States within 3 weeks of the initiation of chemotherapy. Hierarchical regression analyses indicated that 44% of the variance in strain and 40% of the variance in depression were explained by the antecedent variables of caregiver age and gender, patient age and gender, patient functional status, the presence of recurrent disease, perceived efficacy of coping strategies, and perceived adequacy of social support. Further analysis aimed at delineating the mechanisms through which coping and social support operate in the model found no evidence for a moderating or stress-buffering effect. However, coping mediated the relationship between strain and depression and social support mediated the relationship between functional status and depression.     

老年人家庭照顾者及其照顾能力研究现状

我国目前60岁及以上老年人已经达到1.53亿,超过总人口的11.6%[1].相对于庞大的老年人口,我国的养老机构严重不足,远远不能满足广大老年人的养老服务需求.由于我国的国情和传统文化,老年人更愿意在家庭中养老.     

Job innovation for direct caregivers in the care of persons with mental retardation. A system of personal caregiving

Professionals in different branches of the health care sector increasingly advocate a more flexible, individually-tailored type of care. To fit in with this trend, the Job Innovation Model was developed in The Netherlands. This model involves the systematic introduction of a system of personal caregiving. The purpose of the present study, using a pre-test-post-test quasi-experimental design, was to evaluate the effects of the implementation of the Job Innovation Model on the work and work perception of direct caregivers in the care of persons with mental retardation. Caregivers in the experimental group were found to have adopted the principles of the Job Innovation Model to a greater extent than their colleagues in the control group, and as a result, the experimental group started to work more methodically and perceived greater clarity in their work. In addition, a trend was observed towards greater job satisfaction among caregivers as a result of the introduction of the new model. No changes were found concerning burnout.     

Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non-caregivers of non-demented elderly people

Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non-caregivers of non-demented elderly people Fifty-two caregivers for demented and 66 non-caregivers for non-demented elderly were investigated both within a gender and between genders. All participants were relatives and a burden questionnaire was used. The results showed that there was not always a difference between the caregivers for demented and the non-caregivers for non-demented elderly which may indicate that being a relative , even to a non-demented elderly, has obviously its own problems and importance. However, results showed more significant differences between female caregivers and female non-caregivers than between male caregivers and male non-caregivers, with females caring for a demented elderly suffering most strain. Their strain was exhibited by health problems, conflicts in the family, strained relations with family and others, a less positive outlook and limits in social support because of the caregiving situation. When investigating the group of male caregivers and male non-caregivers, it was found that males caring for a demented elderly person experienced a lack of positive outlook and a need for social support. The elderly person's residence in the group of caregivers for demented elderly people and in the group of non-caregivers for non-demented elderly people did not, however, appear to indicate any significant differences.     

The relationship between family obligation and religiosity on caregiving

The purpose of this study was to examine the relationship between family obligation and religiosity on the positive appraisal of caregiving among African-American, Hispanic and non-Hispanic Caucasian family caregivers of older adults. Roy's adaptation model guided formulation of the aims and study design. A cross-sectional, correlational study design was employed to examine the relationship amongst variables for the family caregiver participants. Study participants (N = 69) completed a demographic tool and four instruments the: (1) Katz index, (2) obligation scale, (3) Duke University religion index, and (4) positive appraisal of care scale. There was a significant correlation between family obligation and positive appraisal of caregiving. However, there was no relationship between the family caregiver's religiosity and positive appraisal of caregiving overall. Demographic variables were also examined to show a higher marginal mean for Hispanic primary caregivers in relation to the positive appraisal of caregiving. Future studies should consider replicating these findings in a larger sample to provide health care professionals with substantial evidence to incorporate culturally sensitive interventions aimed at promoting positive outcomes and healthy family behaviors.     

The association between caregiving satisfaction, difficulties and coping among older family caregivers

Aims and objectives. The aim was to study the association between gender, extent and content of care, satisfaction, coping and difficulties in the caregiving situation among older (75+) caregivers and to identify clusters of caregivers. The aim was also to explore psychometrically two instruments assessing satisfaction and difficulties in family caregivers. Background. Caregiving is a complicated phenomenon. Much of the research has focused on negative aspects, such as the burden, stress and emotional strain. Caregiving is known to affect health negatively for the caregivers. Little is known about satisfaction and motivation in voluntary work, such as informal caregiving, especially among older persons. Design and methods. Cross‐sectional. The sample for this study consisted of 171 informal caregivers aged 75 and over, identified from an age‐stratified sample in a postal survey among older people in the southern part of Sweden. Results. Male caregivers proved to be more satisfied than female caregivers; caregiving had seemingly widened their horizon and had helped them to grow as persons. Based on satisfaction scores, those satisfied had a higher proportion of male caregivers and a significantly higher amount of caregiving hours per week. They used other coping strategies than the respondents in the other cluster, i.e. less satisfied in using more problem‐solving strategies. Conclusions. The instruments tested were appropriate for work in clinical and research settings, although the internal dropout indicates that a shorter version would be more useful. Those who found satisfaction in care used more problem‐focused coping strategies and were more often men than women. From a salutogenic point of view, this may give important knowledge about factors that can promote health. The findings indicate that women deserve extra attention as informal caregivers as they did not find caregiving as rewarding as the men did. This may in turn make them less protected against the negative consequences of caregiving. Relevance to clinical practice. Reinforcing the health‐promoting qualities in caregivers who are not feeling well, with women as a particularly vulnerable group, may restrict unnecessary suffering for both the caregiver and the person cared for.     

The relationship between hand strength and the forces used to access containers by well elderly persons.

OBJECTIVE: This study extended previous work of Rice, Leonard, and Carter [AJOT, 52(8), 621-626] and examined the relationship between grip and pinch strengths and the forces produced while accessing common household containers in healthy, elderly persons. METHOD: Forty-two women and 9 men 60 years of age and older were assigned randomly to one of four order groups in a counterbalanced, repeated-measures design. Grip strength was measured via a dynamometer and pinch strength via a pinch meter. The forces required to access six common household containers were measured with force sensing resistors applied to each container. Data analysis included Pearson product-moment correlations between the dependent variables of grip and pinch strength and force produced on the containers. Analyses of variance were used to determine differences by gender on the dependent measures and order of presentation of containers. RESULTS: A fair relationship (r = .31 to .44) was found between grip and pinch strength and the ability to open three containers. Little or no relationship was found between grip and pinch strength and the ability to open the remaining three containers (r = -.03 to .25). Significant gender differences existed on overall strength and the force used to access two of the six containers. No order effects were found. CONCLUSIONS: Strong relationships did not exist between the grip and pinch strength and the amount of force the elderly participants used to open the containers, which is similar to what Rice et al. found for younger persons. The participants appeared to use a greater proportion of their available strength when accessing the containers than did their younger counterparts previously studied. Further research is needed to determine at what level of weakness one would expect to see performance deficits in common daily occupations.     

Dilemmas in decision making for caregivers of cognitively impaired elderly persons

The purpose of this article is to discuss issues that decision makers must consider when confronted with the dilemma of a cognitively impaired older person for whom they are responsible either informally (as family) or formally (as health care professionals). The article examines (1) the decision-making dilemmas faced by caregivers of older persons, (2) coordination necessary among decision makers, (3) legal criteria for incompetency, and (4) caregiver stress. The need for clarification of incompetency criteria for improved coordination among caregivers is suggested.     

The relationship between sleep/awake rhythm development and caregiving activities

Ensuring proper central nerve system (CNS) development is the core issue in premature infant care. Because an infant's sleep pattern (or sleep state) manifests his or her CNS integration, recognizing infant sleep patterns is essential for caregivers involved with developmental care. This article aims to explore the development of biological rhythms and infant sleep/awake states, factors influencing sleep states, and the effectiveness of various interventions to promote infant sleep. Five major factors that influence infant sleep states include noise, light, environmental temperature, physical contact with caregivers, and body position. Accordingly, we propose interventions to improve infant sleep quality to facilitate the growth of premature infants.     

The relationship among background characteristics, purpose in life, and caregiving demands on perceived health of spouse caregivers

Little is known about the impact on the family at home of managing the final course of cancer. Research to date has focused on the negative impact of physical caregiving on the caregiver's physical and emotional well-being. Limited information exists about other dimensions of the experience which may serve to buffer or prevent negative health outcomes. The purposes of this study were to examine the effect of personal meaning and the experience of caregiving on spouse caregiver health. Cross-sectional data were obtained from interviews with 65 spouse caregivers of persons with advanced cancer. Findings from the multiple regression analysis revealed that sense of purpose in life (Beta = .32, p less than or equal to .05) and the caregiver's level of uncertainty (Beta = -.46, p less than or equal to .01) were statistically significant predictors of health. The results of this study suggest that a stronger sense of purpose in life is positively associated with perceived health. Further, the finding that a higher level of caregiver uncertainty is negatively associated with health suggests the need for nursing interventions to assist caregivers to cope with their role.     

Differences in home-based family caregiving appraisal for caregivers of the elderly in rural and urban Japanese communities

This quantitative study aimed to determine the differences between rural and urban residencies related to home-based appraisal (including care burden and positive appraisal) for Japanese primary family caregivers of the elderly with extensive care needs. The study examined a sample of 196 caregivers (106 rural, 90 urban), and stepwise multiple regression analysis was performed. Resident location was significantly associated with care burden, and each factor associated with the appraisal, especially care burden, differed between rural and urban areas. The social and physical environment is thus a necessary consideration to support family caregivers and the elderly requiring home-based care.     

The comparison of motor performance between part and whole tasks in elderly persons.

OBJECTIVE: When teaching clients a multistep functional task, therapists tend to break down the task into part tasks with discrete movements. The purpose of this study was to compare the kinematic performance between part and whole tasks in elderly persons. METHOD: A counterbalanced repeated-measures design was used. Twenty elderly persons without motor problems (7 men, 13 women) performed a signature task in two conditions. For the part-task condition, the participants did the task in a step-by-step manner: (a) reach for a pen, (b) bring the pen to the paper, and (c) sign the name. For the whole-task condition, the participants performed the task in an integrated continuous flow. Kinematic performances for two movement segments (i.e., reaching for the pen, bringing the pen to the paper) were compared between conditions. RESULTS: Generally, the whole-task condition elicited a more efficient, more forceful, and smoother movement than the part-task condition. CONCLUSION: The results suggest the importance of keeping a multistep functional task whole.     

儿童精神分裂症患者亲属心理健康状况及护理干预效果评价

目的探讨儿童精神分裂症住院患者亲属的心理健康状况及护理干预效果,为临床护理干预提供依据。方法将63例儿童精神分裂症住院患儿的亲属分为干预组32例,对照组31例。两组均接受常规陪护指导,干预组在此基础上接受护理干预。观察1个月。于护理干预前后采用焦虑自评量表、抑郁自评量表评定亲属的焦虑抑郁状况,白拟一般项目调查表评定亲属对精神疾病知识的了解度及学习需求。结果亲属焦虑自评量表、抑郁自评量表评分均显著高于常模（t=8．95、12．97,P〈0．01）。护理干预后干预组焦虑自评量表、抑郁自评量表评分均较干预前有显著性下降（P〈0．01）;对照组均有所下降,但差异无显著性（P〉0．05）;干预组焦虑自评量表、抑郁自评量表评分均显著低于对照组（P〈0．01）。护理干预前84％的亲属对精神分裂症不了解,90％的亲属表达了学习的需要;护理干预后57％的亲属能基本了解精神分裂症的基本知识和康复、护理及如何预防复发等知识。结论精神分裂症息儿亲属焦虑、抑郁情绪突出;护理干预能改善这些不良情绪。     

老年脑梗死患者高胰岛素血症的临床研究

目的：探讨高胰岛素血症（ＨＩＳ），胰岛素抵抗（ＩＲ）与老年脑梗死发病的关系。方法：３４例６０岁以上老年脑梗死患者和２０例正常人的葡萄糖耐量试验（ＯＧＴＴ）后血糖，胰岛素及其曲线下面积（ＡＵＣ）和胰岛素／血糖，血脂变化。结果；脑梗死组糖负荷后血糖，胰岛素，胰岛素／血糖，ＡＵＣ以及总胆固醇明显高于对照组，胰岛素敏感性指数及ＨＤＬ－Ｃ明显低于对照组，糖负荷后１小时，２小时胰岛素及其ＡＵＣ与舒张压呈正相关