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Objective The purpose of this investigation was to understand the dynamics among dementia caregiving, vigilance, and home and community-based service use. Methods This paper is derived from a larger, mixed-methods study on caregiving. We used a descriptive qualitative approach to analyze interview data of 30 family caregivers of relatives with dementia. Results We found five domains of vigilance in which caregivers felt “on duty”: ensuring attentiveness, ensuring safety, ensuring resources, ensuring healthcare, and ensuring closeness. Formal service use did not necessarily give caregivers relief from vigilance, with the language of risk often employed by caregivers. Conclusion Because service use could contribute to feelings of vigilance, rather than give caregivers a break from a sense of watchfulness, these findings support calls for dementia-specific training for service providers. In future caregiving research, the relationship between vigilance, caregiver distress, and role captivity should be explored.

The study investigated COVID-19 vaccine acceptance, hesitancy, and barriers among family caregivers of rural community-dwelling persons living with dementia (PLwD). Three waves of telephone interviews with 26 family caregivers (96% White, 81% Female, Mage = 63 ± 12 years) were analyzed using thematic content analysis. At Wave 3, although all dyads were eligible, only 10 dyads had received their first dose of the vaccine. In 10 dyads, neither person had received the vaccine; in2 dyads, the caregivers did but the PLwD did not; and in 4 dyads, the caregiver did not but the PLwD did. Perceived direct and indirect health risks, cues from trusted allies, and ability to overcome vaccination barriers affected COVID-19 vaccination acceptance. Vaccine refusals were motivated by a low perceived risk of COVID-19, vaccine fear, and personal beliefs. Findings have implications for administration of preventative care practices for dementia family caregivers living in remote locations during a public health emergency.

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.

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.

Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver’s economic situation were essential influences on formal service utilization, the main drivers were the caregiver’s identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.

Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.

Objective Researchers have consistently shown that providing care in a gradually deteriorating situation, such as dementia, can be stressful and detrimental to the caregiver’s (CG) health. Although stressor appraisal is important in understanding variability in CG outcomes, the role of personal mastery, a coping resource, in shaping CG’s health outcomes has not been considered. The primary goal of this paper was to determine whether personal mastery is associated with a survival advantage for spousal CGs of persons with dementia. Methods This study assessed the association of CG burden and personal mastery with longevity over a 10-year period in 71 spousal CGs of persons initially diagnosed with mild cognitive impairment. Results Over the 10 years, 16 of 71 CGs (23%) died. Cox regression models with right censoring of CGs’ time to death showed that after adjusting for the health of family CG, spousal CGs who reported high levels of burden had an 83% reduced risk of death when they also reported high personal mastery (hazard ratio [HR] = 0.17, 95% confidence interval [CI] 0.04, 0.65). Conclusions Findings have implications for support programs that help build personal mastery.

There is a paucity of information regarding the uptake of the COVID-19 vaccine among community-dwelling persons living with dementia and their family caregivers. We examined factors influencing COVID-19 vaccine acceptance and hesitancy among community-dwelling persons living with dementia and their family caregivers during the early months of the vaccine rollout (February-March, 2021). Data came from three waves of telephone interviews (Mtime = 38.33 minutes) with 26 family caregivers living in rural Appalachian Virginia (96% White, 81% Female, Mage= 63±12 years, 42% Spouse Caregivers). We conducted a four-stage trajectory-based thematic content analysis and used the health belief model to interpret the data. Whereas all family caregivers and their relative living with dementia were eligible for the vaccine at Wave 3, only 10 dyads received it, while 10 dyads did not. In two families, the caregivers received the vaccine but not the person living with dementia; in four families, the caregiver had not received the vaccine, but their relative did. COVID vaccination acceptance was influenced by perceived direct and indirect health risks, cues from trusted allies, and ability to overcome vaccination barriers. Homebound people living with dementia faced unique barriers including transportation to vaccine sites and providers’ inability to deliver the vaccine to the home. Caregivers who refused or delayed vaccinations for themselves or their relatives discussed confusion about eligibility, low perceived risk of COVID, vaccine fear, and personal choice beliefs. Findings inform direct care delivery for interdependent family members who live in remote locations facing a public health crisis.

Dementia care research typically focuses on primary family caregivers with limited consideration of their engagement with a broader care network and the geographic area in which they reside. Using a mixed-methods approach, we analyzed care networks of 163 primary caregivers and their relative living with dementia in rural Virginia. Six distinct care network types emerged based on the primary caregiver's gender, relationship to the person living with dementia, and presence of other informal caregivers. Networks differed by the caregiver’s emotional connectivity with family/friends and feelings of caregiver strain, role overload, and loneliness. Caregivers’ service use attitudes and support service utilization varied across network types and across divergent economic resources of the rural counties in which families resided. Findings establish a framework for understanding the types and influences of care networks and tailoring services to support dementia family caregivers in diverse rural areas.

Using a lifespan perspective, we investigated a neglected aspect of research on religion, namely, whether perceptions of growth from adversity might strengthen religious worldviews, thus accounting for feelings about one's own death in old age. A directed content analysis of in-depth interviews from 16 adults aged 65+ focused on life events, religious worldviews, and death. Findings suggested that participants’ religious worldview beliefs were associated with positive reinterpretation of lifespan adversities such that stressors functioned as opportunities for spiritual growth. Participants’ views of and beliefs about death were without fear, indicating the potential influence of highly individualized and deeply spiritual religious worldview beliefs on the abatement of death fear.

Objectives:This study explored interpersonal aspects of coping with mild cognitive impairment (MCI), focusing on how shared illness representations between persons with MCI (PwMCI) and their care p...

Family caregivers often find themselves “sandwiched” between caring for an older relative with dementia (PWD) and another person. Serving in a dual caregiving role presents unique challenges and has consequences for caregivers’ physical and mental health. Seven daily diary interviews with 46 dual dementia caregivers assessed their daily stressors and informal and formal supports. Results showed that dementia caregivers who also cared for another older relative reported poorer physical health and used more community-based services to care for the PwD. Conversely, dementia caregivers who also cared for younger relatives reported greater secondary stressors, lower family support, and use of fewer community-based services to care for the PwD. Since the COVID-19 pandemic began, two telephone interviews were conducted with 15 dual dementia caregivers. Caregivers were asked in-depth questions about how the pandemic had impacted their caregiving responsibilities, mental health, and use of community-based services. Guided by stress process and behavior models, a thematic analysis of dual caregivers’ interviews revealed that caregivers had less time for themselves, engaged in self-care activities less often, and felt their social life had suffered. Many of the caregivers reported feeling exhausted, stressed, and had more things to do than they could handle. Of the eight caregivers that used services before COVID-19, six experienced a change in services including loss of services, different workers, or self-selected cancellation of services. Discussion focuses on challenges dual dementia caregivers face and the added stressors they experienced during the COVID-19 pandemic.

Background and Objectives Older adults with HIV face greater health burden than HIV-uninfected counterparts. Little is known about resources that might mediate the influence of physiological health burden on psychological well-being. Informed by the stress process model, we assessed the influence of multifaceted health burden indicators on depressive symptoms and evaluated the mediating effects of social support adequacy. Research Design and Methods This cross-sectional study used structural equation modeling with data from 640 older men who participated in the Research on Older Adults with HIV study in the United States. Health burden assessment included number of age-related chronic conditions, multiple HIV-related chronic conditions, and self-rated health. Perceptions of instrumental and emotional support adequacy measured support as a coping resource. Depressed mood as assessed by the 10-item Center for Epidemiologic Studies Depression Scale was the indicator of psychological well-being. Results Higher incidence of age-related conditions and worse self-rated health was significantly associated with more depressed mood. Self-rated health and HIV-related conditions showed a significant indirect effect on depressed mood via emotional support adequacy. Discussion and Implications Each dimension of health burden demonstrated a distinct pathway to psychological well-being for men with HIV, which should be considered when prioritizing care plans. Complementing research on medical interventions for people with HIV, these findings suggest that nonpharmacological interventions may be important for improving overall well-being.

Dementia caregivers must manage the social worlds of their loved ones as well as their own. In a mixed methods study, we interviewed 50 family caregivers prior to the pandemic, twice during early phases of the pandemic, and again during the vaccine roll-out phase. Findings revealed how implementation of stay-at-home orders altered reliance on informal support as well as social ties and interactions. Using content analysis, we identified three ways in which caregivers’ managed changes in their social world: rethinking family visits (fewer people, higher quality); reinventing public spaces (church services, exercise venues); and reconsidering self-care (setting boundaries, solace in nature). Caregivers showed varying degrees of resilience in the ways they managed adverse social situations and cared for themselves. Findings reinforce the need for inclusive programs and services to help caregivers learn to maintain supportive social connections that reinforce their care decisions and routines, particularly during times of duress.

Scholars and practitioners recognize the importance of family caregivers for persons with dementia (PwD) persevering through difficulties and remaining committed to providing care (i.e., possessing grit). Based on Pearlin’s stress process model, we examined how grit is associated with stressors and strains that interfere with caregiver well-being and jeopardize continued caregiving. The sample included 158 family caregivers of PwD from rural Appalachia. SEM analysis revealed that grit and family and friend affectual solidarity contributed significantly to mastery. Grit and family solidarity were associated indirectly with role overload through their effect on mastery. Results demonstrate the value of acknowledging the role of grit in enhancing caregivers’ confidence about managing difficulties they face and reducing their sense of being overwhelmed by caregiving responsibilities. Thus, strengthening dementia caregivers’ commitment to and perseverance in their role is crucial for sustaining their motivation to provide care, despite the challenges they face.

Little is known about how rural-dwelling older adults anticipate and plan for future care needs. Using a mixed-method explanatory design, structural equation modeling ( n = 535) revealed significant associations between concerns about using services on preference for type of help; preference was associated with likelihood of using future services. Content analysis of interview data from 19 older adults who needed but were not receiving help revealed how they conceptualize their need for assistance and anticipated future care arrangements. Nine older adults were not thinking about future care needs. While most older adults articulated preferences for informal help, they indicated some openness to formal assistance. Preferences did not always align with expectations for the future. Rather, concerns about burdening family and friends outweighed concerns about community services and influenced expectations of using formal services. Understanding rural older adults’ expectations for future care arrangements is necessary for advancing policy and implementing successful services options.

African American families’ experiences with mild cognitive impairment (MCI) have received little attention in the research literature. Guided by the life-course perspective, we analyzed qualitative interview data from members of 27 African American families including the person with MCI (PwMCI), a relative or friend who was highly involved in the PwMCI’s daily life, and if available, a relative or friend who had at least monthly contact with the PwMCI. Findings uncovered variability in families’ MCI awareness, assessment, and need for role changes; the importance of reaching out to trusted others; and honoring PwMCI’s care preferences (e.g., who should provide care). Families held varying beliefs about engaging outside support; some families insisted on keeping all care within the family while others were open to the use of external services. We showcase how diagnosis acceptance and family decision-making are at the heart of how African American families respond to MCI.

An extensive body of literature documents correlates of and barriers to health service use, yet much less is known about satisfaction with home- and community-based services for persons with dementia (PwD). Daily diary data from 122 rural caregivers (CG) of PwD (814 daily diaries) were used to assess everyday service use experiences. At the last diary interview, CG identified areas where service use expectations were and were not being met. CGs reported problems with services used on fewer than 5% of study days (e.g., service provider was delayed because of car trouble). In contrast, 82% of CG identified areas where service expectations were not being met. Their most common concerns were lack of control over service availability and lack of adequate training among service providers. Recommendations for alternative ways for capturing service use satisfaction will be offered, and implications for theory and practice will be discussed.

This essay highlights the influence of mentors' talents, expertise, and generosity on the mentoring performed by the next generation of mentors. It includes selected examples of resources on mentoring that are readily available on the Internet.

Background and Objectives Many dementia caregivers provide care for numerous years. Exhibiting grit, or commitment and persistence in the face of adversity, may bolster their ability to manage caregiving challenges. We explored grit in relationship to memory and behavior problems and response to stressors among women engaged in long-term dementia care. Research Design and Methods Informed by a life course perspective, and guided by stress-process theory, we interviewed 10 women with a spouse or parent initially diagnosed with mild cognitive impairment 4 times over 10 years. Using Charmaz’s analysis methods and grit as a sensitizing concept, we employed an unfolding analytic strategy involving (a) thematic analysis to identify expressions of grit in response to caregiving stressors across interviews and (b) case-by-case comparisons to assess associations of grit with the use of care strategies across caregivers over time. Results Dementia caregivers experienced unrelenting and changing psychosocial and physical challenges. Over time, most women exhibited a sustained commitment to the relationship through the ways in which they protected the identity of the person with dementia, modified their expectations for emotional intimacy, and managed their financial affairs. They persevered as their roles and relationships fluctuated, often finding purpose and relief through employment and leisure pursuits. As care intensified, women who took charge and consciously made decisions in the best interest of the care recipient and themselves minimized stress. Discussion and Implications While some caregivers exhibited grit from the outset, all showed enhanced perseverance and commitment to the ways they managed memory-related changes over time. Developing confidence in their ability to manage and provide care helped the caregivers respond to stressors with purpose and sustain their roles and responsibilities. Enhancing grit in long-term dementia caregivers may result in better individual and relational outcomes.

Most family caregivers provide appropriate care and a supportive environment for their older relatives with dementia (PwD), yet the stress and strain associated with caregiving can trigger potentially harmful responses. Although much has been written about dealing with memory problems, researchers know less about how caregivers cope with difficult behaviors such as hallucinations, violent outbursts, or refusing food, medicine, or bathing. Interviews with 30 relatives providing care to community-dwelling PwD in rural Virginia revealed that caregivers typically used four behavior management strategies: reasoning with PwD; redirecting PwD’s attention; forceful actions, such as shouting at PwD; and withdrawing from interactions. Forceful management strategies and withdrawing from interactions were usually employed after reasoning and redirection failed to elicit desired behavior. Understanding whether caregivers’ expectations of PwD’s capacities are realistic, and why and when caregivers use various behavior management strategies, can help service providers develop appropriate educational interventions for frustrated caregivers.

A demanding aspect of caregiving for a relative with dementia is need for constant vigilance of their behavior and well-being. Vigilance is associated with higher quality of care, but can take a toll on caregivers who have few opportunities for respite. Home- and community-based services have the potential to offer caregivers relief from constant vigilance. Using in-depth interviews with 30 rural caregivers, we found that service use did not necessarily provide relief from constant vigilance. Caregivers typically needed to monitor aspects of home- and community-based services and care facilities such as scheduling and quality of care from CNAs. In contrast, some caregivers found respite from constant vigilance when they used formal services—typically in extreme situations such as when a husband with dementia became violent and moved temporarily to a long-term care facility. Findings connect caregiver needs and concerns related to vigilance with availability, quality, and use of formal services.

Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults. Published version

Family caregivers of persons with dementia (PWD) often look to home- and community-based services (HCBS) as resources for assisting with the provision of family care and for coping with the stress of caregiving. Guided by Pearlin’s stress process model, we examined the relationship between daily variation in stressors experienced by caregivers and daily reports of negative affect. Thirty-nine caregivers (64% spouses; 72% women) of PwD completed telephone diaries for seven consecutive evenings (Average diary days=6.7). Caregivers reported HCBS used on each diary day. The severity of the PWD memory and behavior problems served as an indicator of primary stressors. Daily secondary stressors included the severity of health, financial, work, and network stressors. The PANAS was used to assess daily negative affect. Sex, relationship to PWD, income, PWD’s disabilities, and ongoing life stressors (e.g., housing problems) were controlled in the analyses. Multilevel models were analyzed in STATA. On average, caregivers reported using services on 16% of the diary days. Higher daily primary stressor severity was related to higher daily negative affect (B=.24, p

Residents in central rural Appalachia counties live in under-resourced communities and experience disproportionately high rates of dementia. Guided by stress process and health behavior models, we conducted a within-case/across-cases thematic analysis of in-depth interviews with 10 family caregivers (CGs) of persons with dementia (PWD) to explore individual and cultural influences on service use. Findings revealed themes related to caregiver reluctance to seek or accept help from informal and formal sources and both strained family relationships and limited use of services (due to availability, cost, acceptance by PWD, perceived quality) as influences on care decisions. When caregiving became overwhelming and emotionally exhausting, it challenged CGs’ cultural beliefs about family responsibility and reliance on formal services. CGs coped by drawing upon faith, practicing self-care, relinquishing activities, creating routines, and seeking services. The combination of individual and geographic influences on CGs requires careful consideration when planning and delivering services in rural Appalachian communities.

Although families have always cared for their aging members, changes in contemporary society have added to the stress and challenges of providing daily care and support for relatives experiencing physical and/or cognitive decline. Personal characteristics, geographic location, and family structures and relationships influence beliefs about family care; thus, recognizing differences within and across families is crucial for developing culturally informed caregiving programs and practices. This symposium focuses on four diverse groups of caregivers. Recognition of caregiving cultures and the barriers caregivers encounter is the central theme of all four papers. Using daily diary interviews and GIS data, Savla and colleagues discuss the unique cultural and geographical challenges caregivers in rural Appalachian Virginia face when caring for a family member with dementia. J. Angel employs quantitative and qualitative data from two nationally representative datasets to discuss the effects of immigration on family structures and caregiving for Mexican-American older adults with dementia. Miyawaki and her colleagues provide a profile of caregivers of older Vietnamese refugees, the resources they use and support structures they rely on. Finally, Roberto and Savla expand the definition of family caregivers to include extended and fictive kin who are providing dementia care and provide an in-depth view of the circumstances that influence the responsibilities they assumed, the type of care they provide, and the coping strategies they use. Dr. Rosemary Blieszner will discuss the presenters’ collective findings considering their unique caregiving practices and beliefs as well as the common grounds between the different races, regions and relationships.

To explore the potential influence of curriculum, frequency of practice, and dietary quality on the health of experienced Taiji and qigong practitioners.Theoretical and cross-sectional study.Responses from a volunteer sample of Taiji practitioners from across the United States were collected using an online survey. The instrument was designed to collect data on health-related quality of life, diet, and Taiji practice regimens. All experienced (≥4 years) practitioners (n = 94; mean age, 55.82 years [range, 24-83 years]) were included in the analysis. Relationships among self-reported health, diet, experience, practice frequency, and curricular complexity were analyzed.Practitioners' health status did not show the typical negative association with age and was positively associated with complex curricula, practice, and high-quality diets. Significant interaction effects were seen between (1) curricular complexity and additional practice (p 0.05) and (2) curricular complexity and diet (p 0.05).Intervention designers, Taiji teachers, and practitioners should consider the potential influence of curricula, out-of-class practice, and healthy diets for optimizing health-related gains and minimizing age-related losses in interventions and community-based programs.

RÉSUMÉLes tendances démographiques et sociales aboutissent à une variété de contextes structurels internes à un niveau micro qui influent sur la prestation de soins pour les familles avec des membres plus âgés. Les résultats des changements au niveau macro ont attiré peu d'attention sur les études du vieillissement, où une grande partie des recherches sur la prestation de soins a traité de questions dans le contexte de la structure familiale traditionnelle. La plupart des soins aux personnes agées est fournie par des parents, bien qu'avec les modes d'engagement et de responsabilité dans les structures familiales variées. Pourtant, le modèle de la famille nucléaire conventionnelle devient de plus en plus rare, puisque nouveaux modèles pluralistes de la vie familiale apparaîssent dans la société contemporaine. Les familles conventionnelles et pluralistes, tous les deux, font face aux défis en répondant à la nécessité pour les soins de leurs membres les plus anciens, en laissant certaines personnes âgées à risque de ne pas avoir réponse aux besoins. Des recherches supplémentaires seront justifiées au sujet du risque et de la résilience de la famille relative à la prise en charge des parents âgés, particulièrement concernant les modèles pluralistes de la vie familiale.

Community cohesion, feelings of trust and belonging in physical living places, may encourage elders’ participation in social activities and enhance psychological well-being. Using two waves (R1, R2) of the National Health and Aging Trend Study, we examined the direct effect of community cohesion on psychological well-being and the indirect effect of social activity participation among elders living in the community. Both the dementia (n=806) and the no dementia (n=3754) groups rated community cohesion (R1) and psychological well-being (R2; quality of life, positive and negative affect). Elders also reported the number of social activities in the last month (visiting others, religious services, clubs/classes, going out for enjoyment) at R2. Stratified structural equation models were estimated for elders with and without dementia. For the dementia group, community cohesion had direct effects on quality of life (β=0.195, p

More than one-third of family caregivers provide care for a relative with dementia for six years or more. Guided by Pearlin’s stress process model, we used a case-study approach to analyze data from four interviews spanning 10 years, with 10 women aged 28 to 72 at the time their relative was diagnosed with mild cognitive impairment. Findings revealed the women used a wide array of strategies to manage daily life and sustain themselves in meaningful ways. As their care journey progressed, they sought information about memory impairment, engaged in self-care activities, maintained social relations and activities as best they could, and relied on friends and family for support. Although they discussed the stress and burden of providing care, the caregivers showed resilience as they faced unrelenting and frequently changing psychological, social, and physical challenges both personally and in the family. Findings have implications for addressing the needs of long-term caregivers.

Grounded in Pearlin and colleagues’ stress process model, we examined changes in the psychological well-being of primary care partners (PCP, N=92) of old adults diagnosed with Mild Cognitive Impairment. Data were collected in 3 Waves (shortly after diagnosis and at mean 13.2 and 36.8 months after W1). Regarding stressors, older adults’ MMSE scores declined (p

African American families' experiences with mild cognitive impairment (MCI) have received little attention in the research literature. Guided by the life-course perspective, we analyzed qualitative interview data from members of 27 African American families including the person with MCI (PwMCI), a relative or friend who was highly involved in the PwMCI's daily life, and if available, a relative or friend who had at least monthly contact with the PwMCI. Findings uncovered variability in families' MCI awareness, assessment, and need for role changes; the importance of reaching out to trusted others; and honoring PwMCI's care preferences (e.g., who should provide care). Families held varying beliefs about engaging outside support; some families insisted on keeping all care within the family while others were open to the use of external services. We showcase how diagnosis acceptance and family decision-making are at the heart of how African American families respond to MCI.

Elder care in rural Appalachia is challenging due to poor socioeconomic conditions, geographical isolation, and lack of services and transportation. Certain aspects of Appalachian culture, namely self-reliance, traditionalism, and strong family ties, also create unique barriers for using services to help care for persons with dementia (PwD). Quantitative and qualitative data from 85 caregivers of PWD with moderate to high care needs were explored to examine caregivers’ use of personal care services, identification with their community, attitudes towards service use, and geographical distance from the nearest service location. Results suggest that although services such as adult day centers, food banks, meal delivery, and support groups are widely dispersed throughout rural Appalachian counties, use or nonuse of services was driven by lack of economic resources, care preferences of the PwD, and dissatisfaction with previous service use. Discussion focuses on suggestions for uptake of services by caregivers of PwD in rural Appalachia.

More than 62% of adults aged 65+ have more than one chronic condition; this number increases to more than 82% for those 85+. Older adults simultaneously experience changes in their relationships due to negative relational life events, including illness, injury, or death of a loved one. Stressors occurring in tandem can overload psychological resources and increase risk for poor mental health. Informed by the stress process model, we assessed the influence of relational life events on depressive symptoms over time and evaluated the moderating effects of chronic condition onset. Self-reports of four stressful life events, five chronic conditions, and depressive symptoms as measured by the CES-D came from 2,948 older adults participating in the ORANJ BOWL panel. Using longitudinal multilevel mixed effect modeling, we examined trajectories of depressive symptoms across three waves. While depressive symptoms increased over time, they were greater for people who experienced more relational life events and the onset of more chronic conditions. Participants who reported experiencing all four relational life events but no chronic conditions had an average CES-D score of 5.28 (p

This study examines the effects of daily primary objective stressors (behavioral problems exhibited by persons with mild cognitive impairment) and subjective stressors (unpleasant marital interactions) on the diurnal cortisol pattern and the diurnal pattern of salivary alpha-amylase (sAA) of spousal care partners. Thirty spouse care partners (age 59-85 years) participated in a 7-day diary study and submitted saliva samples on 4 consecutive study days, totaling 406 valid samples. Results from multilevel models revealed that daily objective stressors were associated with elevated cortisol levels and a flatter slope but were not associated with sAA activity. Conversely, unpleasant marital interactions were associated with flatter sAA slopes but not associated with cortisol activity. Furthermore, daily levels of sAA moderated variations in cortisol in the presence of a primary objective stressor. The utility of our research has implications for advancing scientific understanding of biosocial processes and the development of stress prevention and intervention strategies.

The authors explored changes in couple dynamics in the context of mild cognitive impairment (MCI). Guided by family systems theory and the biopsychosocial model, they used grounded theory methods to examine how 11 couples perceived change in their relationships when husbands were primary care partners for their wives with MCI. Analysis revealed four major themes: (a) care partnering is like working, (b) care partnering influences interpersonal dynamics, (c) care partnering shifts roles, and (d) care partnering modifies social relations. Findings point to the usefulness of systemic therapies and interventions for helping couples adjust to the behavioral manifestations of MCI.