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Background and Objectives Home- and community-based services (HCBS) are underutilized, despite offering significant health benefits to both care recipients and caregivers. Drawing upon Andersen's extended behavioral model of health services use, we examined individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia. Research Design and Methods We analyzed data from telephone interviews with 123 dementia family caregivers in rural Appalachian counties (M age = 64.7, SD age = 12.2). Multilevel analyses were conducted to examine the effects of individual-level and county-level factors on the use of home-based services (home healthcare and personal care services) as well as community-based services (adult day care and transportation services). Results Results indicated that caregivers' receipt of informal support from family or friends was associated with more use of home-based services (B = 0.42, p =.003). Conversely, longer travel times to service providers were linked to use of fewer community-based services (B = −0.21, p <.001). Residing in counties with more home health agencies was associated with higher utilization of home-based services (B = 0.41, p =.046). However, higher county tax expenditures for HCBS were not linked to home-based or community-based service use. Discussion and Implications Findings suggest that informal support in caring for the person living with dementia enables HCBS use in rural Appalachia. In contrast, limited geographic accessibility and service availability can impede HCBS use in rural regions. Policymakers are urged to allocate direct public funding to service providers to expand service availability in underresourced rural regions. [ABSTRACT FROM AUTHOR]

Background and Objectives Behavioral expressions of dementia are often stressful for family caregivers to manage as they strive to ensure their relative's needs are met. Guided by Lazarus and Folkman's Transactional Model of Stress and Coping, we identified specific behaviors that disrupt daily routines and challenge the achievement of caregiving goals, and the approaches and strategies caregivers employ to address them. Research Design and Methods We conducted semistructured interviews with 30 family caregivers in rural Appalachia caring for a relative living with dementia. Analysis involved use of open and focused coding processes to identify the ways caregivers managed behaviors and bar graphs to examine management approaches relative to categories of behaviors and caregiver demographic and emotional well-being variables. Results Analyses revealed 10 types of behavioral expressions of dementia associated with confusion, irritability, and resistance to engaging in necessary activities of daily living. Caregiver approaches to managing behaviors included gentle persuasion, being harsh by yelling or threatening, being persistent in expecting the person with dementia to complete the tasks at hand, disengaging by postponing the activity, and employing a combination of strategies. Approaches differed across types of behavior and caregiver demographics and had varying effects on caregiver well-being. Discussion and Implications Uncovering specific behaviors family caregivers of persons living with dementia found bothersome, caregivers' adaptive strategies for managing behaviors, and the impact of those approaches provides new information to inform training on effective dementia caregiving practices and development of targeted intervention programs for dementia care. [ABSTRACT FROM AUTHOR]

Despite changes in the structure of contemporary families, little is known about extended family members—siblings, grandchildren, nieces/nephews, stepkin—who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face. [ABSTRACT FROM AUTHOR]

Objectives Examinations of cultural variations in caregiving experiences and practices tend to focus on racially and ethnically diverse family caregivers. We extended this research by exploring the role of place-based cultural constructs on care decisions of family caregivers for persons living with dementia in rural Appalachia whose experiences and backgrounds dwell outside the lines of dominant culture. Methods Guided by our sociocultural conceptual model of service use and a descriptive qualitative study design, we conducted in-depth interviews with 30 caregivers for persons living with dementia to understand how predisposing and enabling factors influence caregiving decisions, including the use of services to care for persons living with dementia. Results Three predisposing factors reflecting the culture of rural Appalachian counties in Virginia (reasons for becoming a caregiver, previous caregiving experience, and deference to the person living with dementia) shaped decisions about caregiving responsibilities and service use. Three place-based enabling factors (a personal sense of belonging, knowledge of services, and family support for service use) played an important role in facilitating access to services. Discussion Findings revealed subtle variation across caregivers in this study and in comparison, to caregivers' experiences more generally. We interpret these variations in light of culturally influenced attitudes, family norms, and sources of information about formal services. Place-based cultural experience influenced dementia family caregivers' behaviors and choices regarding formal service use, suggesting that investigators should pay more attention to cultural influences in future caregiving research. [ABSTRACT FROM AUTHOR]

The purpose of the present research was to develop questionnaires to assess outcome expectancy for resistance training (RT), behavioral expectation in the context of perceived barriers to RT, and self-regulation strategies for RT among young-old adults (50-69 years). Measurement development included (a) item generation through elicitation interviews (N = 14) and open-ended questionnaires (N = 56), (b) expert feedback on a preliminary draft of the questionnaires (N = 4), and (c) a quantitative longitudinal study for item-reduction and psychometric analyses (N = 94). Elicitation procedures, expert feedback, and item reduction yielded four questionnaires with a total of 33 items. Positive outcome expectancy (α = .809), negative outcome expectancy (α = .729), behavioral expectation (α = .925), and self-regulation (α = .761) had—with one exception—moderate bivariate associations with two different indicators of self-reported RT behavior at one-month follow-up (r = .298 to .506). The present research provides preliminary support for newly developed questionnaires to facilitate understanding of the psychosocial determinants of RT among young-old adults. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to assess family caregivers' primary appraisal of stressors related to COVID-19 stay-at-home orders, secondary appraisal of resources and support availability, and use of coping strategies as predictors of perceived role overload during the stay-at-home phase of the pandemic. Method Telephone interviews with 53 family caregivers of persons with dementia from rural Virginia 2 weeks after enactment of the governor's stay-at-home order using structured and open-ended questions were conducted. Results Caregivers who were more concerned about the COVID-19 pandemic were at greater odds of experiencing high role overload than those who recognized positive aspects of the pandemic, as were those who received insufficient support from family and friends. Discussion Use of the transactional model of stress responses yielded important insights about families coping with dementia. Caregivers' perceptions of the pandemic's impact varied, with differential effects on their well-being. [ABSTRACT FROM AUTHOR]

Objective: Despite overall improvements in the U.S. health care, older adults living in rural counties, such as Appalachian Virginia, continue to be underserved. Method: Multinomial regression models, including both individual and county data from 503 older adults aged 65+, were used to examine factors associated with informal and formal care use. Results: Older adults with stronger filial beliefs and less positive attitudes toward community services preferred informal help. If the county had more formal care services, however, older adults were more likely to use them, regardless of their filial beliefs. Disparities based on gender were observed, in that women who lived in counties with a higher percentage of older adults below the poverty line were more likely to receive no help than men. Discussion: Developing effective service promotion tactics, destigmatizing community services, and targeting services and support, especially to women, could decrease health disparities in rural Appalachia and similar geographic areas. [ABSTRACT FROM AUTHOR]

The article offers information on interpersonal neurobiology, an interdisciplinary theory being used by couple and family therapists. Topics discussed include National Longitudinal Study of Adolescent to Adult Health (Add Health), attachment theory and the connections between experiences in relationships and brain development. Also mentioned are exploring couple relationship quality, self-acceptance and neuroticism, a personality trait characterized by emotional reactivity.

Objectives: This research documents spousal accounts of daily symptoms and behaviors of their husbands or wives with mild cognitive impairment (MCI) and assesses how MCI-related symptoms and care needs are associated with spouse care partners’ psychological well-being and biomarkers of physiological wear and tear. Method: Thirty spouse care partners participated in a 7-day diary study and reported on behavior problems associated with MCI as well as daily stressors and strains they experienced. They also provided saliva samples on 4 of the study days. Results: Multilevel models revealed daily variability and change in psychological affect and the diurnal cortisol rhythm. Daily primary stressors, everyday secondary strains, and marital interactions predicted these changes. Discussion: The findings document the negative physiological effects of having a spouse with MCI and provide new details on probable causes of psychological and biological distress. They shed light on MCI-specific interventions to address couples’ needs before severe disease progression occurs that could interfere with spouses’ ability to provide home-based care and support. [ABSTRACT FROM PUBLISHER]

Objectives. This article examined exposure to and appraisal of care-related stressors associated with use of adult day services (ADS) by family caregivers of individuals with dementia. Methods. Using a within-person withdrawal design (A-B-A-B), we compared caregivers’ exposure to and appraisal of behavior problems on days their relative attended and did not attend ADS. Participants were 121 family caregivers enrolling a relative with dementia in an ADS program. Daily assessments were obtained prior to the person's attending ADS for the first time and after 1 and 2 months of attendance on days the person attended and did not attend ADS. Results. Total exposure to stressors and stress appraisals decreased significantly over time on ADS days compared with non-ADS days. Most of this difference was accounted by the time the person with dementia was away from the caregiver, but there were also significant reductions in behavioral problems during the evening and improved sleep immediately following ADS use. Discussion. ADS use lowered caregivers’ exposure to stressors and may improve behavior and sleep for people with dementia on days they have ADS. The study highlights how a within-person design can identify the effects of an intermittent intervention, such as ADS. [ABSTRACT FROM PUBLISHER]