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Acute family stress in this article is defined as the sudden or unexpected onset of moderate to severe discomfort or disequilibrium and feeling of inadequacy among family members in light of perceived insufficient available resources. Historically, there has been some ambivalence about stress—especially acute stress—and family life education. More recently, authors have suggested that the important issue determining appropriateness is not the topic but the approach used by the professionals. Several approaches are presented here that have been used by professionals to help children and families dealing with acute stress. They include care for self, identify acute stress, support caregivers and central figures in social networks, help families understand stress and coping, help adults talk with children, connect families with the familiar, collaborate with other professionals, and advocate for families. [ABSTRACT FROM AUTHOR]

Objectives: The Alzheimer's Society has culturally adapted an Information Programme for South Asian families (IPSAF) who support an individual living with dementia. The objectives of this evaluation were to establish whether IPSAF had an immediate and medium-term impact on those who attended and how it impacted on the wider family and the person with dementia.Methods: An inclusive, pluralistic approach was adopted. Seven focus groups were conducted with 42 participants, and 37 participated in a pre-post knowledge quiz. Seven family interviews were conducted with 17 participants, and 3 families were followed up after 6 months. Thematic analysis was conducted on the data.Findings: The IPSAF was found to improve participants' knowledge of dementia leading to increased understanding of the person with dementia. Participants became more aware of available services and accessed services to make use of practical support. IPSAF was reported to have an impact for people living with dementia, with carers' newfound understanding resulting in some changes in care practice that promoted empowerment and independence for people living with dementia. There was also some evidence to suggest that IPSAF had an impact on the wider family, with participants sharing information about dementia with family members who had not attended the programme. Families were continuing to make changes to improve the lives of people living with dementia 6 months later, suggesting IPSAF had a sustained impact.Conclusion: This culturally adapted programme was found to have a significant impact on carers, the person with dementia, and the wider family. [ABSTRACT FROM AUTHOR]

Traumatic brain injury ( TBI) is highly prevalent, with many survivors experiencing long-term disability as a consequence of cognitive impairments, adverse personality changes, and emotional and communication difficulties. Because family members most often assume the long-term role of caregiver, their feelings, relationships, and life plans are often negatively affected. Boss has defined a type of ambiguous loss in which the person is physically present but psychologically absent, which is the case for many families after brain injury. Over the past 2 decades we have developed interventions incorporating ambiguous loss theory to enhance resilience and improve psychological outcomes in families after TBI. This article provides a brief overview of TBI, discusses ambiguous loss in families after TBI, and describes the therapeutic goals and framework of empirically supported family interventions using the lens of ambiguous loss theory. [ABSTRACT FROM AUTHOR]

It is well established that married heterosexual women do more intergenerational caregiving for aging parents and parents-in-law than married heterosexual men do. However, gay men and lesbian women's recent access to marriage presents new questions about the gendered marital dynamics of intergenerational caregiving. We use dyadic data with gay, lesbian, and heterosexual spouses to examine the marital dynamics of intergenerational caregivers. Results show that gay and lesbian spouses provided intensive time and emotional support for an intergenerational caregiver. In contrast, heterosexual women described their intergenerational caregiving as rarely supported and at times even undermined by their spouse. Dyadic data on heterosexual men corroborate women's accounts; heterosexual men rarely reported providing intergenerational caregiving, and thus heterosexual women rarely described providing spousal support. These findings provide new insight into the intermingled roles of 'greedy' marriages and 'needy' parents, wherein marital negotiations around caregiving vary by gender for gay, lesbian, and heterosexual marital dyads. [ABSTRACT FROM AUTHOR]

In this article, I explore how migrant caregivers in Israel/Palestine use internet communication technology (ICT) to contest and navigate the gendered and racialized naturalization of their work and social and legal discrimination. I argue that, within the asymmetrical migrant caregiver/citizen-employer relationship, caregivers use ICT as a coping mechanism, for self-expression, to fortify relationships of support with family and friends and to strengthen networks of community solidarity and activism. I conclude by suggesting how each of these strategies and daily modes of contestation can be seen as a 'diagnostic of power' that reveals the multiple forms that structural violence against migrants can take. [ABSTRACT FROM AUTHOR]

Objectives Patients with bipolar disorder are characterized by an unusually high divorce rate. As such, the purpose of the present study was to uncover information relating specifically to the impact of bipolar disorder on patients and spouses individually, and on the marital relationship from the perspectives of both patients and spouses. Methods Eleven patients with bipolar disorder and ten spouses were interviewed separately about the impact of bipolar disorder on their lives and on their marital relationship. Data were analyzed using the grounded theory method. Results The impact of bipolar disorder for spouses included self-sacrifice, caregiving burden, emotional impact, and a sense of personal evolution. The impact of bipolar disorder on patients included an emotional impact, responsibility for self-care, and struggling socially and developmentally. When comparing patient and spouse perspectives on the impact of the disorder, neither the patient nor the spouse was able to accurately assess the impact of the disorder on their partner's lives. The impact of bipolar disorder on the relationship included volatility in the relationship, strengthening the relationship, weakening the relationship, and family planning. Conclusions The research indicated that patients and partners alike struggle with the tremendous impact of bipolar disorder on their lives and on their relationships. Given the high rates of divorce and volatility in these relationships, healthcare professionals can provide (or refer to) emotional and practical support both to patients and spouses on their own, and as a couple in their clinics. [ABSTRACT FROM AUTHOR]

Using data from the National Survey of Midlife Development in the United States and using the stress process model, this study compared caregiving parents and caregiving adult children with regard to health outcomes. The study sample consisted of 74 caregiving parents and 219 caregiving adult children. Predictors included type of family relationship, provision of activities of daily living, duration of caregiving, and family demands. Social support did not mediate the relations between significant predictor variables and health outcomes. The type of family relationship was associated with health outcomes with caregiving parents demonstrating poorer self-perceived health and more chronic conditions than caregiving adult children. Perceived family demands were associated with increased number of chronic conditions for caregiving adult children and caregiving parents. Unlike previous studies that measured objective family demands, perceived family demands was found to have a strong association with the number of chronic health conditions for both groups of caregivers. [ABSTRACT FROM AUTHOR]

Complex trauma (CT) results from exposure to severe stressors that occur within the caregiver system or with another presumably responsible adult, are repetitive, and begin in childhood or adolescence. As a result, many of these children and adolescents experience lifelong difficulties related to self-regulation, relationships, psychological symptoms, alterations in attention and consciousness, self-injury, identity, and cognitive distortions. The aims of this article include the following: (a) to examine several representative approaches identified as treatments for children and adolescents exposed to CT with respect to similarities and differences; (b) to examine representative evidence of model effectiveness; (c) to discuss how these approaches are and/or could be implemented in clinical practice; and (d) to suggest research designs that would facilitate greater translation of effective treatment into clinical settings. [ABSTRACT FROM AUTHOR]

For older adults who have experienced early life trauma, the aging process can be particularly challenging as resources, abilities, and environments change. Although researchers have documented these challenges well, few studies have examined the experiences of family caregivers to older adults who have endured early life trauma. In this qualitative study, the researchers interviewed 17 family caregivers to Holocaust survivors. Content analysis revealed themes typical of caregiving, including stress, filial piety, and guilt; however, these themes appeared to be amplified by the early life trauma endured by the older adults. Caregivers were also reluctant to seek assistance, as they compared their own stress with the incomparable stress endured by the Holocaust survivors. The findings provide an understanding of the specific challenges faced by family caregivers to older adults who have experienced early life trauma and hold important implications for health care professionals who work with these groups. [ABSTRACT FROM AUTHOR]

Guided by life course and stress process theory, this study investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and nonfamily (employment) roles. Eight waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong evidence for a 4-class model of caregivers' role pathways. The four pathways were (a) Not-Married, Early-Transition to Not-Working Caregivers (34%), (b) Married, Not-Working Caregivers (26%), (c) Married, Late-Transition to Not-Working Caregivers (23%), and (d) Married, Not-Working Caregivers with Coresiding Child (17%). Caregivers' background characteristics and contexts predicted pathway membership. Adult child caregivers have structurally diverse life pathways that have implications for theory, research, and practice. [ABSTRACT FROM AUTHOR]

Objective: The present study examined the role of personal loss due to mental illness and meaning-related coping strategies on reports of caregiving among well siblings of adults with serious mental illness. Method: A sample of 103 well siblings of adults with serious mental illness completed an online survey. Participants were recruited through websites related to mental illness and through contact with leaders of family support groups. Results: Personal loss, not meaning-related coping, was the strongest predictor of current caregiving among well siblings. Well siblings' age, support group affiliation, and perceived level of sibling dependence also contributed to variation in reports of current caregiving. Conclusion: Personal loss has powerful implications for research and interventions focused on sibling involvement in caregiving for adults with mental illness. [ABSTRACT FROM AUTHOR]

The quality of the relationship between individuals with dementia and their family caregivers has an impact on important clinical outcomes for both. It is unclear, however, how quality of relationship (QoR) affects caregivers' desire to place their relative in a nursing home. We examined the association of QoR with caregivers' desire to institutionalize (DTI), using a sample of 237 male and female caregivers of community-dwelling individuals with dementia. Findings revealed an interaction between QoR and caregiver gender, with stronger DTI significantly associated with lower QoR for male but not female caregivers. Health care providers should recognize poor QoR as a risk factor for institutionalization, especially among male caregivers. [ABSTRACT FROM AUTHOR]

The concept of 'scale' and usage of this term have raised much debate within human geography over the past 25 years. At the same time, these very debates have developed the concept dramatically by offering new considerations of its use. Building on notions that scale is experienced and that scalar concepts offer a vocabulary to articulate complex phenomena, this analysis aims to explore the relevance of scale as an explanatory concept used by informal family caregivers and front-line health and social care workers when discussing their experiences with a Canadian social programme, the Compassionate Care Benefit (CCB). The goal of the CCB is to provide income assistance and job security to those who take temporary leave from employment to care for a terminally ill family member. As part of a larger evaluative study on the CCB, semi-structured interviews with 57 family caregivers and 50 front-line health and social care workers from across Canada were conducted and transcripts were thematically analysed. Emerging from analysis of both datasets was the common usage of scalar concepts, specifically 'region', 'community' and 'home'. Respondents employed these scalar categories to reference both differences and relationships in highly spatial and comparative ways, and also to organise and articulate their thoughts in ways meaningful to them and their lives in place. Based upon these scalar categories and issues highlighted by respondents, particular spatial challenges and inequities are illuminated, and implications for the CCB and its administration are identified. These findings provide insight into the complex ways family caregivers and front-line health and social care workers make sense of their world and more specifically, understand how federal programmes like the CCB operate. By considering how such programmes are experienced in scalar ways, knowledge can be maximised and thus, informed decision-makers can more effectively meet the needs of programme users. [ABSTRACT FROM AUTHOR]

In this review, we summarize and critically evaluate the major empirical, conceptual, and theoretical directions that studies of aging families have taken during the .first decade of the 21st century. The field has benefited from an expanded perspective based on four overarching themes: (a) complexity in emotional relations, (b) diversity in family structures and households, (c) interdependence of family roles and functions, and (d) patterns and outcomes of caregiving. Although research on aging families has advanced theory and applied innovative statistical techniques, the literature has fallen short in fully representing diverse populations and in applying the broadest set of methodological tools available. We discuss these and other frontier areas of scholarship in light of the aging of baby boomers and their families. [ABSTRACT FROM AUTHOR]

Objectives: Previous research has largely focused on the lived experience either of those who have fibromyalgia syndrome (FMS) or their spousal carers. This study aimed to explore the lived experiences of both those with FMS and their spousal carers. Methods: Participants were aged between 38 and 65 years and all came from the south-west of England. Semi-structured interviews were conducted with four women with FMS and their spousal carers, who were interviewed separately. The resultant transcripts were analysed using interpretative phenomenological analysis. An overriding theme running throughout was loss of identity, which fed into a sense of isolation. Participants reported feeling isolated from: healthcare professionals, whom they felt they had to convince that they had something ‘real’, and from friends and family because the unpredictability of their symptoms meant that they were less able to plan ahead and often had to pull out of arranged outings. They also felt isolated from their identity because they no longer recognized the person that they once were, and struggled to recognize the person that they had become. As a consequence, the people with FMS and their carers were both engaged in a process of reassessing who they were, now that FMS had become such a large part of their lives. This sense of isolation was evidenced for the carers as well as the people with FMS and is documented in three sub-themes described in the paper: ‘others’ attitudes', ‘invisible illness’ and ‘role’. Conclusion: This study has provided new information regarding the lifeworlds both of people living with FMS and their spousal carers. We identified a number of practical and attitudinal barriers that had led to the diminution of social networks for both members of the couple and have explored the related clinical and theoretical implications of this. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Accessible summary. It is not easy for parents to care for a child with profound intellectual and multiple disabilities (PIMD). But we do not know how much effort it actually takes. If we want to help the parents, it is good to understand what it is they need to do and how much time that takes. We asked parents with what basic care tasks they had to help their child. And how much time that took them. We also asked parents if they had help from friends and relatives. We also wanted to know if professionals could really help to make the lives of parents a bit easier. There were 133 parents who answered all those questions. What they told us was important. They said: • Our children are very dependent on us. We have to help them with getting up, getting dressed, eating and drinking, and so on. And that will never stop, even if they grow older. • Some of us still have to get up night after night to look after the child. This is very tiring. To be up every night is really a burden. • We learn to live with the needs that our children have. It is more difficult for younger parents than it is for parents with an older child. • The support of professionals from special educational centre’s is very important for us. To us, it is even more important than help from friends. Raising children with profound intellectual and multiple disabilities is considered to be extremely difficult for parents, but figures on the content and amount of time needed for the caring task of parents is lacking. Data on what the caring task actually means (in terms of amount of time and type of task) is needed to be able to understand the parents’ support needs. A questionnaire was developed in order to collect information about both the caring task and the level of parental burden concerning health-related tasks and basic need tasks such as eating and drinking, dressing and sleeping. Furthermore, the level of support parents experience from friends, relatives and special services is included and the use of special aids and resources is taken into account. A total of 133 parents completed the questionnaire. Most children are dependent on them for meeting all their basic needs and have several health problems. Significant relationships were found between the number of times parents have to get up at night and the level of burden at night, and between the days a child stayed in hospital and the level of parental burden. The results indicate that the caring task places heavy demands on parents. Professional support is alleviating and extremely important for parents. The caring task is not necessarily indicative for the subjective burden parents experience. Parents of young children express higher levels of burden than parents of older children. [ABSTRACT FROM AUTHOR]

Being a close relative brings with it a large number of consequences, with the life situation changing over time. The aim of this study was to illuminate the experiences of being a middle-aged close relative of a person who has suffered a stroke 6 months after being discharged from a medical rehabilitation clinic. Narrative interviews were conducted with nine middle-aged close relatives and analysed using a content analysis with a latent approach. The analysis revealed that being close to someone who had suffered a stroke 6 months after discharge meant; a struggling for control and a renewal of family life in the shadow of suffering and hope. The middle-aged close relatives began to perceive the changed reality. They were struggling to take on something new, become reconciled and find a balance in their family life. Their ability to work, relief from caring concerns and having support and togetherness with others seemed to be essential for the close relatives in their efforts to manage their life situation and maintain their well-being. Having reached the ‘halfway point’ in their lives and still with half of their life in front of them created worries. They felt dejected about their changed relationships and roles, experience a sense of loss of shared child responsibilities, a negative impact on their marital relationships and sexual satisfaction. They felt trapped in a caring role and they worried about how to endure in the future. The middle-aged close relatives’ experiences were of being alone and neglected, in an arduous and complex life situation filled with loss and grief. The findings highlights that health professionals need to see and listen to the close relatives’ experiences of transition in order to provide appropriate support adjusted to their varying needs during a time of renewal. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the burden experienced by family caregivers of older adults with depression and to examine the positive effects on caregivers of treating late-life depression. DESIGN: Two-phase treatment study for major depressive disorder (MDD) that included 6 weeks of open treatment with antidepressant medication for all older patients followed by 16 weeks of randomized treatment for patients who were partial responders, comparing a combination of medication and interpersonal psychotherapy with medication alone. SETTING: Primary care and university late-life mental health research clinic. PARTICIPANTS: Adults aged 60 and older participating in a randomized trial for treatment of MDD who enrolled in a family caregiver study and their caregiver (N=244 dyads). MEASUREMENTS: Improvement in patient symptoms during open treatment (lower scores on the Hamilton Rating Scale for Depression (HRSD)) and remission of depression during randomized treatment (3 consecutive weekly HRSD scores of ≤7) were examined as predictors of lower general caregiver burden and burden specific to patient depression. RESULTS: Caregivers reported a moderate to high level of general caregiver burden on average. Change in patient depression during open treatment was associated with significantly decreased depression-specific burden (β=−0.22, P=.001) and a trend toward lower general burden (β=−0.08, P=.08). Caregivers of patients who remitted showed significantly decreased depression-specific burden ( F (1,76)=4.27, P=.04). CONCLUSION: Treatment of late-life depression has benefits that extend to the family members on whom patients depend. Caregiver education and support may strengthen these effects. [ABSTRACT FROM AUTHOR]

People with multiple sclerosis depend heavily upon their families and other informal carers as they receive limited support from health-care professionals or health-care services. Adopting the carer role results in a life-changing experience, which may bring rewards and challenges to the carer. This paper reviews the research addressing the experiences of carers of people with multiple sclerosis published between 2002 and 2007 building upon an earlier review. The literature suggests that carers have needs across various domains and that spouses/partners have particular needs. Much of the evidence has limited generalizibility although the geographical spread of the evidence indicates considerable consistency of need. The review describes ongoing carer needs which require supportive care and provides the basis for the development and testing of carer interventions for use by health-care professionals. [ABSTRACT FROM AUTHOR]

The prevalence of depressive symptoms among family caregivers has been documented as a serious social problem that could threaten the lives of the elderly and their family caregivers. Social support is considered to be a promising remedy for this problem, although a comprehensive examination of the availability and effectiveness of social support that includes both formal and informal support across multiple dimensions remains limited. In addition, little research has been conducted in Japan on gender differences in stress processes. This study tried to fill those gaps by analyzing recent survey data on sons and daughters who are caring for their elderly parents. The results indicate that sons and daughters have similar levels of formal and informal support for daily care and advice, while there are some gender differences in regard to the availability of other types of social support. It was also found that many types of informal support were significantly associated with a lower caregiver burden for daughters, although this was not necessarily the case for formal support. General instrumental support from formal sources was even associated with higher levels of distress. For sons acting as caregivers, daily caregiving support was the only formal support that was significantly associated with their lower level of distress. Issues of formal support are discussed, in order to reduce the psychological burdens borne by sons and daughters who care for their parents at home. [ABSTRACT FROM AUTHOR]