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Men comprise an estimated 25% of informal caregivers in the U.S., but research on them is scarce. This study compared physical health in male caregivers (CGs) and non-caregivers (NCGs). 694 men, aged 64-93 years, who participated in the Baltimore Men's Osteoporosis Study completed a standardized questionnaire. CGs were men who helped a relative or friend, without pay, with greater then 1 instrumental and/or basic activity of daily living (IADLs/ADLs), NCGs were men who helped no one with IADLs/ADLs; 117 (17%) men were CGs. CGs and NCGs did not differ on age (mean=74 yrs), race (28% black), being married (80%), self-rated health (49% rated excellent/very good), mean body mass index or grip strength. When stratified by race and marital status, spouse CGs were significantly older than other white (78 vs 74 yrs) and black men (75 vs 72 yrs). Souse CGs helped with more ADLs/IADLs among whites; non-spouse CGs helped with more among blacks. Married men were more likely than unmarried men to rate their health as excellent or very good, and to have been physically active in the past week, regardless of caregiver status. Compared to the 120 unmarried NCGs, they adjusted odds ratio for health rated as excellent/very good was 1.6(95% CI=0.8-3.2) in 47 spouse CGs, 1.4(0.9-2.2) in 456 married NCGs, 0.8 (0.4-1.6) in 51 married nonspouse CGs, and 0.9(0.3-2.7) in 19 unmarried CGs. Based on these results, studies of male CGs and NCGs should account for effects of marital status and race.

It is well established that caregiving for an older adult is stressful. However, by treating caregivers (CGs) as a homogenous group, it is possible that factors related to stress are misrepresented for some CGs. The current study utilized a sample of 246 CGs (mean age = 81) to examine multiple group path models of perceived stress for all CGs, CGs of adults with dementia (n = 72), and CGs of adults without dementia (n = 174). The sample was taken from the Caregiver Study of Osteoporotic Fractures (CG-SOF), an ancillary study of SOF, a 4-site cohort study of 9704 women. CGS were SOF respondents who helped a relative or friend, without pay, with > 1 instrumental and/or basic activity of daily living. Preliminary results indicate a significantly higher mean level of stress on the Perceived Stress Scale (PSS) in CGs to persons with dementia than without (19.67 vs. 17.45). For CGs overall and CGs of persons without dementia, the effects of the main predictors of stress, number of caregiving hours/day and number of care recipient behavioral problems, are mediated through feelings of role captivity. However, for CGs of persons with dementia, there is a direct relationship between stress and these factors. Results confirm the impact of the care recipient's disability on the experience of caregiving. Such findings are important for developing and targeting caregiver interventions.

Affective status is commonly assessed by measures of depression. However, emotional vitality, a recently proposed measure of global affective well being, may be better to use in elderly caregivers (CGs) who are less likely than. younger Gs to report depressive symptoms. Factors associated with depression (Center for Epidemiologic Studies Depression Scale (CES-D)), and emotional vitality (CES-D; Pearlin's Mastery Scale; Perceived Stress Score, PSS)were examined in 246 CGs from an ancillary study of the Study of Osteoporotic Fractures (SOF). SOF is a 4-site cohort study of women aged gt; 65 years at baseline in 1986. CGs were SOF respondents who aided a friend or relative without pay with gt; 1 basic and/or instrumental activities of daily living. CGs had a mean age of 81 years, and 87% were white. To date, 37 CGs reported high depressive symptoms (CES-Dgt; 16), and 145 had low emotional vitality (CES-Dgt; 16, mastery gt; 10, PSS gt;12). In multivariate analyses, high depression and low emotional vitality were associated with higher levels on Pearlin's Role Captivity Scale and more problematic behaviors in care recipients. T-here were trends toward decreased social activity, caring for co-residents, and caring for persons with dementia. Co-residency was related more strongly to low emotional vitality than depression. Although emotional vitality and CES-D were associated with similar factors, emotional vitality might be a preferable outcome measure as it captures more CGs.

OBJECTIVES: To determine whether positive affect is associated with a lower incidence of frailty over 2 years in elderly community-dwelling women and to test the stress-buffering hypothesis by evaluating whether these associations differed in caregivers and noncaregivers. DESIGN: Prospective cohort study with three annual interviews conducted in four U.S. communities between 1999 and 2004. SETTING: Home-based interviews. PARTICIPANTS: Three hundred thirty-seven caregiver and 617 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who were not frail at the baseline Caregiver-SOF interview. MEASUREMENTS: High and low positive affect and depressive symptoms were derived from the baseline 20-item Center for Epidemiologic Studies Depression Scale. Frailty was the development of three or more indicators (weight loss, exhaustion, slow walking speed, or weak grip strength) at the first or second follow-up interview. RESULTS: Respondents' mean age was 81.2. Caregivers and noncaregivers had similar levels of positive affect (56.3% vs 58.3%) and frailty incidence (15.4% vs 15.9%) but differed in perceived stress (mean Perceived Stress Scale score 16.7 vs 14.8, P<.001). Frailty risk was lower in respondents with high positive affect than in those with low positive affect in the total sample (adjusted hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35-0.70), caregivers (adjusted HR=0.44, 95% CI=0.24-0.80) and noncaregivers (adjusted HR=0.50, 95% CI=0.32-0.77). CONCLUSION: These findings add to the evidence that positive affect protects against health decline in older adults, although it had no additional stress-buffering effect on health in elderly caregivers. [ABSTRACT FROM AUTHOR]

The association between severe headaches and suicidal thoughts or behaviors is generally attributed to underlying depression, but it is plausible that severe headaches can lead to suicidal thoughts/behaviors, independent of the effects of psychiatric conditions. This association has been observed in only 1 previous study. Our multivariate analysis examined the longitudinal association between severe headaches and development of suicidal thoughts/behaviors over a period of 1 to 2 years among 6832 community-dwelling adults interviewed during the Epidemiologic Catchment Area Study. Severe headaches were significantly associated with developing suicidal thoughts/behaviors after adjusting for psychiatric diagnoses and demographics [adjusted odds ratio (ORa) = 1.48; 95% confidence interval (CI) = 1.04, 2.11], or additionally adjusting for interaction between anxiety and depression (ORa = 1.52; 95% CI = 1.07, 2.16). These results suggest that individuals with severe headaches should be screened for suicidal thoughts/behaviors, irrespective of the presence of a psychiatric condition. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women. DESIGN: Cross-sectional study conducted in four communities in 1999 to 2001. SETTING: Home-based interviewer-administered questionnaires. PARTICIPANTS: Three hundred seventy-five caregiver and 694 noncaregiver participants from the Study of Osteoporotic Fractures. MEASUREMENTS: Self-reported frequency of three sleep problems in the previous month: trouble falling asleep, trouble staying asleep, and waking early and having trouble falling back asleep. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), excluding the sleep disturbance item. RESULTS: In adjusted analyses, caregivers did not report more sleep problems than noncaregivers, although respondents with high depressive symptoms (CES-D > or = 16) were twice as likely to report each sleep problem. When depressive symptoms and caregiving were considered together, caregivers with high depressive symptoms were most likely to report sleep problems (adjusted odds ratios ranging from 2.5, 95% confidence interval (CI)=1.2-5.2 for trouble falling asleep to 4.0, 95% CI=2.0-7.8 for waking early, compared with nondepressed noncaregivers). By contrast, there was no difference in sleep problems between caregivers and noncaregivers who were not depressed. The combination of high depressive symptoms and high-stress caregiving situations (e.g., caring for a spouse or a person with dementia, or living with the care recipient) also increased the likelihood of sleep problems. CONCLUSION: Caregivers with high levels of depressive symptoms reported sleep problems more than nondepressed noncaregivers. These results underscore the importance of screening elderly female caregivers for depressive symptoms and sleep problems. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Caregiving for older adults is stressful; however, by treating caregivers as a homogenous group, it is possible that stress-related factors are misrepresented for some. This study of 349 elderly caregivers explored mediators of the caregiving / stress relationship for caregivers to adults with (n = 106), and without (n = 243) dementia. METHODS: The sample was from the Caregiver Study of Osteoporotic Fractures (CG-SOF), ancillary to SOF, a four-site cohort of 9,704 women. RESULTS: Stress was higher (p < .001) in dementia than nondementia caregivers (m = 19.85; 16.45). For caregivers overall, intensity and recipient problems were associated with stress but mediated through role captivity. However, relationships differed when stratified by recipient dementia status. Only recipient problems among nondementia caregivers was mediated through captivity. DISCUSSION: Results confirm previous findings of lower stress among nondementia caregivers and suggest that different factors influence caregivers' appraisal of the situation, including their perception of stress, based on recipients' dementia status. [ABSTRACT FROM AUTHOR]

Context: Editors, authors, and reviewers are influential in shaping science. The careers of women in public health have received less scrutiny than those of women in medicine and other branches of science. The performance of women as editors, authors, and reviewers in epidemiology has not been previously studied.Objective: To examine changes over time in the representation of women at the editorial level in US epidemiology journals compared with the proportion of women authors and reviewers.Design and Setting: Cross-sectional study of 4 US epidemiology journals, American Journal of Epidemiology, Annals of Epidemiology, Epidemiology, and the Journal of Clinical Epidemiology (formerly the Journal of Chronic Diseases), for 1982, 1987, 1992, and 1994.Subjects: Editors, authors, and reviewers for the selected years.Main Outcome Measures: Sex of editors, authors, and reviewers.Results: We identified 2415 reports associated with 8005 authors. One of 7 editors in chief was a woman, a position she shared with a man. For all journals, the proportion of editors who were women ranged from 5 (6.5%) of 77 in 1982 to 42 (16.3%) of 258 in 1994. Over all journals and all years, women comprised a higher proportion of authors (28.7% [2225/7743]) compared with reviewers (26.7% [796/2982]) or editors (12.8% [89/696]).Conclusions: Fewer women in public health hold editorial positions than are authors and reviewers. The reasons for this important discrepancy, including the possibility of a selection bias favoring men, should be further investigated. [ABSTRACT FROM AUTHOR]

Limited prospective data exist on how living arrangements are associated with change in functional health. This study evaluated whether elderly women living alone were less likely to experience functional decline when compared with women who lived with others. A total of 619 community-dwelling, white women from Baltimore, Maryland, aged 65–99 years at baseline were questioned annually from 1984 to 1986. Functional health was measured as the sum of limitations in seven physical and seven instrumental activities of daily living (Instrumental ADL). A total of 148 women experienced functional decline over the 2 years, primarily as a deterioration in Instrumental ADL The association between living arrangement and change in Instrumental ADL depended on the level of physical impairment. Among women without severe impairment, Instrumental ADL deterioration was significantly less for those living alone compared with those living with spouses (odds ratio (OR) = 0.60, 95% confidence interval (Cl) 0.45–0.92) or nonspouse others (OR = 0.62, 95% Cl 0.45–0.96). For women with severe impairment, however, those living alone had a greater decline in Instrumental ADL, especially when compared with those living with nonspouse others (OR = 5.13, 95% Cl 1.23–21.28). These results suggest that, unless severely physically impaired, women living independently have less deterioration in functional health when compared with peers in alternate living arrangements. Am J Epidemiol 1998; 147: 370–8. [ABSTRACT FROM AUTHOR]

Although approximately one of five people in the United States die in nursing homes (NHs), little has been written about their quality of dying, including the quality of terminal medical care. The purpose of this study is to review actual medical practices in NHs to suggest factors important for delivering good quality terminal care. Four NHs were surveyed for management of residents who died in 1992. A convenience sample of charts of newly admitted and longer term residents were abstracted for demographic variables, death, diagnostic categories, and various laboratory and other parameters. Charts of those residents who died were further reviewed using indicators of quality medical care, such as presence of advance directives, control of pain, and control of dyspnea, based upon recent published clinical practice guidelines for terminal care in NHs. Three hundred and seventy-one charts were abstracted. Forty-one charts documented the resident's death. We found that NHs without regulatory difficulties usually had expected deaths that were managed appropriately as measured by terminal medical care quality indicators. NHs with a history of regulatory difficulties had a higher prevalence of residents who died suddenly and unexpectedly, often with problems in the quality of care as measured by the same indicators. There was a correspondence between physician certification, antemortem diagnosis of terminal illness, and appropriate terminal care. We conclude that physicians are able to recognize impending death and redirect the medical care of dying NH residents toward goals of terminal care management. This is more likely to occur in a NH environment that places greater emphasis upon total quality management. We suggest that another indicator in providing good NH terminal care is the physician's performance in predicting a short life expectancy. [ABSTRACT FROM PUBLISHER]

The associations between self-reported rewards and difficulties of caregiving and burden were examined in a sample of 200 informal caregivers to older post-rehabilitation patients. Sixteen percent (16%) of caregivers reported that caregiving was physically difficult only, 15% reported emotional difficulties only, 11% reported social difficulties only, 17% reported multiple difficulties, and 40% had no difficulties. Each type of difficulty (e.g., social, emotional, and physical) was significantly associated with burden in univariate and multiple linear regression analyses, controlling for confounding characteristics. Caregivers reporting multiple types of difficulty experienced higher levels of burden than caregivers who reported only one type of difficulty. Caregivers who received more rewards from caregiving reported fewer difficulties. Caregiving rewards had no independent effect on burden but modified the associations between social and emotional difficulties and burden. In summary, caregiving rewards and difficulties were not mutually exclusive, and their relationship in turn affected burden. [ABSTRACT FROM AUTHOR]