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Objectives: The objectives of this study were to examine the relationship between selected decedent and caregiver characteristics, facility-related perceptions, and emotional and physical health of 434 informal caregivers (94% family) of recently deceased residents of residential care/assisted living facilities and nursing homes. We also examined potential mediating effects of social support (informal, staff, and spiritual)., Methods: We analyzed data using linear mixed models., Results: Among caregivers, younger age, female gender, more education, financial burden, other dependents, poorer perceptions of care, and more care involvement were associated with more emotional strain. More staff support also was associated with more emotional strain and partially mediated the relationship between having a trusted staff member and emotional strain. Characteristics associated with poorer physical health included unemployment, financial burden, poorer physician communication, and trusted staff member. Informal social support was directly related to better physical health and mediated the relationships between physical health and both physician communication and financial burden., Discussion: Many characteristics related to end-of-life caregiving outcomes in long-term care are consistent with community-based studies, suggesting that end-of-life caregiving outcomes in long-term care are not markedly different than in other settings. However, the role of staff support may either facilitate or complicate emotional strain and merits additional study.

Purpose: This study examined connections (linking, compensatory, or none) between three systems of social support (informal, church, and formal). Predictors of each system were also examined., Design and Methods: A community sample of 187 caregivers who provided care to older African American participants in the Duke Established Populations for Epidemiological Studies of the Elderly was used. Multiple regression analyses were used to examine relationships between systems of social support as well as to determine predictors of each social support system., Results: Findings provide evidence for linking connections between systems of support: Informal and formal supports were linked, and church support and formal support were linked. The relationship of need as positively related to social support was limited to the care recipient's number of instrumental activities of daily living limitations being associated with formal support. Level of education was also associated with use of formal support., Implications: Cohesive family networks and network size are important factors that help determine what support caregivers receive. African American caregivers may be at risk for negative health outcomes because they are less likely to use formal support as care recipients' activities of daily living limitations increase.

Culture and race are constructs that are conceptually distinct, but often are used interchangeably and without a working definition. The distinctions and unique contribution of each blur even more when one considers socioeconomic status (SES). In this paper, we will offer working and conceptual definitions of culture, race, and SES. We also will address application of the concepts to end of life considerations for informal caregivers, and other family members, of older African Americans with end-stage dementia. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the sociodemographics, self-rated health, and involvement levels of family caregivers of residents with dementia in residential care/assisted living (RC/AL) versus nursing home settings. Design and Methods: We conducted telephone interviews with the family caregivers most involved with 353 residents of 34 residential care and 10 nursing home facilities. We measured involvement by caregiver self-report of monthly out-of-pocket spending, involvement and burden ratings, and the frequency of engaging in eight specific care activities. Open-ended questions elicited areas in which caregivers preferred different involvement and ways the facility could facilitate involvement. Results: Nursing home caregivers rated their health poorer than RC/AL caregivers, but there were no sociodemographic differences between the two. RC/AL caregivers rated both their perception of involvement and burden higher and engaged more frequently in monitoring the resident's health, well-being, and finances than did nursing home caregivers, although the reported time spent per week on care did not differ. Implications: RC/AL and nursing home caregivers to residents with dementia may tailor their care to fit the needs of the resident and setting. Results are discussed in relation to the Congruence Model of Person-Environment Fit. [ABSTRACT FROM AUTHOR]