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Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.A causal model was developed and tested using structural equation modeling that examined depression scores of 503 older (age 50-85), male Veterans with moderate to severe symptomatic OA of the knee\hip.The results of the structural equation modeling produced a final model of depressive symptomatology that fit the data well (Chi square = 12.23, DF = 11, p = .346; TLI = .99; CFI = 1.00; RMSEA = .02).The findings indicate the central role that OA severity (pain, stiffness, and functional difficulties) plays in the mental health of older Veterans in terms of the level of reported depressive symptoms.

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In this article we examine the nurse's role in assessing the spiritual needs of older adults in long-term care. The spiritual needs of older adults have not been adequately addressed in nursing care planning, and this has diminished the quality of care for residents in long-term care facilities. Understanding spirituality as a coping mechanism or social support intervention for older adults would be helpful to nurses who provide care to geriatric residents. Based on the literature, several topics of significance are discussed, including definitions of spirituality and religion, cultural considerations, research on spirituality as a coping mechanism and social support intervention, spiritual assessment models, and nurses' use of spirituality and religion in planning holistic care for long-term residents.

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The pilot study described here was a test of interventions designed to enhance long-term disease management of African-Americans with type 2 diabetes in faith-based organizations. A quasi-experimental design based on 46 participants was used comparing three interventions: guided imagery, group counseling, and routine care. Unexpectedly, the number of self-reported hypoglycemic episodes significantly increased in the Rational Emotive Behavioral Therapy (REBT) group, depressive symptoms significantly increased in the guided imagery group, and the mean hemoglobin A1c values did not significantly differ for any group. In future research, the authors will incorporate an interim step investigating the theory of integration (Hernandez, Antone, & Cornelius, 1999) to increase the explanatory power in assessing treatment effects of African-Americans in faith-based organizations.

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Increasing effort in response to a complex workload is detrimental to workers' health and may explain the negative health consequences experienced by millions of family caregivers who are the primary workforce for older adult care in the United States. This cross-sectional, descriptive correlational study used survey data from 110 family caregivers of community-dwelling older adults to theoretically explain caregiving effort (as perceived exertion) and to examine the relationship between effort and depressive symptoms, a particularly persistent adverse caregiver health outcome. Visual analog scales and exemplar quotes explicated physical, mental, emotional, and time-related effort. Notably, effort was considered too multidimensional by several caregivers to discretely categorize. Among the relationships tested, effort was statistically significantly correlated with workload proxies (time, difficulty, overload), caregiver health and depressive symptoms, and care receiver function. Using regression analysis, effort and workload did not have direct effects on depressive symptoms. Surprisingly, effort was not decreased for caregivers who had formal or informal caregiving help. These findings support an energetical conceptualization in caregiving and highlight the complexity of a caregiving workload assessment. Practice suggestions are offered toward tailored health promotion strategies to benefit the families who constitute this essential, global caregiving workforce.

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PURPOSE: Transitions in caregiving, such as becoming a primary caregiver to grandchildren or having adult children and grandchildren move in or out, may affect the well-being of the grandmother. DESIGN AND METHODS: This report describes caregiving patterns at 3 time points over 24 months in a sample of 485 Ohio grandmothers and examines the effects of stability and change in grandmother caregiving roles (raising a grandchild, living in a multigenerational home, or not caregiving to grandchildren). Drawing on the Resiliency Model of Family Stress, the study examined caregiving stress and reward, intrafamily strain, social support, resourcefulness, depressive symptoms, mental and physical health, and perceived family functioning. Caregiver group, time of measurement, switching between caregiver groups, and baseline age, race, education, work status, and marital status were considered as independent variables within the context of a one-way treatment structure in a mixed-model multivariate analysis. RESULTS: There were significant caregiver group effects for all variables, except mental health and resourcefulness. Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning, the worst physical health and more depressive symptoms, and the least reward and subjective support. Across groups, there were significant time effects, with worsening physical health and increased stress over time. Switching to higher levels of caregiving was associated with worsening physical health and increases in stress, intrafamily strain, and perceived problems in family functioning. IMPLICATIONS: Recommendations for research and for practice, especially during times of caregiving transition or for grandmothers raising grandchildren, are discussed.

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This paper offers a conceptual framework that focuses on "care-getting", a proactive means of insuring responsive and high quality care that is necessary for maintenance of good quality of life during the final years of life. Unlike traditional formulations and empirical studies that consider end of life issues among the terminally ill, we call for a broader consideration of the final years of life among older adults experiencing different health trajectories. We expect frail older adults' dispositions, proactive adaptations, and responsiveness of their informal and formal social resources, to play key roles in achieving good quality of life close to the end of life. Such positive outcomes near the end of life help preserve the integrity of the person and contribute to a sense of being cared for [1]. The conceptual framework we propose is a necessary next step for social gerontology, in order to incorporate preparation for dying into the life course. This important final life stage has been previously neglected in gerontological life course theory. Cross-cultural considerations in getting responsive care close to the end of life are discussed.

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The purpose of this study was to compare differences in emotional self-disclosure between young adult Internet users who prefer face-to-face therapy to those who prefer Internet therapy. A convenience sample of 328 was recruited from Facebook to complete an online survey. A total of 263 preferred face-to-face therapy (F2FT) while 65 preferred Internet therapy (IT). Significant differences were found with the F2FT group willing to disclose emotions of depression, jealously, anxiety, and fear to a therapist more frequently than the IT group. The majority reported a preference for F2FT over IT. Recommendations for future professional practice and research are included.

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This study used the resiliency model of family stress, adjustment, and adaptation as the framework to examine the main and moderating effects of social support and resourcefulness in the relationship between family life stresses and strain and depressive symptoms in grandmothers raising grandchildren, grandmothers in multigenerational homes, and noncaregivers to grandchildren. A sample of 486 Ohio grandmothers, recruited using random and supplemental convenience methods, completed mailed surveys. Analysis of variance was used to examine differences in family life stresses and strain, resourcefulness, support, and depressive symptoms across the three groups of grandmothers. Hierarchical multiple regression analyses were used to examine whether family stresses and strains affected the grandmother's depressive symptoms and whether social support and resourcefulness moderated the relationship between family stresses and strain and grandmothers' mental health. Grandmothers raising grandchildren reported more depressive symptoms, but in multiple regression analyses of the full sample that controlled for demo-graphics, primary caregiving status was not related to depressive symptoms. More strain and less subjective support and resourcefulness were associated with higher depressive symptoms for all grandmothers, with 33% to 54% explained variances of such symptoms for each caregiving group and the full sample. Subjective support moderated the effects of strain and instrumental support moderated the effects of family life stresses on depressive symptoms. Social support and resourcefulness may help protect grandmothers from the effects of family stresses and strain, and interventions to enhance these factors may assist grandmother caregivers to achieve better mental health.

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This paper offers a stress theory based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal sources are discussed. This "Care-Getting" model explores benefits of proactive care-getting for diminishing physical discomfort/suffering, burden of illness and disability, and psychological distress. We highlight unique issues in care-getting that patients face at different stages of the life course. Implications of prior research related to the model for practice and intervention are discussed.

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Relocation is a major life event for elders and has been found to adversely affect their adjustment and ability to perform daily activities. Rosenbaum's theory of learned resourcefulness suggests that such adverse effects can be minimized if elders have positive cognitions and are resourceful. A cross-sectional design was used to examine the hypothesized relationships among the study variables in a sample of 104 cognitively unimpaired elders (aged 65+ years) who have relocated to retirement communities in Northeast Ohio. Results indicate that positive cognitions had a direct positive effect on learned resourcefulness and on relocation adjustment. Furthermore, learned resourcefulness had a moderating effect on the relationship between relocation controllability and relocation adjustment when controlling for covariates. It is imperative to generate interventions to enhance positive thinking and learned resourcefulness for elders facing the need to relocate and to create the therapeutic milieu within the retirement communities.

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The specific aims of this study were to (a) identify relationships among care-giving stress, caregivers' functional ability, and number of self-care behavior responses to physical and psychological symptoms in caregivers of persons with dementia and (b) examine the mediating function of functional ability in the relationship between caregiving stress and self-care behavior response to symptoms. A correlational, cross-sectional design was used, and a survey was mailed to 99 caregivers. The survey questionnaire contained items about demographics, caregiving stress, functional ability, and self-care behavior. The results indicate that caregivers who reported higher levels of caregiving stress had poorer self-rated health, poorer physical function, more symptoms, high levels of depressed mood, and more self-care behaviors. Caregiving stress was indirectly related to self-care behavior response to symptoms through functional ability, which suggests a need for developing early interventions to enhance the functional ability and self-care behaviors in response to some caregivers' symptoms.

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The purpose of this study was to explore the relationship of demographic characteristics, contextual factors, social support, and coping on health outcomes of family caregivers of older adults with dementia in Taiwan. This study also examined caregiving stress and whether support moderated the effects of caregiver stress on health. Lazarus and Folkman's (1984) Stress model guided this study. The descriptive cross-sectional study included subjects who were primary family caregivers of older adults with dementia from two settings in southern Taiwan. A convenience sample of 148 participants was interviewed. Data analysis consisted of Pearson's correlations, and simple and multiple regression analysis. Findings indicated that younger caregivers, those with paid assistants, and those with longer duration of caregiving had better health. Females with lower income and without assistants had more depressive symptoms. In addition, moderating effects of social support were supported. The results from this study provided a basis for developing interventions to minimize negative impacts on caregivers.

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A quasi-experimental 2-group repeated-measures design was used to test the impact of a feeding skills training program on 67 nursing assistants (treatment group n = 31; control group n = 36) regarding their knowledge, attitudes, perceived behavior control, intentions, and behaviors in feeding dementia patients. The treatment group received a feeding skills training program. Nursing assistants' knowledge, attitudes, perceived behavior control, and intentions were measured before (Pretest) and after the program (Posttest 1), and again 4 weeks later (Posttest 2). Nursing assistants (treatment group n = 20; control group n = 16) and the same number of dementia patients were measured on feeding behaviors during mealtimes before and after the training. The treatment group had significantly more knowledge (P < .001), greater intention to feed (P = .05), and better behaviors toward feeding dementia patients (P = .009) than the control group. There were no significant differences between the groups in attitude (P = .85), intention beliefs (P = .11) or perceived behavior control (P = .99). Thus, the intervention was effective at changing knowledge, intention, and behaviors among nursing assistants.

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Caregiving and its consequences are major concerns for nurses. Many studies have examined health-promoting behaviors in general (Duffy, 1993; Walker, Volkan, Sechrist, & Pender, 1988), but few studies have explored health-promoting behaviors of caregivers. The purpose of this study was to examine the effects of age, gender, race, and length of caregiving on perceived health status and health-promoting behaviors of African-American and White informal caregivers of impaired elders. Data from a larger study was used to examine a conceptual model linking perceived health status and health-promoting behavior. A sample of 136 (n = 136) African-American and 257 (n = 257) White caregivers was recruited from northeastern Ohio through random digit dialing and interviewed face to face. English-speaking caregivers were selected for study who provided unpaid assistance or care for a minimum of five hours a week to an impaired person 60 years of age or older living in the community. The Health-Promoting Behavior Questionnaire, perceived health status, and a demographic profile were used to measure the study variables. Data were analyzed using hierarchical multiple regression. Findings from this study suggest that the overall fit of the conceptual model was significant, and that moreover, the relationship found between perceived health status and health-promoting behaviors supported Pender's model of health promotion (Pender, 1987). The relationship between perceived health status and health-promoting behaviors has not been documented in prior studies of caregivers, or in studies comparing the two racial groups of African-Americans and Whites.

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UNLABELLED: Although resourcefulness may facilitate coping with caregiver stress and burden, it has not been among African American women for whom caregiving is culturally prescribed. OBJECTIVE: Using Rosenbaum's theory of resourcefulness, this study examined situational (socioeconomic status, social support, daily hassles), physiological (age, body mass index, number of health problems, systolic blood pressure), and psychological factors (positive cognitions) as predictors of resourcefulness. METHODS: A random sample of 97 African American caregivers and 110 noncaregivers provided data via structured interviews and 24-hour ambulatory blood pressure monitoring. RESULTS: No physiological indicators predicted resourcefulness; however, daily hassles, social support, and positive cognitions were significant predictors. Age, number of health problems, daily hassles, and social support had indirect effects on resourcefulness through positive cognitions. DISCUSSION: These findings suggest a need to further examine the impact of daily hassles, social support, and positive cognitions on caregiving and continued review of models for predicting resourcefulness in African American women.

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The primary purpose of this study was to compare knowledge of use of and need for community services between older (60 years of age and older) African-American men and women. A secondary purpose was to determine whether predisposing, enabling, and health-status factors could predict knowledge of need for, and use of specific community services among African-American women and men, 60 years of age and older Data were gleaned from a community-based random telephone survey of African-Americans (77 female and 23 male), 60 years of age and older, living in northeastern Ohio. Data generated from this study were analyzed using chi-square, and independent samples t-test, and multiple regression. Findings from this study suggested that women had higher levels of knowledge of use of and need for community-specific services than their male counterparts. Another finding from this study suggested that none of the identified predisposing, enabling, and health-status factors found in this study could plausibly explain knowledge of need for, or use of community-specific services.

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