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Purpose: Dementia caregiving is a rapidly growing public health problem. Logistical problems prevent many caregivers from utilizing available interventions. This article provides a demonstration of the usefulness of technology for conducting telephone-based support groups in ethnically diverse dementia caregivers. Design and Methods: Participants were 41 White American and Cuban American dementia caregivers participating at the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health (known as REACH) program. Support groups were conducted over the telephone in English and Spanish as appropriate. Results: Eighty-one percent of the participants found the group 'valuable,' largely because of the social and emotional support and useful information obtained from other group members. The majority of caregivers also reported that their participation had increased their knowledge and skills as caregivers. Implications: The findings demonstrate that telecommunications technology can overcome the often formidable logistical problems faced by both English- and Spanish-speaking caregivers, and it can provide benefits similar to those obtained in face-to-face support groups. Key Words: Technology, Cuban American, Intervention, Support Group, Caregiving

The effects of change in the site of care from the private spaces of the home to the semipublic space of the residential care home, on the emotional and affective entity of informal caregiving for frail older people are examined. The narrative accounts of informal carers' experience in New Zealand reveal how the shift from home to nursing home settings is characterized by an intense embodied emotional experience that has a significant impact on carers' own health and well being.

To date, narrative correspondence has been relatively neglected as a geographical research method. This is particularly true within the subdiscipline of health geography. Drawing on the literature on narrative approaches, as well as a qualitative study of informal carers' experiences of transitions in the place of care for older people in New Zealand, this paper highlights the valuable insights this approach can offer into the interrelationship between people, place and care. More specifically, it explores how caring identities and care related behaviour are constructed and reconstructed over time and space. Key words: care, informal carers, narrative correspondence, older people, transition.

Government policy in Sweden, as in other developed countries, pays increasing attention as to how best to support the family carers of older people. New and innovative means of support, such as information and communication technology, are emerging. This paper explores the perceived benefits of, and barriers to, information technology as a means of supporting family carers of older people. Following a brief overview of the care-giving literature, with particular reference to the Swedish context, interview and questionnaire data collected from 34 families who took part in the Swedish ACTION project are used to explore the role of user-friendly information and communication technology to inform and enable family carers of older people to exercise choice, to care more effectively and to work in partnership with professionals. Interview data from two groups of professionals that utilised ACTION are also examined to throw light on its potential benefits for both carers and professionals. Consideration is given to the barriers to using information technology, and to identifying those carers most likely to benefit. Areas for further development are the need for practitioners' education and a wider range of programmes to address carers' diverse needs. Clearly, lessons learned from the Swedish project have wider relevance, given that new forms of support are being developed in most technically advanced countries. KEY WORDS--family carers, practitioners, partnership, information and communication technology, community care.

An exploratory study examined the narratives of 15 Mexican American primary caretakers and the perceived effects of adult day care centers (ADCs) on the lives of their elderly, impoverished parents. The data provides insight into the complicated dynamics regarding the differential treatment of daughters and sons in Mexican American families.

Abstract This article develops an approach towards dementia care that highlights the nature of dementia care triads comprising the person with dementia, their informal carer, and the health and social [...]

A variation of the stress, appraisal, and coping model was used to examine the negative and positive consequences of providing care to a person diagnosed with Alzheimer's disease (AD). Data were collected from a sample of 113 Hispanic and non-Hispanic adult children who were providing care to impaired parents. Results showed that the Hispanic caregivers were more likely to be experiencing less depression, lower levels of role captivity, and higher amounts of self-acceptance than the non-Hispanic (White) caregivers. While significant differences between Hispanic and non-Hispanic caregivers were present, results from multiple regression analysis demonstrated that feelings of role captivity were stronger predictors of both negative and positive caregiving outcomes than was the caregivers' ethnic status. The findings of this study indicate a continued need for future research with more diverse groups of AD caregivers in order to develop more culturally appropriate interventions. KEYWORDS. Alzheimer's disease caregiving, Hispanic caregivers, role captivity, diversity

This qualitative study examined ethical dilemmas faced by female caregivers of frail elders as well as the dominant role of caregivers' spirituality in addressing these dilemmas. Dilemmas are difficult decisions that involve conflicting values, e.g., freedom versus safety. In-depth interviews were conducted with thirteen ethnically diverse caregivers recruited from a home health agency and its parent hospital. Purposive sampiing was used to obtain variation among research participants. Focus group interviews of home health staff, key informant caregivers, and interviewees provided guidance for the research design, reflection on findings and development of implications. In order to deal with ethical dilemmas, all caregivers used spirituality as (1) a philosophy of life, e.g., 'This is what you do when you're family,' (2) an aid to decision-making, e.g., through the use of prayer; and/or, (3) a way to transcend dilemmas, e.g., 'no choice is hard.' Implications include the importance of care giver-driven assessment, professional self-reflection, and sustained formal services for caregivers. KEYWORDS. Ethics, caregiving, aging, religion, spiritual assessment

This study analyzes the transfer of specialized professional activities from health care workers to patients and their family members in the context of the shift to ambulatory care for acute and chronic illnesses requiring hospitalization. Based on 119 semidirective interviews with patients released from hospital after early discharge and/or with the family members caring for them, and based on 26 focus groups and 9 individual interviews with health care professionals from hospitals and home care agencies in five regions of the province of Quebec, this article raises the issue of the trivialization of professional care which underlies this transfer. This article also examines two stages in this trivialization: the preparation for discharge and the transfer of specialized activities. Theoretical and empirical implications include the need to better understand how health care workers support this transfer through a process of trivialization and the implications of this transfer for patients and their families. Keywords: home care; hospital discharge; ambulatory care; caregivers

Abstract Research suggests that problem behaviors displayed by children with emotional and behavioral disorders (EBD) are often reinforced and maintained by typical caregiver or teacher responses to such behavior. The [...]

The purpose of this study was to determine the opinions of registered dietitians in Louisiana concerning nutrition support at the end of life. A questionnaire was mailed to the 777 active members of the Louisiana Dietetic Association. Questions addressed 3 issues: removal of nutrition support, the role of patients and family in decision making, and the role of the dietitian in decisions to use nutrition support for the terminally ill. A mean composite score was determined for each category. Kruskal-Wallis 1-way ANOVA was conducted on the composite scores to determine differences in responses by age, years of practice, and area of current practice. At least 60% of the respondents agreed with foregoing, withholding, or withdrawing nutrition support at the end of life. Most of the dietitians agreed that the patient or family is more qualified than the health care professional to make decisions about nutrition support at the end of life. More than 95% of the dietitians agreed that the dietitian should be involved in the decision-making process. However, only 50% of the dietitians felt fully qualified to provide the information needed to help a patient or family make the decision about nutrition support at the end of life. Differences of opinions about the removal of nutrition support were found by age, number of years of practice, and current area of practice. Results from this study may encourage dietitians to explore their own attitudes and seek continuing education on ethical dilemmas to enable them to make better decisions, provide better care, and become better patient advocates. J Am Diet Assoc. 2002;102:837-841., Some of the more difficult decisions made by caregivers involve questions about end-of-life health care, Being at end of life is defined as having an advanced incurable disease in a [...]

Optimal quality of care for long term residents, especially those suffering from Alzheimer's disease (AD), has been linked to meaningful and rewarding communication with staff caregivers. However, the precise methods of effective, supportive communication used by care providers of persons with AD have not been identified. The purpose of this exploratory study was to investigate caregivers' perceptions of communication used in dementia-specific community residential facilities. Eight care providers were interviewed and asked a series of in-depth, semistructured questions regarding their communication experiences with AD residents. Employing features of grounded theory methodology, all interviews were audio recorded and transcribed verbatim. The transcripts were coded using an open-coding technique followed by selective coding processes. Results merged into two core categories: (1) Compliance Gaining Strategies and (2) Learning the Language. Results indicated that care providers used several communication strategies that are advocated in the literature, but that they also employer creative techniques that have not been previously emphasized. While interesting these strategies have yet to be validated. As such, discussion points focus on future research needed to verify these communication tactics. Keywords: Residential care, communication, Alzheimer's disease, staff training

Care-giving research has predominantly focused on the care-givers of those with long-term illness and the elderly. Little attention has been given to examining care-giving from the perspective of the person receiving the care, differentiating how the sex or age of the person may influence the care received, or examining care-giving in the context of shorter term situations where the patient is expected to recover. The purpose of this study was to examine the characteristics of the informal care-givers of cardiac surgery patients from three hospitals in one Canadian province and the effect of patient characteristics (sex, age) on their experience of receiving that care. A prospective, non-randomized design, was used to examine the short-term recovery from cardiac surgery of 120 subjects (60 men, 60 women). Patients were interviewed preoperatively and then at monthly intervals through the third postoperative month. The findings from this study suggest that the patterns of informal care-giving noted in the chronic care literature are also present in the short-term care of post-surgical cardiac patients. The burden of care-giving continues to rest predominantly on women. Female patients relied on their spouses for help less frequently than did male patients and their care-givers were more frequently employed outside the home and in lower status jobs than were the caregivers of male patients. 30% of care-givers were reported to have a health problem of their own to manage while caring for the recovering patient. Patients who were male or who were < 65 years of age had higher social support scores than did patients who were female or who were [greater than or equal to]65 years of age. These findings suggest that the cardiac patient's sex affects the availability of home-based care. In addition, care-givers may themselves be patients in need of care. Further research is needed to examine the receipt of home-based care-giving, particularly for female patients. Keywords: Care-giving; Social support; Cardiac surgery; Canada

Attitudes toward women in surgery appear to be shifting in a positive direction. Why, then, do women still represent only 27% of surgeons in Canada? The answer may, at least in part, lie in the field's inability to adequately accommodate caregiving duties, which are still disproportionately 'women's responsibilities' in our society. Although most Canadian academic centres now have paid maternity leave policies for trainees and faculty, these do not necessarily apply to surgeons working in the community, nor do they always reflect what occurs in practice. The perceived inability of the field to accommodate both personal and professional duties is often a significant deterrent to young women considering a career in surgery. In this commentary, we explore the need to address the 'caregiver problem' as an important step toward achieving gender equity in surgery., We have been talking about gender inequity in surgery for decades. Countless studies, opinion pieces and news articles later, we are still talking about it. Attitudes toward women in surgery [...]

Introduction and Overview In the Caregiving in the United States report by the National Alliance for Caregiving and the AARP Policy Institute (2015), it was reported that an estimated 43.5 [...]

Byline: Tahereh. Khoshnazar, Mrayam. Rassouli, Mohammad. Akbari, Farah. Lotfi-Kashani, Syrus. Momenzadeh, Nahid. Rejeh, Maryam. Mohseny Introduction: Since communication is considered to be one of the central concepts in caregiving practices, [...]

Introduction: Children living with HIV rely on adult caregivers for access to HIV testing and care, including clinical monitoring and adherence to treatment. Yet, many caregivers confront barriers to ensuring children's care, including fear of disclosure of the child's or the parents' HIV status, competing family demands, fluctuating care arrangements and broader structural factors such as entrenched poverty or alternative beliefs about HIV's aetiology and treatment. Thus, many children are 'falling through the gaps' because their access to testing and care is mediated by guardians who appear unable or unwilling to facilitate it. These children are likely to suffer treatment failure or death due to their caregivers' recalcitrance. Discussion: This Commentary presents three cases from paediatric HIV services in Zimbabwe that highlight the complexities facing health care providers in providing HIV testing and care to children, and discusses the implications as a child's rights issue requiring both legal and programmatic responses. The cases provide examples of how disagreements between family members about appropriate care, conflicts between a child and caregiver and religious objections to medical treatment interrupt children's engagement with HIV services. In all three cases, no social or legal mechanisms were in place for health staff to intervene and prevent 'loss to follow up.' Conclusions: We suggest that conceptualizing this as a child's rights issue may be a useful way to raise the debate and move towards improved treatment access. Our cases reflect policy failure to facilitate access to children's HIV testing and treatment, and are likely to be similar across international settings. We propose sharing experiences and encouraging dialogue between health practitioners and global advocates for children's right to health to raise awareness that children are the bearers of rights even if they lack legal capacity, and that the failure of either the state or their caregiver to facilitate access to care is in fact a rights violation. Keywords: Zimbabwe; children; antiretroviral treatment; access; human rights; caregivers., Introduction The World Health Organization estimates that 740,000 HIV-infected children below the age of 15 were taking antiretroviral treatment in 2014 [1], while in 2013 there were 190,000 deaths in [...]

This research note examines some advantages and drawbacks of using Experience Sampling Method (ESM) for the study of gerontological social work and other related fields of social and health services. ESM typically requires participants to respond to signals from electronic pagers at randomly determined intervals. In response to these, participants are expected to fill out a short self-report about their activities, as well as of their thoughts and feelings of these activities. ESM is, compared to conventional methods of observation (when people know that they are being studied and may behave differently from normal), a rather 'unobtrusive' method, and ESM-data does not, unlike conventional survey-data, rely on retrospective information. KEYWORDS. Experience Sampling Method, gerontological social work, unobtrusive methods

The emergence of gerontological social workers as an important part of health care service can be attributed to the expanding aging population. Their roles focus on easing the physical, psychological and social well being of geriatric patients. Social workers belonging to interdisciplinary teams conduct biological, psychological and social assessments of the patient, determine the most appropriate care management program and serve as the link between patients, their families and the community.

Compelling evidence exists that conflict and communication problems occur between nursing home staff and family members of residents. However, few interventions have been documented that simultaneously address the needs of both groups. The Partners in Caregiving program was created to train staff and family members in communication techniques and conflict resolution skills. Through a joint meeting with facility administrators, both groups also have the opportunity to influence facility practices. Evaluation data indicated that satisfaction with the program was extremely high, and that positive changes in staff-family interactions occurred. Key Words: Nursing homes, Family-staff relationships, Programming, Long-term care

Research into the work of keyworkers in residental homes for the elderly found that many of the clients were not given the choice of having a keyworker and that they did not understand the concept of a care plan. Keyworkers should endeavour to make care plans in conjunction with their elderly clients to ensure that the elderly, as users, are receiving the type and quality of care that they individually require. Some homes only used care plans to help staff arrange their work. Care plans devised by the staff emphasize their powerful relationship over their elderly clients.

The article discusses the provision of community service information to the caregivers of people with disabilities by general practitioners and pharmacists. Those two groups seem to be well placed to act as a service link for family carers, but additional high-intensity strategies would help them in this role.