Neurobiology of Aging, Vol. 15, pp. Sl-S170,
1994 Copyright 8 1994 Elsevier Science Ltd Printed in Ihe USA. AI1 rights reserved 0197-4580/94 $6.00 + .OO
1 *creSSOr* a year later. HCIW~“~~, to a large extent this relationship is somewhat indirect. Th"s, the subjective stressors, overload in particular, are strongly influenced by the objective conditions and demands of caregiving. These subjective states, in turn, are the major factors underlying the generation of secondary stressors. Once established. the secondarv stressors are as "owerful as the primary in contributing to-states of distress. such as Clinicians and practitioners, therefore, would depression. find it useful to consider secondary stressors in their effort to understand the sources of distress among caregivers and to devise effective interventions.
Charting the Caregiving Career: A Unified Framework for Interpreting Informal Caregiving Processes and Outcomes. K. Kosloski and R. Montgomery, Gerontology Center, University of Kansas, Lawrence, KS, 66045 USA. Over the past decade, a large body of literature has emerged describing caregiving processes (e.g., background and demographic characteristics of care providers and recipient, the type of care provided, etc.) and outcomes (e.g.. physical and psychological consequences). Although certain consistent patterns have emerged (e.g., characteristics of caregivers), the frequent inconsistency in findings between caregiving studies has diminished the utility of this research. The purpose of this paper is to present a conceptual framework that provides a context within which to interpret these diverse and sometimes conflicting findings. Six markers in the caregiving career characterize the basic framework: (1) initial provision of care, (2) self-definition as a caregiver, (3) provision of personal care, (4) seeking out or using assistive services, (5) consideration ot lnstltuttonalizatlon, and (6) actual nur,ll8y ilul,lo placement. These six markers are hypothesized to be ordinal in their timing, although not every caregiver is expected to reach each successive stage. For example, not all caregivers reach Marker #6. Caregivers may also skip certain stages (e.g., reach Marker #6 without attaining Markers #3 or #4). The major factors hypothesized to determine whether and when a caregiver will reach a particular marker are discussed for each marker. By grouping caregivers according to their location in the caregiving career within this framework, meaningful comparisons can be made among caregiving outcomes despite differences in the etiology of the disorder of the dependent elder, the patterns of care provided, or the background characteristics of the caregiver. To illustrate, the framework is used to explain inconsistencies in the research literature in four areas: 1) the prevalence and patterns of caregiving, (2) the use and consequences of formal support services, (3) the inconsistency of measures of caregiving burden and other psychological measures, and (4) differences in models of nursing home placement.
3 ALZHEIMER’S DISEASE CAREGIVING: PREVALENCE AND HEALTH EFFECTS. R. Schulz and A. T. O’Brien, Department of Psychiatry and UCSUR University of Pittsburgh, Pittsburgh, PA 15260 Although it is difficult to pinpoint exactly the. prevalence of disability in the population and the associated prevalence of -giving, current estimates suggest that the number of family caregivers in the United States lies somewhere between 5 and 9 million persons. If we assume the prevalence of severe Alzheimer’s disease’ (AD) in the community is approximately 1 million persons requiring continual care, and at least half of the 2-4 million mildly and moderately impaired individuals need supervision and assistance in order to survive in the community, then at lease 2-2.5 million caregivers are needed to support this population. This is probably an underestimate because even mildly demented persons require some care, and many patients are likely to have multiple caregivers. Using the latest estimates of the prevalence of AD and varying definitions of caregiving, we will generate culTem and future estimates of AD caregiving. A second focus of this discussion will be on extent to which and under what circumstances AD caregiving leads to clinically significant health effects. Providing care to a relative suffering from dementia has been likened to being exposed to a severe, long-term, chronic stressor. The demands of caregiving frequently require major role changes among both men and women and may put the caregiver at risk for physical and psychiatric morbidity. A large range of studies are reviewed including those focusing on self-reports of physical health and psychiatric symptoms, standardized clinical assessments, health care utilization, and immune function. Prevalence estimates of health effects are reported, and the policy implications of this analysis are discussed in the context of current initiatives to assist caregivers.
2 CAREGIVING AND THE PROLIFBRATION OFSTRESS.
L. I. Pearli", C. of California San S. Aneshensel, and J. T. Mull?.". Univ. Francisco, Human Development/Aging Program. 1350 7th Ave., San Francisco, CA 94143. This analysis tracks the hardships and stressors experienced by 555 caregivers to spouses and parents with Alzheimer's Disease (AD). Participants were administered a structured It was hypothesized interview on five occasions a year apart. that stress, particularly when it is chronic and severe, tends I" the case of caregiving, it over time to beget other stress. means that the persistent and difficult demands involved in caregiving to a close relative impaired by AD eventually give rise to stresses in areas of life outside of caregiving. This process is referred to as stress proliferation. To observe whether and how proliferation occurs, 8 distinction is made between primary and secondary stressors. Primary stressors are those that are directly anchored in caregiving activities; secondary stressors are those surfacing in other major roles such a8 those involving kinship, occupation, and activities, and network relationships. In part, primary economic status, stressor are assessed by the impaired relative's needs for IADL as gauged by ADL and assistance and attention, cognitive deterioration and problematic or dependencies, It is assumed that the stress of dlsrupclve behevlol-. caregiving increases with these kinds of disabilities of the AD Other measures of primary stressors involve the patient. subjective states of the caregiver, such as the level of The measures of secondary overload that is experienced. stressors are in the form of a variety of scales created for the study. The results of regression analyses generally confirm the stressors increase. a hypothesis: as primary guiding corresponding increase is found in the levpl of secondary
4 ADAPTATION TO SPOUSAL CAREGNING: W RACE AND GENDER MATTER? B. Miller, R.T. Campbell, L. Davis, C. Farran, 1. Kaufman. Jane Addams College of Social Work and Dept. of Sociology, Univ. of Illinois at Chicago (mc 779), Chicago IL 60612, USA and Rush Univ. College of Nursing and Chicago State University. Spousal caregiving does not occur ia a social vacuum. Race and gender differences in marital status, living arrangemenu, mortality, and morbidity influence the probability of AFricsn-Am&an and white men and woman becoming caregivers. But do race and gender differences in predictors of negative adaptation (e.g. depression) and positive adaptation (e.g. satisfaction) to caregiving persist among those who have bacome caregivers? What exactly is it about race and gender that affects reactions to stress?