Scholarly Publications on Civic Engagement and Later Life

This page lists citation information and abstracts for articles on civic engagement and later life that were published in The Gerontologist, The Journals of Gerontology: Psychological Sciences, and The Journals of Gerontology: Social Sciences between January 1999 and July 2006. The information is organized under the following subheadings:

* Caregiving
* Community Service and Volunteering
* Multiple Roles
* Paid Work
* Political Participation
* Voluntary Group Participation
* Miscellaneous


Children-in-law in caregiving families
ND Peters-Davis, MS Moss and RA Pruchno (1999) The Gerontologist, Vol 39, Issue 1 66-75

Data were collected from 252 coresident caregiving daughters and daughters-in-law and their husbands. We hypothesized that biological children would give more care than children-in-law and that children-in- law would have very different caregiving experiences and resultant appraisals than biological children. Contrary to our hypotheses, we found that the experiences are very similar for biological children and children-in-law in caregiving families. We suggested that the important factor is not the relationship to the elder that has the impact--it is the quality of the relationship with the elder that is consistently significant.

The impact of new demands for assistance on caregiver depression: tests using an inception cohort
CW Given, BA Given, M Stommel and F Azzouz (1999) The Gerontologist, Vol 39, Issue 1 76-85

Family caregivers of patients facing high numbers of new demands for assistance following hospital discharge were more likely to experience increased levels of depression in the following six months compared with caregivers facing similar overall demands but few new demands for assistance following hospital discharge. New demands for assistance had a significant independent effect upon the levels of depression and were independent of family relationship (spouse vs nonspouse) and caregiver gender. These findings provide insight into theories of caregiver stress, begin to specify the interaction of time following the onset of a stressful event and caregivers' subsequent reactions, and suggest which caregivers may require some assistance following discharge of their patients.

Contributors to and mediators of psychological well-being for informal caregivers
ME Yates, S Tennstedt and BH Chang (1999) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 1 P12-P22

This article explores the relationships between caregiving stressors and caregiver well-being in a representative community sample of disabled elders and their informal caregivers. The direct and indirect effects of stressors and potential mediators on the outcome of caregiver psychological well-being, as measured by depression, were examined using path analysis. Potential mediators of the primary stressors on depression included mastery, emotional support; quality of relationship between the caregiver and the care recipient, formal service use and role overload. Findings indicate that the caregiving stressors (needs for care) led to caregiver depression indirectly through their effect on hours of care provided and the resulting caregiver perception of role overload. Quality of the caregiver/care recipient relationship mediated the relationship of the caregiving stressors and caregiver overload and depression. Finally, regardless of the level of primary stressors, caregivers with high levels of mastery or emotional support were at lower risk of depression. These findings can be used to inform the design of proactive caregiver interventions.

The effects of family conflict resolution and decision making on the provision of help for an elder with Alzheimer's disease
MA Lieberman and L Fisher (1999) The Gerontologist, Vol 39, Issue 2 159-166

This study explored how characteristics of multigeneration families of patients with Alzheimer's disease (AD) affected the family's ability to provide help to their ill elder. An intensive patient and family assessment battery was employed with 211 families with an elder with AD, and measures of the amount and kind of help offered by the family group were recorded. Above and beyond control variables, families that used a focused decision-making style and positive conflict resolution methods provided more help than families that did not use these styles and methods. These data suggest the importance of the family system of care in disease management.

Prevalence and impact of caregiving: A detailed comparison between dementia and nondementia caregivers
MG Ory, RR Hoffman 3rd, JL Yee, S Tennstedt and R Schulz (1999) The Gerontologist, Vol 39, Issue 2 177-185

Analyzing data from more than 1,500 family caregivers from the 1996 National Caregiver Survey, this study documents the ways in which dementia care is different from other types of family caregiving. Not only do dementia caregivers spend significantly more hours per week providing care than nondementia caregivers, they also report greater impacts in terms of employment complications, caregiver strain, mental and physical health problems, time for leisure and other family members, and family conflict. Differential impacts remain even after controlling for intensity of caregiving involvement and sociodemographic factors. Study findings suggest the need to tailor programs and services to the unique challenges faced by dementia caregivers.

Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia
SK Ostwald, KW Hepburn, W Caron, T Burns and R Mantell (1999) The Gerontologist, Vol 39, Issue 3 299-309

This 3-year randomized clinical trial tested the effectiveness of an interdisciplinary psychoeducational family group intervention in decreasing the caregivers' perceptions of the frequency and severity of behavioral problems in persons with dementia and their reactions to those problems, and in decreasing caregiver burden and depression. The intervention consisted of seven weekly, 2-hour multimedia training sessions that included education, family support, and skills training for 94 primary caregivers and their families. Repeated measures ANOVA was used to test for significant differences between the intervention and waiting list control groups over a 5-month period. The intervention was successful in reducing caregivers' negative reactions to disruptive behaviors and in reducing caregiver burden over time.

Relationship between caregiver burden and health-related quality of life
SL Hughes, A Giobbie-Hurder, FM Weaver, JD Kubal and W Henderson (1999) The Gerontologist, Vol 39, Issue 5 534-545

This study tested the cross-sectional relationship between caregiver burden and health-related quality of life (HRQOL) among 1,594 caregivers of veterans identified to qualify for formal home care. A two-stage model found that familial relationship, coresidence, and low income predicted objective burden. Coresidence also predicted subjective burden, whereas being African American was protective. In the full model, spousal relationship, low income, and burden were associated with poor HRQOL scores. Total variance explained in HRQOL ranged from 14% to 29%, with objective burden contributing more than subjective burden. These findings suggest a direct effect of objective burden on caregiver HRQOL, indicating a need among caregivers for assistance in caring for disabled family members.

Caregiving as a life course transition among older husbands: A prospective study
BJ Kramer and JD Lambert (1999) The Gerontologist, Vol 39, Issue 6 658-667

Guided primarily by transitions theory, this study examined changes over two points in time (approximately 5 years apart) in multiple life domains (i.e., household tasks, social life, marital relationship, and well-being) between two groups of husbands aged 60 and older, who indicated that their wives were not in need of care or assistance due to an illness or disability at the initial interview. The two groups included husbands who identified themselves as a provider of care at Time 2 (T2; i.e., they had transitioned into the caregiver role; n = 26), and those married to healthy wives at T2 (i.e., noncaregivers; n = 262). Data came from a national probability sample of U.S. adults who were primary respondents to the National Survey of Families and Households in 1987-88, and who were followed up longitudinally in 1992- 93. Findings suggested that husbands who entered the caregiving role demonstrated significant changes in household responsibilities, social integration, marital relationship, and well-being. Implications for practice and future research on the older husband caregiver are highlighted.

A multimedia intervention to support family caregivers
EJ Hanson, J Tetley and A Clarke (1999) The Gerontologist, Vol 39, Issue 6 736-741

The lack of choice and predominance of crisis-oriented care in relation to respite and long-term care for family carers and frail older people provided the authors with the rationale for the development, within the European-funded Assisting Carers using Telematic Interventions to meet Older person's Needs (ACTION) project, of two innovative multimedia programs. The key aim of the programs is to provide education, information, and support about respite care and planning for the future for family carers and frail older people in their homes. In this way, it is intended that family carers and frail older people will be able to make informed choices concerning their health and social care needs. The authors describe the conceptual basis of the multimedia programs, the research and development process, the content of the multimedia programs, and the evaluation of the developed product.

Gender Differences in Psychiatric Morbidity Among Family Caregivers: A Review and Analysis
JL Yee and R Schulz (2000) The Gerontologist 40:147-164

The major goal of this article was to review and synthesize the empirical research on caregiver gender and psychiatric morbidity, with the aim of answering three questions: (a) Is there greater psychiatric morbidity among female than male caregivers, (b) is the excess psychiatric morbidity among female caregivers attributable to caregiving, and (c) what factors in the caregiving situation contribute to the excess psychiatric morbidity among female caregivers? In almost all studies reviewed, women caregivers reported more psychiatric symptoms than men caregivers. Comparisons with noncaregiving community samples suggest that female caregivers experience excess psychiatric morbidity attributable to caregiving. Using a stress process model as an organizing framework, the study demonstrated that at all stages of the stress process, women are at greater risk for psychiatric morbidity than men. Directions for future research and implications for interventions and public policy are discussed.

Predicting caregiver burden and depression in Alzheimer's disease
LD Clyburn, MJ Stones, T Hadjistavropoulos and H Tuokko (2000) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 55, Issue 1 S2-13

OBJECTIVES: The purpose of this study was to investigate the predictors of caregiver burden and depression, including objective stressors and mediation forces influencing caregiving outcomes. METHODS: This investigation is based on the 1994 Canadian Study of Health and Aging (CSHA) database. Participants were 613 individuals with dementia, living in either the community or an institution, and their informal caregivers. Participants for the CSHA were identified by screening a large random sample of elderly persons across Canada. Structural equation models representing four alternative pathways from caregiving stressors (e.g., functional limitations, disturbing behaviors, patient residence, assistance given to caregiver) to caregiver burden and depression were compared. RESULTS: The data provided the best fit to a model whereby the effects on the caregiver's well-being are mediated by appraisals of burden. A higher frequency of disturbing behavior, caring for a community-dwelling patient, and low informal support were related to higher burden, which in turn led to more depressive symptomatology. Caregivers of patients exhibiting more disturbing behaviors and functional limitations received less help from family and friends, whereas those whose care recipients resided in an institution received more informal support. DISCUSSION: Our findings add to the preexisting literature because we tested alternative models of caregiver burden using an unusually large sample size of participants and after overcoming methodological limitations of past research. Results highlight the importance of the effective management of disturbing behaviors, the provision of formal services for caregivers with highly impaired patients and no informal support, and the improvement of coping skills in burdened caregivers.

The Dynamics of Caregiving: Transitions During a Three-Year Prospective Study
M Mailick Seltzer and L Wailing Li (2000) The Gerontologist 40:165-178

This prospective study (n = 476) examined 3 types of caregiving transitions experienced by wives and daughters of older persons: entry, institutionalization, and bereavement. Daughters were more likely to enter the caregiving role than wives, but the impact of entering the role was more pronounced for wives. After becoming a caregiver, wives decreased in their participation in leisure activities, perceptions of quality of family relations, and marital satisfaction. Daughter caregivers were more likely than wives to place their care recipient in an institution, and they increased in social participation and decreased in subjective burden after placement. Roughly the same percentage of wife and daughter caregivers were bereaved during the study period, and for wives bereavement was accompanied by an increase in social involvement and personal growth. The results underscore the highly dynamic nature of the caregiving career and the importance of the kinship relationship between caregiver and care recipient in conditioning the effects of caregiving transitions.

Does Type of Disease Matter? Gender Differences Among Alzheimer's and Parkinson's Disease Spouse Caregivers
K Hooker, M Manoogian-O'Dell, DJ Monahan, LD Frazier, and K Shifren (2000) The Gerontologist 40:568-573

Purpose of study: Mental health outcomes are widely reported among spouse caregivers, with wives generally faring worse than husbands. We hypothesized that gender differences would not be as strong in a cognitively intact group because caring for cognitively intact spouses may involve less severe reciprocity losses. We also examined gender differences in coping strategies within each group. Design and method: 175 spouse caregivers for patients with Alzheimer's disease (AD; n = 88) and Parkinson's disease (PD; n = 87) were interviewed. Participants completed perceived stress (PSS), depression (CES-D), state anxiety (STAI, Form Y), and coping strategies (WCCL-R) measures. Results: Wives in the AD group reported significantly worse mental health outcomes than husbands, while wives and husbands in the PD group showed no differences. AD caregiving wives were less likely than husbands to use problem-focused coping strategies. There were no significant gender differences in either group for social support or emotion-focused coping. Implications:Loss of reciprocity in marital relationships may affect women more negatively than men. Future studies that address underlying mechanisms of gender differences and focus on similar caregiving situations and contexts deserve attention.

Patterns of Caregiver Experiences among Partners of Cancer Patients
C Nijboer, M Triemstra, R Tempelaar, M Mulder, R Sanderman and G van den Bos (2000) The Gerontologist 40:738-746

This study describes patterns of caregiving experiences in partners of patients with cancer (N=148) over a 6-month period. Caregiving experiences were assessed by means of the Caregiver Reaction Assessment Scale (CRA), which consists of four negative dimensions and one positive subscale: Disrupted Schedule, Financial Problems, Lack of Family Support, Loss of Physical Strength, and Self-Esteem. Subgroup analyses were performed according to gender, age, and socioeconomic status (SES). Type, size, and direction of changes in caregiving experiences over time were analyzed both at a group level and at an individual level. Patterns of caregiver experiences appeared to vary between the subgroups; women, younger caregivers, and caregivers with a higher SES experienced caregiving more negatively or less positively. The findings illustrate the value of studying inter- and intraindividual patterns across different subgroups, and stress that caregiver experiences should be regarded as a multidimensional concept that includes both negative and positive experiences of caregiving.

Contextual or General Stress Outcomes: Making Choices Through Caregiving Appraisals
V Braithwaite (2000) The Gerontologist 40:706-717

This study contributes to the debate on general versus contextual measures of caregiver well-being through examining the differential relationships of caregiving appraisals to outcomes. Six dimensions of caregiving appraisal were examined as predictors of minor psychiatric symptoms, affect balance, and burden. Burden was high, symptoms were high, and affect was poor when caregivers held appraisals that reflected (a) low personal resiliency and (b) a conflict-ridden and dysfunctional relationship with the care receiver. When caregivers reported expending (c) considerable energy in maintaining their social networks, burden was also high, with some risk of symptoms, but affect was positive. The fourth appraisal, (d) a close loving caregiver–care receiver relationship, was positively correlated with general well-being, but was not related to burden. The fifth appraisal, (e) dealing with a heavy workload in providing care, was linked with poor affect, but neither symptoms nor burden. Finally, (f) caring at a distance was related to burden, but not to the general outcome measures. These findings suggest that the foci of research questions might be usefully located within an appraisal framework, and that this framework might then provide guidance for the choice of appropriate outcome variables. In many cases, however, a deeper understanding ensues from assessing both contextual and general well-being.

Comparisons of African American and White Women in the Parent Care Role
TM White, AL Townsend, and MA Parris Stephens (2000) The Gerontologist 40:718-728

Little is known about African American women's experiences providing care to impaired older relatives. This study investigated potential differences in depressive symptomatology, parent care stress and rewards, parent care mastery, and the quality of the parent care relationship between 261 White and 56 African American daughters and daughters-in-law who were providing care for an impaired parent or parent-in-law. Multivariate analysis of variance, controlling for significant background characteristics and interrelationships among caregiving experiences, revealed that African American women reported less stress and more rewards in the parent care role than White women did. Race did not have a significant effect on caregivers' depressive symptomatology, parent care mastery, or the quality of their relationship with the parent. However, this research demonstrates the importance of examining a broad range of caregiving experiences in order to detect both similarities and differences between African American and White caregivers.

A Randomized, Controlled Trial of a Home Environmental Intervention: Effect on Efficacy and Upset in Caregivers and on Daily Function of Persons With Dementia
LN Gitlin, M Corcoran, L Winter, A Boyce, and WW Hauck (2001) The Gerontologist 41:4-14

Purpose of Study: The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients. They also determined if treatment effect varied by caregiver gender, race, and relationship to patient. Design and Methods: Families (N = 171) of dementia patients were randomized to intervention or usual care control group. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifi-cations. Results: Compared with controls, intervention caregivers reported fewer declines in patients' instrumental activities of daily living (p = .030) and less decline in self-care and fewer behavior problems in patients at 3 months post-test. Also, intervention spouses reported reduced upset (p = .049), women reported enhanced self-efficacy in managing behaviors (p = .038), and women (p = .049) and minorities (p = .037) reported enhanced self-efficacy in managing functional dependency. Implications: The environmental program appears to have a modest effect on dementia patients' IADL dependence. Also, among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving.

Balancing Parent Care With Other Roles: Interrole Conflict of Adult Daughter Caregivers
MA Parris Stephens, AL Townsend, LM Martire and JA Druley (2001) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 56:P24-P34

This study examined interrole conflict experienced by 278 women who simultaneously occupied 4 roles: parent care provider, mother to children at home, wife, and employee. Compared with women who experienced no conflict between parent care and their other roles, women reporting parent care conflict tended to have fewer socioeconomic resources, to have older children, and to be caring for parents with greater impairment. Women who reported conflicts between parent care and employment were older; had more education; had marriages of longer duration; and had older, more self-sufficient children than women who reported conflict between the parent care role and the mother role. Some evidence was found for the hypothesis that interrole conflict between parent care and other roles mediates the relationship between parent care stress and psychosocial well-being. Results suggest that one way parent care stress exerts its deleterious effects on the well-being of adult daughters is through the incompatible pressures of parent care and other roles.

Judging Outcomes in Psychosocial Interventions for Dementia Caregivers: The Problem of Treatment Implementation
L Burgio, M Corcoran, KL Lichstein, L Nichols, S Czaja, D Gallagher-Thompson, M Bourgeois, A Stevens, M Ory, R Schulz, and for the REACH Investigators (2001) The Gerontologist 41:481-489

Purpose: In published dementia caregiver intervention research, there is widespread failure to measure the level at which treatment was implemented as intended, thereby introducing threats to internal and external validity. The purpose of this article is to discuss the importance of inducing and assessing treatment implementation (TI) strategies in caregiving trials and to propose Lichstein's TI model as a potential guide. Design and Methods: The efforts of a large cooperative research study of caregiving interventions, Resources for Enhancing Alzheimer's Caregiver Health (REACH), illustrates induction and assessment of the three components of TI: delivery, receipt, and enactment. Results: The approaches taken in REACH vary with the intervention protocols and include using treatment manuals, training and certification of interventionists, and continuous monitoring of actual imple-mentation. Implications: Investigation and description of treatment process variables allows researchers to understand which aspects of the intervention are responsible for therapeutic change, potentially resulting in development of more efficacious and efficient interventions.

The Experiences and Challenges of Informal Caregivers: Common Themes and Differences Among Whites, Blacks, and Hispanics
Maryam Navaie-Waliser, Penny H. Feldman, David A. Gould, Carol Levine, Alexis N. Kuerbis, and Karen Donelan (2001) The Gerontologist 41:733-741

Purpose: This study examined commonalities and differences in the experiences and challenges of White, Black, and Hispanic informal caregivers in New York, NY. Design and Methods: A randomly selected representative cross-section of 2,241 households was contacted through telephone interviews. Complete data were available for 380 eligible participants, who were classified as White (n = 164), Black (n = 129) and Hispanic (n = 87). Descriptive, bivariate, and multivariate analyses were conducted to examine differences in caregiving intensity, reported difficulty with providing care, and having unmet needs with care provision. Results: Over 70% of caregivers had no help from formal caregivers, even though over 80% had been providing care for at least 1 year, and 40% had been providing this care for 20 or more hr per week. Compared with White caregivers, Black caregivers were more likely to provide higher intensity care, to report having unmet needs with care provision, and to experience increased religiosity since becoming caregivers, but were less likely to report difficulty with providing care. Hispanic caregivers were more likely than White caregivers to have help from formal caregivers and to experience increased religiosity since becoming caregivers. Implications: Although many similarities exist in the experiences and challenges of informal caregivers, gaining insight from different populations of family caregivers would help program planners, policy makers, and formal caregivers to develop and implement culturally sensitive programs and policies that are supportive of the needs of these caregivers in their ever-expanding roles. Future efforts also should focus on exploring the potentially significant role that community resources, in particular, religious institutions, could play in providing outreach and support to racial/ethnic minority caregivers.

The Effects of Nursing Home Placement on Family Caregivers of Patients With Alzheimer's Disease
MA Lieberman and L Fisher (2001) The Gerontologist 41:819-826

Purpose: This study sought to determine the effects of nursing home placement (NHP) for patients with Alzheimer's disease, compared to maintaining community placement, on changes in family caregiver health and well-being over time. Design and Methods: We utilized a 2-year, longitudinal study with one baseline and four follow-up assessments for patients' spouses, adult offspring, and in-laws (married to offspring). Families were recruited from eight clinical outpatient centers, supported by the State of California, and followed in the community over time. A multidisciplinary clinical evaluation was undertaken by the centers, and follow-up assessments included questionnaire and interview data. Results: Family caregiver health and well-being did not improve over time following NHP, and there were no significant differences in health and well-being between family caregivers who placed their ill elder in a nursing home and those who kept the elder at home or in the community. However, female family caregivers and spouses displayed greater declines in health and well-being over time, compared to other family caregivers, regardless of whether or not NHP occurred. Implications: Families considering NHP need to be advised of what may and may not change following NHP. In particular, spouses and female family caregivers may not experience those changes in life satisfaction and well-being that are hoped for. Variation in the effects of NHP may be more related to pre-NHP family processes and relationships than to the severity of the patient's disability, caregiver strain, patient and caregiver demographics, and use of community-based professional services.

Self-Gain and Self-Loss Among African American and White Caregivers
K Long Foley, HJ Tung and EJ Mutran (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:S14-S22

Objectives. This study compared the effects of a traditional ideology of care and role conflict on the intrinsic rewards (self-gain) and consequences (self-loss) of caregiving among African Americans and Whites. Methods. Using a cross-sectional telephone survey of caregivers in North Carolina (n = 481), the authors performed a structural equation groups analysis to assess the equality of an a priori caregiving model for African Americans (n = 257) and Whites (n = 224). Results. Despite a stronger preference for family care among African Americans, traditional caregiving ideology was associated with more self-gain among Whites only; there was no relationship between preference for family care and self-loss for either group. Furthermore, role conflict was unrelated to self-gain but was related to more self-loss for both groups. Three additional relationships differed between African Americans and Whites: age and self-gain, gender and self-gain, and care recipient depression and role conflict. However, 12 proposed relationships were statistically significant and equivalent for African Americans and Whites. Discussion. The findings suggest that contextual elements that influence preference for family care and role conflict are almost identical for African Americans and Whites. Caregiver demographics are associated with caregiving ideology, whereas care recipient frailty is related to role conflict. However, there are differences between African American and White caregivers, which primarily stem from the role of age, gender, and preference for family care with self-gain.

The Revised Scale for Caregiving Self-Efficacy: Reliability and Validity Studies
AM Steffen, C McKibbin, AM Zeiss, D Gallagher-Thompson and A Bandura (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P74-P86

Two samples of family caregivers (Study 1: N = 169; Study 2: N = 145) of cognitively impaired older adults were used to revise, extend, and evaluate a measure of perceived self-efficacy for caregiving tasks. The Revised Scale for Caregiving Self-Efficacy measures 3 domains of caregiving self-efficacy: Obtaining Respite, Responding to Disruptive Patient Behaviors, and Controlling Upsetting Thoughts. The 3 subscales show strong internal consistency and adequate test–retest reliability. Construct validity is supported by relationships between these 3 facets of perceived caregiving efficacy and depression, anxiety, anger, perceived social support, and criticism expressed in speech samples. The Revised Scale for Caregiving Self-Efficacy has potential uses for both research and clinical purposes.

Neighbors, Friends, and Other Nonkin Caregivers of Community-Living Dependent Elders
JC Barker (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:S158-S167

Objectives. To describe naturally occurring care relationships between unpaid, nonprofessional, nonkin (unrelated) caregivers and frail community-living older adults. Methods. Face-to-face, semistructured interviews were conducted with a convenience sample of 114 caregivers and care recipients recruited from the community through a variety of organizations. Standard techniques for thematic analysis of qualitative data were used along with descriptive and other statistics as appropriate for numerate data. Results. Nonkin caregiving proved to be heterogeneous in initiation of relationship, form, duration, tasks performed, and association with family caregivers. Partnerships ranged from 0.1 to 57 years in duration, with just over half (58%) starting with the provision of care. Many caregivers (47%) were themselves older adults, aged 65 or older. There was little variation in what motivated or rewarded caregivers, many of whom felt morally obligated to help. More than half the sample used kin terms to characterize their relationship. Four distinct styles of relationship were discerned, varying by degree of emotional intimacy and types of assistance given. All relationships, however, involved socializing and help with at least two instrumental tasks of daily life. Discussion. This kind of caregiving is important for sustaining community living for about 10% of frail elderly persons. A greater understanding is needed, from both theoretical and practical perspectives, of when and how nonkin relationships are beneficial and why they in many ways successfully mirror the actions and sentiments of family caregivers.

Informal Caregiving for Diabetes and Diabetic Complications Among Elderly Americans
KM Langa, S Vijan RA Hayward, ME Chernew, CS Blaum, MU Kabeto, DR Weir, SJ Katz, RJ Willis and AM Fendrick (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:S177-S186

Objectives. Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care. Methods. We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM. Results. Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p < .01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM. Discussion. Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

Caregiving as a Dyadic Process: Perspectives from Caregiver and Receiver
KS Lyons, SH Zarit, AG Sayer and CJ Whitlatch, (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P195-P204

Most family caregiving research has relied on the perspective of the caregiver but has not systematically examined the views and opinions of the elder who is receiving care. The present study examined 63 caregiving dyads to determine how the responses of each member had an impact on the well-being of the other member of the dyad. Caregiver relationship strain predicted his or her own depression and negative health, but no significant association was found between caregiver and care recipient outcomes. Multilevel modeling was used to assess the level of dyadic discrepancy over the care recipient's needs and appraisal of caregiving difficulties. Results indicate that there is little disagreement over the care recipient's needs, but a significant amount of variation in how much the care recipient and caregiver agree on their appraisals of caregiving difficulties. Relationship strain perceived by the caregiver, but not the care recipient, was significantly associated with this disagreement.

Coping and Depression in Alzheimer's Caregivers: Longitudinal Evidence of Stability
DV Powers, D Gallagher-Thompson and HC Kraemer (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P205-P211

The present study examined the longitudinal relationship between depressive symptoms and coping strategies in older adult primary caregivers of noninstitutionalized Alzheimer's patients. Coping and depression were measured in 51 healthy, nondepressed caregivers (37 women, 14 men) at 4 times of testing approximately 6 months apart. The caregivers' coping strategies and depressive symptoms were found to be largely stable over all times of testing—with a recently developed method for evaluating construct stability—despite significant decline in the patients' cognitive functioning over the same interval. Avoidance coping was also found to be positively associated with depressive symptoms. Results suggest that a strong stable component is present in caregiver coping style and that caregiver intervention researchers may want to examine the extent to which commonly used outcome measures are assessing stable caregiver traits rather than state-dependent distress.

Toward the Conceptualization and Measurement of Caregiver Burden Among Pueblo Indian Family Caregivers
R John, C Hagan Hennessy, TB Dyeson, and MD Garrett (2001) The Gerontologist 41:210-219

Purpose: The purpose of this study was to evaluate burden experienced by a group of American Indian primary family caregivers and to determine if caregiver burden is a multidimensional concept. Design and Methods: This analysis is based on the results of a survey questionnaire administered to 169 Pueblo primary family caregivers in New Mexico. Results: Analysis of the items composing the Caregiver Burden scale indicated that caregiver burden is multidimensional and consists of several types of burden. Caregiver burden, as identified in this sample, is composed of four dimensions: role conflict, negative feelings, lack of caregiver efficacy, and guilt. Investigations of caregiver burden should consider the multidimensionality of this experience and evaluate burden accordingly. Implications:By identifying the specific type of burden that a caregiver experiences, interventions can be targeted more accurately to support family caregiving.

The Stress Process of Family Caregiving in Institutional Settings
CJ Whitlatch, D Schur, LS Noelker, FK Ejaz, and WJ Looman (2001) The Gerontologist 41:462-473

Purpose: This study adapts the Stress Process Model (SPM) of family caregiving to examine the predictors of depression in a sample of caregivers (n = 133) with demented relatives residing in suburban skilled nursing facilities. Design and Methods: We interviewed family caregivers of family members residing in skilled nursing homes using a variety of measures to assess primary stressors, secondary strain, nursing home stressors, and caregiver depression. We used block-wise regression analyses to determine the predictors of caregiver de-pression. Results: Results indicated that positive resident adjustment to placement was best predicted by the closeness of the resident–caregiver relationship and nursing home stressors. Caregiver strain, resident adjustment, and nursing home stressors best predicted caregiver adjustment. In turn, the best predictors of caregiver depression included caregiver age, caregiver adjustment to the nursing home, and nursing home stressors. Implications:These results suggest that caregiver depression is closely linked to how well both the resident and caregiver adjust to the nursing home environment. Results also indicate that by broadening the SPM to include stressors common to the nursing home experience, researchers will be able to understand more clearly the specific components of the stress process that may lead to depression in family caregivers of persons living in nursing homes.

Burden Among Family Caregivers of Persons With Alzheimer's Disease in Nursing Homes
JB Tornatore and LA Grant (2002) The Gerontologist 42:497-506

Purpose: This article examines family caregiver burden after placement of a relative with Alzheimer's disease or a related dementia in a nursing home. Design and Methods: A systems-oriented contextual approach was used to study burden in 276 family caregivers. Results: SAS PROC MIXED analysis showed burden to be associated with caregiver age, length of time involved in caregiving, custodial units, involvement in hands-on care, and expectations for care. Implications: The findings suggest that more services aimed at relieving caregiver burden after nursing home placement may be warranted, particularly so for caregivers who are older and for those who had a shorter length of involvement in direct caregiving before institutionalization.

The Influence of Parental Bonding on Emotional Distress in Caregiving Sons for a Parent with Dementia
AP Daire (2002) The Gerontologist 42:766-771

Purpose: The purpose of this study was to investigate the influence of childhood parental bonding on emotional distress experienced by primary caregiving sons for a parent with dementia. Design and Methods: Data from the 40 participants were obtained using the Parental Bonding Inventory (PBI), Brief Symptom Inventory (BSI), and Caregiver Survey Questionnaire (CSQ). A multivariate analysis of variance was conducted to investigate any main effects or interaction between the two PBI bonding variables (care and overprotection) and the two distress variables, the BSI's Global Severity Index and the CSQ's distress percentage. Results: Caregiving sons who identified more care in the childhood bond with their parent attributed less distress to their primary caregiver role. Sons reporting less care attributed more distress to the primary caregiver role. Implications: Results suggest that the parental bond developed during childhood may play a role in predicting the extent to which caregiving sons will attribute distress to their caregiving role.

Burden and Well-Being Among Caregivers: Examining the Distinction
NL Chappell and RC Reid (2002) The Gerontologist 42:772-780

Purpose: This study assessed overall quality of life of caregivers, using a path model in which burden was conceptualized as distinct from well-being. Design and Methods: Data were drawn from a representative sample of caregivers to dementia and nondementia care receivers in British Columbia, Canada (N = 243). The model used was based on a previously proposed stress/appraisal path model and used multiple regression path estimates. Primary stressors were care receiver cognitive status, physical function, and behavioral problems; the primary appraisal variable was hours of caregiving during the previous week. Mediators were perceived social support, frequency of getting a break, and hours of formal service use; secondary appraisal was subjective burden. The outcome measure was generalized well-being. Results:Well-being was directly affected by four variables: perceived social support, burden, self-esteem, and hours of informal care. Burden was affected directly by behavioral problems, frequency of getting a break, self-esteem, and informal hours of care and was not affected by perceived social support. Discussion: The finding that perceived social support is strongly related to well-being but unrelated to burden reinforces the conceptual distinctiveness of the latter two concepts. This suggests that quality of life of caregivers could be improved even with burden in their lives and that the overwhelming focus in caregiving research on burden should be supplemented with an emphasis on quality of life.

Multiple Role Occupancy in Midlife: Balancing Work and Family Life in Britain
M Evandrou, K Glaser and U Henz (2002) The Gerontologist 42:781-789

Purpose: This article investigates the extent of multiple- role occupancy among midlife individuals in Britain in cross-section and over the life course, focusing on work and family commitments. The association between demographic and social factors and multiple-role obligations is also investigated. Design and Methods: The research is based on secondary analysis of the British Family and Working Lives Survey, which contains retrospective paid work, caregiving, and child coresidence histories. Results: The proportion of individuals in midlife (women aged 45–59 and men aged 45–64) who have multiple roles, in terms of paid work and consistent family care, at any one point in time is low (2%). This is primarily due to the relatively small proportion (7%) of people in this age group who are caring for a dependent. Being older, unmarried, and in poor health significantly reduces the number of roles held among men and women. Although the frequency of multiple role occupancy, and intensive multiple role occupancy, is low on a cross-sectional basis, a much higher proportion of individuals have ever occupied multiple roles over their life course (14%). Implications: The findings will inform debate on how policy can best aid those endeavouring to balance paid work, family life, and caring responsibilities.

Evaluation of Geriatric Day Care Units: Effects on Patients and Caregivers
S Zank and C Schacke (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P348-P357

The aim of this study was to evaluate the effects of geriatric day care on patients and caregivers. Day care patients (n = 43) were compared with an untreated matched control group (n = 40). Matching criteria were age, gender, physical and mental health status, and socioeconomic status. The mean age of both groups was 79.5 years. Data were collected at three measurement points: T1 took place during the first 10 days of service use, T2 was conducted 6 months later, and T3 took place 9 months after service use began. In addition, a short follow-up was conducted 6 months after T3. Well-being, dementia symptoms, health indicators, and activities of daily living were investigated. Individual growth curves of these patient variables were computed and analyzed with multivariate analyses of variance. The results show significant positive effects of day care on well-being and dementia symptoms. Patients in day care stabilized or improved on various measures, whereas the untreated control participants worsened. Follow-up data showed a significant decline in health in the control group in comparison with the day care users. Results concerning effects on caregivers were not that clear. Individual change parameters in subjective well-being and burden did not differ between the two groups of caregivers in the longitudinal follow-up. In a semistructured interview, however, caregivers of patients in the treatment group reported substantial positive change due to use of day care.

The Gendered Nature of Men's Filial Care
LD Campbell and A Martin-Matthew (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S350-S358

Objectives. This paper investigates sociodemographic and family structure factors that predict men's involvement (n = 773) in different gendered dimensions of filial caregiving: traditionally male, gender neutral, and traditionally female care. Methods. The concepts that guide this research relate to family obligations or motivations to provide care, specifically, commitment to care, legitimate excuses, and caring by default. Data for this research come from the Work and Family Survey (1991–1993) conducted by the Work and Eldercare Research Group of CARNET: The Canadian Aging Research Network. Results. Although such factors as geographic proximity and sibling network composition predict men's involvement independent of the type of task, the gendered nature of the task is important in how other factors, such as filial obligation, parental status, education, and income influence involvement in care. Discussion. The findings suggest that, for traditionally male tasks, legitimate excuses or a commitment to care may play a more minor role in influencing men's involvement than is true for traditionally female tasks. Overall, this research demonstrates the importance of examining the gendered nature of the care tasks and highlights the value of the conceptual framework for explaining variations in men's filial care.

Recruitment and Retention of Latino Dementia Family Caregivers in Intervention Research: Issues to Face, Lessons to Learn
D Gallagher-Thompson, N Solano, D Coon, and P Areán (2003) The Gerontologist 43:45-51

Purpose: This article reviews and critiques several issues of importance to those whose goal is to make intervention research with Latino caregivers more "user-friendly." Issues range from current demographic trends showing the ever-increasing number of Latino caregivers to discussion of cultural values that influence their help-seeking behavior. Design and Methods: This article presents a review of current published information on this topic. The gerontological literature was searched for the past decade for relevant material; in addition, the authors' own experience in this area is described. Results: Although limited information was found that derived from actual empirical studies, a number of articles describe potential barriers to research involvement and provide suggestions for making participation more attractive and culturally appropriate for Latinos. Implications: Clinical researchers need to increase their sensitivity to such issues as cultural values and language preference and develop effective collaborations with the Latino community so that intervention research programs can be designed and implemented successfully with Latinos caring for cognitively impaired elderly family members at home.

Associations of Stressors and Uplifts of Caregiving With Caregiver Burden and Depressive Mood: A Meta-Analysis
M Pinquart and S Sörensen (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:P112-P128

In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.

Transitions in Spousal Caregiving
LC Burton, B Zdaniuk, R Schulz, S Jackson, and C Hirsch (2003) The Gerontologist 43:230-241

Purpose: This study describes transitions over 5 years among community-dwelling elderly spouses into and within caregiving roles and associated health outcomes. Design and Methods: Participants in the Caregiver Health Effects Study (n = 818) were interviewed four times over 5 years with changes in their caregiving status described. Analyses of the effect on health outcomes of transitions were performed on those for whom four observations were available (n = 428). Results: Only half (49.5%) of noncaregivers at baseline remained noncaregivers at 5-year follow-up. The remainder experienced one or more transitions, including moving into the caregiving role, their own or their spouse's death, or placement of their spouse in a long-term care facility. The trajectory of health outcomes associated with caregiving was generally downward. Those who transitioned to heavy caregiving had more symptoms of depression, and poorer self-reported health and health behaviors. Implications: Transitions into and within the caregiving role should be monitored for adverse health effects on the caregiver, with interventions tailored to the individual's location in the caregiving trajectory.

Exploring the Issues of Race, Ethnicity, and Culture in Caregiving Research: A 20-Year Review (1980–2000)
P Dilworth-Anderson, I Canty Williams, and BE Gibson (2002) The Gerontologist 42:237-272

Purpose: The goals of this review are to synthesize what is known about caregiving among diverse groups and to identify gaps in knowledge to guide future research on caregiving. The review focuses on conceptual and theoretical approaches, sampling strategies, measurement techniques, and similarities and differences found among groups and across studies. Design and Methods: A narrative approach was used to review 59 articles published between 1980 and 2000, with particular attention to race, ethnicity, and/or culture. Primary sources of relevant articles included electronic databases, other review articles, and reference lists. Results: Caregiving experiences and outcomes varied across racial and ethnic groups. However, the use of nontheoretical approaches, nonprobability samples, and inconsistent measures among studies has limited understanding of caregiving among diverse populations. Implications: It is important that conceptualization and theorizing broaden with increasing numbers of studies that include diverse groups. Future caregiving research needs to give more attention to such issues as acculturation, assimilation, and cultural values, beliefs, and norms, while also improving theoretical and methodological rigor.

Neuroticism and Longitudinal Change in Caregiver Depression: Impact of a Spouse-Caregiver Intervention Program
Y Jang, OJ Clay, DL Roth, WE Haley and MS Mittelman (2004) The Gerontologist 44:311-317

Purpose: We examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention. Design and Methods: We analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. We used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention. Results: Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression. Implications: Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention like ours, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment.

The Relationship Between Care-Recipient Behaviors and Spousal Caregiving Stress
B Ingersoll-Dayton and M Raschick (2004) The Gerontologist 44:318-327

Purpose: This study examines gender differences in spousal caregiver stress associated with care-recipient problem behaviors and helping behaviors. Design and Methods: Using data from the National Long-Term Care Survey, we examined bivariate and multivariate relationships between the behaviors of care recipients and the stress experienced by their spouses. Results: Gender differences in caregiver stress emerged with respect to problem behaviors and helping behaviors of the care recipient. Helping behaviors had a moderating effect on the relationship between care-recipient problem behaviors and stress for caregiving husbands, but not for caregiving wives. Implications: As practitioners attempt to reduce spousal caregiving distress, they should assess the extent to which care recipient's problem behaviors and efforts to be helpful contribute to caregiver stress.

A Study of 10 States Since Passage of the National Family Caregiver Support Program: Policies, Perceptions, and Program Development
L Friss Feinberg and SL Newman (2004) The Gerontologist 44:760-769

Purpose: This study describes the preliminary experiences of 10 states in providing support services to family or informal caregivers of elderly adults and adults with disabilities; it focuses on the newly created National Family Caregiver Support Program, state general funds, Medicaid-waiver programs, and other state-funding streams. Design and Methods: Case studies were conducted, between March and July 2002, through in-person interviews with state officials and stakeholders in Alabama, California, Florida, Hawaii, Indiana, Iowa, Maine, Pennsylvania, Texas, and Washington. Results: States were in the start-up phase of implementing the National Family Caregiver Support Program and varied greatly in program design and integration of caregiver support into their home- and community-based care system. Viewing family caregivers as a client population was a paradigm shift for many state officials. Implications: Heavy reliance is currently placed on family and informal caregivers in home- and community-based care, without adequate support services. Family support should be an explicit goal of long-term-care system reform.

Identifying Changeable Barriers to Family Involvement in the Nursing Home for Cognitively Impaired Residents
C Lindman Port (2004) The Gerontologist 44:770-778

Purpose: Barriers to family involvement in the nursing home with the potential for change through intervention are examined, including transportation, caregiver health, relationships with staff, and resident characteristics. Design and Methods: Data were collected for 93 family caregiver–resident pairs by means of telephone interviews and chart review. Regression modeling was used to identify relationships between involvement (caregiver visit frequency) and the changeable barriers after the known variables of distance, kinship, payment source, length of stay, and cognitive function were taken into account. Results: Lower visit frequency was found for caregivers reporting problems with transportation, poor relationships with staff, and a smaller network of supportive family and friends. Higher caregiver anxiety was related to higher visit frequency. Implications: Several barriers to family involvement are shown to be as or more influential than ones identified in previous research, thus providing empirical support for interventions currently used as well as suggesting new areas for intervention.

Caregiver Stress and Noncaregiver Stress: Exploring the Pathways of Psychiatric Morbidity
AA Amirkhanyan and DA Wolf (2003) The Gerontologist 43:817-827

Purpose: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members. Design and Methods: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings. Results: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers. Implications: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.

Effects of a Caregiver Intervention on Negative Caregiver Appraisals of Behavior Problems in Patients With Alzheimer's Disease: Results of a Randomized Trial
MS Mittelman, DL Roth, WE Haley and SH Zarit (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:P27-P34

Behavioral problems are among the most challenging aspects of caring for a person with Alzheimer's disease. A sample of 406 spouses–caregivers of patients with Alzheimer's disease was randomized to an active multicomponent counseling and support intervention condition or to a usual care condition. Caregivers reported on the frequency of troublesome patient behaviors and their reactions to them at baseline and at regular follow-up interviews. Random-effects regression models over the first 4 years after randomization revealed that, although the intervention did not affect the frequency of patient behavioral problems, it did significantly reduce caregivers' reaction ratings. Because caregiver appraisals have been found to mediate the impact of caregiving stress on depression and to predict nursing home placement rates, they deserve greater attention as an important target of intervention services.

Can Culture Help Explain the Physical Health Effects of Caregiving Over Time Among African American Caregivers?
P Dilworth-Anderson, PY Goodwin and S Wallace Williams (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:S138-S145

Objectives. The purposes of this study were to longitudinally examine the health outcomes of 107 African American caregivers who provided care to their elderly dependent family members and to determine the role of culture in predicting health outcomes. Methods. With use of the stress and coping model of Pearlin and colleagues (1990) as a guide, the direct effects of background characteristics and stressors and the direct and mediating effects of resources (including culture) on two caregiver health outcomes (i.e., psychosocial health and physical functioning) were analyzed with hierarchical multiple regression analyses. Results. Similar to other studies, we found that combinations of caregiver background characteristics, stressors, and resources at wave 1 had direct effects on African American caregivers' health outcomes at wave 3. Unlike previous studies, where culture was not measured, we found that cultural beliefs and values did help to explain health outcomes for African American caregivers. Specifically, culture justifications for caregiving, baseline psychosocial health, and caregiving mastery predicted wave 3 psychosocial health. Caregiver education, number of morbidities, and physical functioning at wave 1 were associated with physical functioning at wave 3. Discussion. The findings from this study have implications for future studies, particularly in regard to cultural beliefs and values among African American caregivers.

Longitudinal Changes in the Well-Being of Japanese Caregivers: Variations Across Kin Relationships
Y Sugihara, H Sugisawa, Y Nakatani and GW Hougham (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:P177-P184

This study examined how the psychological well-being of Japanese caregivers changed over time; it also examined the variation across kin relationships with care recipients. Three interviews over the course of 30 months were conducted with a representative sample of community-dwelling caregivers of frail elderly persons living in a Tokyo suburb. Latent growth modeling demonstrated that mean levels of both depression and emotional exhaustion worsened over time. Change in emotional exhaustion over time showed significant individual variability, whereas change in depression showed little individual variability. Although wife caregivers tended to experience the worst trajectory of emotional exhaustion, daughters-in-law also showed a similar negative trend. The difference in individuals' well-being trajectories by kinship may be explained partly by differences in care recipients' disabilities.

Positive Aspects of Alzheimer's Caregiving: The Role of Race
L Lee Roff, LD Burgio, L Gitlin, L Nichols, W Chaplin and JM Hardin (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:P185-P190

We examined differences in positive aspects of caregiving (PAC) among 275 African American and 343 Caucasian caregivers of individuals with Alzheimer's disease from the National Institutes of Health Resources for Enhancing Alzheimer's Care Health (REACH) study sites in Birmingham, Memphis, and Philadelphia. African Americans reported higher scores on PAC than did Caucasians. African Americans' higher religiosity partially mediated the relationship between race and PAC. Additional variables that contributed to their higher PAC scores were African Americans' lower anxiety, lower feelings of bother by the care recipient's behavior, and lower socioeconomic status.

From Caregiving to Bereavement: Trajectories of Depressive Symptoms Among Wife and Daughter Caregivers
LW Li (2005) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60:P190-P198

This study examined the trajectory of depressive symptoms for wife and daughter caregivers during the transition from caregiving to bereavement, and it investigated whether the trajectory varies by caregivers' caregiving stress, social support, and background characteristics. Hierarchical linear modeling was used to analyze four-wave longitudinal data collected from 157 wife and daughter caregivers who lost elderly relatives to death. Results show that, on average, caregivers experience increasing depressive symptoms as their care recipients approach death, and they experience decreasing symptoms after. Care recipients' problematic behavior and caregivers' kinship, income, and feelings of overload moderate the change in depressive symptoms during the transition. Services to support caregivers should target specific groups of caregivers, based on caregiving experience and background characteristics, at times when they are most in need.

Ethnic Differences in Stressors, Resources, and Psychological Outcomes of Family Caregiving: A Meta-Analysis
M Pinquart and S Sörensen (2005) The Gerontologist 45:90-106

Purpose: We investigated ethnic differences in caregiver background variables, objective stressors, filial obligations beliefs, psychological and social resources, coping processes, and psychological and physical health. Design and Methods: We used a meta-analysis to integrate the results of 116 empirical studies. Results: Ethnic minority caregivers had a lower socioeconomic status, were younger, were less likely to be a spouse, and more likely to receive informal support. They provided more care than White caregivers and had stronger filial obligations beliefs than White caregivers. Asian-American caregivers, but not African-American and Hispanic caregivers, used less formal support than non-Hispanic White caregivers. Whereas African-American caregivers had lower levels of caregiver burden and depression than White caregivers, we found that Hispanic and Asian-American caregivers were more depressed than their White non-Hispanic peers. However, all groups of ethnic minority caregivers reported worse physical health than Whites. Observed ethnic differences in burden and depression were influenced by study characteristics, such as the type of illness of the care recipient and the representativeness of the sample. Implications: The results suggest that more specific theories are needed to explain differential effects of ethnic minority groups of caregivers. Intervention needs vary, in part, between ethnic groups of caregivers.

Investigating the Effects of Communication Problems on Caregiver Burden
MY Savundranayagam, M Lee Hummert and RJV Montgomery (2005) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60:S48-S55

Objectives. The goal of this study was to explore the relationship between communication problems associated with dementia and caregiver burden, within the context of problem behaviors and cognitive and functional abilities of the care recipient. Methods. A scale on communication problems associated with dementia was developed and administered to 89 family caregivers. Participants also completed measures of care-recipient cognitive and functional status, problem behavior, and caregiver burden (demand, stress, and objective burden). Results. Analyses using structural equation modeling showed that care-recipient cognitive and functional status indirectly predicted problem behaviors via communication problems. The status indicators also directly predicted demand burden. In addition, problem behaviors mediated the relationship between communication problems and all forms of burden. Discussion. The study findings not only lend further support to the existing literature that has documented problem behaviors as strong predictors of burden but also emphasize the importance of communication problems in the caregiving process.


Volunteering and mortality among older adults: Findings from a national sample
MA Musick, AR Herzog and JS House (1999) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 3, S173-S180

OBJECTIVES: Although a number of authors have proposed that older volunteers should benefit in terms of better health and well-being, few researchers have examined the issue empirically to see whether this is true. The purpose of this article is to build on this literature by empirically examining the association between volunteering and mortality among older adults. METHODS: Using data from a nationally representative sample, we use Cox proportional hazards regression to estimate the effects of volunteering on the rate of mortality among persons aged 65 and older. RESULTS: We find that volunteering has a protective effect on mortality among those who volunteered for one organization or for forty hours or less over the past year. We further find that the protective effects of volunteering are strongest for respondents who report low levels of informal social interaction and who do not live alone. DISCUSSION: We discuss the possibility that the curvilinear relationship we observe between volunteering and mortality is due to a combination of factors, including self-identity, role strain, and meaningfulness. Other research using more precise data is needed to determine whether these ideas are supportable.

Building community for the long-term: An intergenerational commitment
G Hamilton, S Brown, T Alonzo, M Glover, Y Mersereau and P Willson (1999) The Gerontologist, Vol 39, Issue 2, 235-238

Intergenerational visitation programs have demonstrated advantages for the young and old, but few programs last more than a year or two. Weaving long-term intergenerational programs into the fabric of both school curricula and community cultural life was the goal of a project launched in 1988 in Phoenix, Arizona. Classrooms of children visit weekly or biweekly with nearby nursing home residents, developing friendships while pursuing educational activities. Carefully planned and widespread community support through board participation, donations, and publicity has allowed the program to continue to expand, while the budget has decreased. Materials are available which facilitate program replication.

Giving Social Support to Others, Socioeconomic Status, and Changes in Self-Esteem in Late Life
N Krause and BA Shaw (2000) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 55:S323-S333

Objective. The purpose of this study was twofold: (1) to see if providing emotional support to others bolsters the self-esteem of older adults over time; and (2) to assess whether the salubrious effects of helping others are more likely to be enjoyed by high socioeconomic status (SES) elders. Methods. Interviews were conducted with a nationally representative sample of older adults at three points in time: 1992–1993, 1996–1997, 1998–1999. Complete data are available for 511 elderly people. During each round of interviews, respondents were asked how often they provided emotional support to their social network members. Information on the self-esteem of older support providers was also gathered at each point in time. Results. Initially, the findings revealed that helping others tends to bolster the self-esteem of all study participants regardless of their SES standing. However, these benefits began to taper off for lower SES elders during the course of the study. By the third wave of interviews, the salutary effects of helping others were evident only among older adults in upper SES levels. Discussion. The results highlight the dynamic nature of the helping process and underscore the importance of taking SES into account when studying the effects of assisting others in late life.

Differential Benefits of Volunteering Across the Life Course
M Van Willigen (2000) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 55:S308-S318

Objectives. Studies often fail to adequately test the causal relationship between volunteering and well-being. Yet the media and empirical research have focused attention on the impact of volunteering on the well-being of elderly persons. This study addresses two questions: First, does volunteering improve the psychological and physical well-being of elderly persons? Second, do elderly volunteers experience different benefits than younger adults? Methods. Using nationally representative panel data, I assessed the long-term impact of volunteering on the life satisfaction and perceived health of persons aged 60 and over. I then compared ordinary least squares regression results for seniors with those for younger adults. Results. I found that older volunteers experienced greater increases in life satisfaction over time as a result of their volunteer hours than did younger adult volunteers, especially at high rates of volunteering. Older adults experienced greater positive changes in their perceived health than did younger adult volunteers. Discussion. The type of volunteer work in which older and younger adults engage may be part of the reason for these differential effects. But the context in which older and younger adults volunteer and the meaning of their voluntarism are more likely explanations. Researchers should take into account volunteer commitment when studying volunteering's effect on well-being, not simply volunteer role.

An Intergenerational Partnership Between a College and Congregate Housing Facility: How It Works, What It Means
JA Krout and CH Pogorzala (2002) The Gerontologist 42:853-858

Purpose: We describe the goals, development, operation, and outcomes of an intergenerational programmatic relationship between a private comprehensive college and a congregate facility that houses both independent-living apartments and assisted living for older adults. Design and Methods: Activities are based on a communal-developmental model that promotes "learning with" as opposed to "doing for." We identify key components involved in implementing such a model and provide examples of the activities that constitute the programmatic relationship. We also identify program implementation challenges and discuss outcomes. Results: Faculty and students report that partnership activities provide excellent opportunities for increasing the understanding of aging and older adults. Residents report programs provide social, recreational, and educational benefits. Implications: Programmatic partnerships between colleges and residential facilities for older adults provide many benefits for students and residents. They require shared responsibility, deliberate and creative planning, and ongoing coordination.

Preparing Future Aging Advocates: The Oklahoma Aging Advocacy Leadership Academy
P Baker, J Leitner, and WJ McAuley (2001) The Gerontologist 41:394-400

Purpose: This article describes the organization, operation, and evaluation of the Oklahoma Aging Advocacy Leadership Academy (OAALA). Design and Methods: The Academy was designed to assure the continuation of future cohorts of advocates and volunteers for aging programs and services. It is a statewide training program consisting of 10 weekend sessions. The curriculum incorporates age-related content and advocacy/leadership/voluntary skills training. Evaluation consisted of: (a) a pre–post assessment of perceived familiarity with advocacy and volunteer leadership issues; (b) post-Academy participant assessments of the quality of various aspects of the Academy; (c) post-Academy written statements about areas that were valuable and in need of change; and (d) a compilation of student volunteer and advocacy activities. Results: Evaluation results indicate that the OAALA led to significant increases in perceived familiarity with issues and very positive participant assessments of quality. In addition, many participants spontaneously initiated advocacy and volunteer activities while enrolled in the Academy. Implications: Our experience with the Academy suggests that it is a feasible means of preparing individuals to become successful old-age advocates and volunteer leaders.

Effects of Volunteering on the Well-Being of Older Adults
N Morrow-Howell, J Hinterlong, PA Rozario and F Tang (2003)The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S137-S145

Objectives. This study tests the effects of volunteering on the well-being of older adults, including the effect of level of engagement, the moderating effects of demographic and social factors, and the effects of the nature of the volunteer experience. Methods. This is a secondary data analysis of three waves of data from the Americans' Changing Lives Study. Self-rated health, functional dependency, and depression are regressed on the well-being measures from the previous waves, other control variables and volunteer status, volunteer hours, type and number of volunteer organizations, and the perceived benefit to others of the volunteer work. Results. Older adults who volunteer and who engage in more hours of volunteering report higher levels of well-being. This positive effect was not moderated by social integration, race, or gender. There was no effect of the number of organizations for which the older adult volunteered, the type of organization, or the perceived benefit of the work to others. Discussion. This work contributes to a knowledge base that points to the development of social programs and policies that maximize the engagement of older adults in volunteer roles. The findings suggest that targeting efforts may not be warranted, in that there are not differential benefits according to personal characteristics of the volunteer. Future studies have to address the nature of the social institutions that will maximize the number of elders in these roles and the benefits that they accrue.

Giving While in Need: Support Provided by Disabled Older Adults
K Boerner and JP Reinhardt (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S297-S304

Objectives.This paper focuses on predictors and patterns of support provision over time among disabled older adults. The ability to provide support to others may become an especially critical issue for persons who are dealing with a progressive, chronic impairment that typically results in increased functional disability and thus places them in greater need for support. Methods.This multilevel analysis examined change in support provision over time, as well as the degree to which sociodemographics, health, functional disability, use of rehabilitation services, and the receipt of support predicted support provision. Participants, 449 older adults with a progressive, chronic visual impairment, were interviewed three times over an 18-month period. Results.Affective and instrumental support provided to family and friends each showed a decrease over time. Age, gender, and education emerged as predictors of support provided at baseline. Receipt of support was positively related to support provision at all three time points, both within and across support types. Discussion.Findings indicated that there may be feasible ways of providing support, even by older adults who are in need of support themselves.

Volunteerism and Socioemotional Selectivity in Later Life
J Hendricks and SJ Cutler (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:S251-S257

Objectives. The goal of this work was to assess the applicability of socioemotional selectivity theory to the realm of volunteerism by analyzing data drawn from the September 2002 Current Population Survey Volunteer Supplement. Methods. Total number of organizations volunteered for and total number of hours engaged in volunteer activities were utilized to obtain measures of volunteer hours per organization and volunteer hours in the main organization to determine whether a selective process could be observed. Descriptive statistics on age patterns were followed by a series of curve estimations to identify the best-fitting curves. Results. Logistic age patterns of slowly increasing then relatively stable volunteer activity suggest that socioemotional selectivity processes are operative in the realm of voluntary activities. Discussion. Socioemotional selectivity theory is applicable to voluntary activities.

Formal Volunteering as a Protective Factor for Older Adults' Psychological Well-Being
EA Greenfield and NF Marks (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:S258-S264

Objectives. Guided by interactional role theory and employing a resilience framework, this study aimed to investigate whether formal volunteering protects older adults with more role-identity absences in major life domains (partner, employment, and parental) from poorer psychological well-being. Methods. We used data from 373 participants, aged 65–74, in the 1995 National Survey of Midlife Development in the U.S. (MIDUS). Multivariate regression models estimated the effects of major role-identity absences, formal volunteering, and the interaction between major role-identity absences and volunteering on respondents' negative affect, positive affect, and purpose in life. Results. Participants with a greater number of major role-identity absences reported more negative affect, less positive affect, and less purpose in life. Being a formal volunteer was associated with more positive affect and moderated the negative effect of having more major role-identity absences on respondents' feelings of purpose in life. Discussion. Consistent with previous studies, findings indicate that having more role-identity absences constitutes a risk factor for poorer psychological well-being. Results further demonstrate that being a formal volunteer can protect older adults with a greater number of major role-identity absences from decreased levels of purpose in life. The findings suggest that associations between volunteering and psychological well-being might be contingent upon the volunteer's role-identity status and the dimension of psychological well-being examined.

Altruism Relates to Health in an Ethnically Diverse Sample of Older Adults
WM Brown, NS Consedine and C Magai (2005) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60:P143-P152

The existing literature indicates links between aspects of social network functioning and health outcomes. It is generally believed that networks that are larger or provide greater instrumental and emotional support contribute to improved health and, perhaps, greater longevity. Recently, it has been suggested that giving as well as receiving social support may be of benefit. On the basis of evolutionary theories of emotion and altruism, the current study sought to test this thesis in a large, ethnically diverse sample of community-dwelling older adults. As expected, levels of social support given were associated with lower morbidity, whereas levels of receiving were not. It is important that these relations held even when (a) socioeconomic status, education, marital status, age, gender, ethnicity, and (b) absolute network size and activity limitation were controlled for. Results are discussed in terms of their implications for theory regarding the relations among social exchanges, giving, and later life adaptation among older adults.


The retiree identity: gender and race differences
ME Szinovacz and SE DeViney (1999) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 4 S207-S218

OBJECTIVES: This study's focus on the retiree identity complements research on institutionalized retirement criteria. We test whether tensions between individuals' own life circumstances and institutionalized retirement criteria manifest themselves in the extent to which individuals assume a retiree identity and in the overlap between self-definitions and attainment of institutionalized retirement criteria. METHODS: The analyses rely on logistic regressions and are based on data from the National Survey of Families and Households (N = 1,633). RESULTS: Labor force participation serves as the main basis for the retiree identity, but other life experiences (work history, disability, spouse's retirement, economic status, family history) also contribute to individuals' self-identification as retiree and the "fit" between self-identification and attainment of institutionalized retirement crieria. Men's retirement identity seems more closely tied to their attainment of institutionalized retirement criteria and a continuous and successful work career, whereas a variety of life circumstances impinge on women's retiree definitions. Moderately disabled African Amerians are more likely to self-identify as partly or fully retired. DISCUSSION: While employment constitutes the main reference for individuals' self-definition as retiree, other life circumstances also have some influence. Full understanding of retirement transitions will require more attention to the meaning context of retirement among divergent population groups.

The Impact of Involuntary Job Loss on Subsequent Alcohol Consumption by Older Workers: Findings From the Health and Retirement Survey
WT Gallo, EH Bradley, M Siegel and SV Kasl (2001) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 56:S3-S9

Objective. To estimate the effect of involuntary job loss on subsequent alcohol consumption by older workers in the United States. Methods. Using longitudinal data from the 1992 and 1994 waves of the Health and Retirement Survey, the authors estimated multivariate models to assess the impact of involuntary job loss on subsequent alcohol use. Two outcomes were investigated: reported daily alcohol consumption and onset of drinking. The analysis sample included 207 workers who experienced involuntary job loss between survey dates and a comparison group of 2,866 continuously employed workers. Results. After baseline alcohol consumption and a variety of socioeconomic and illness-related covariates were controlled, involuntary job loss was not associated (p > .05) with number of daily drinks consumed at follow-up. However, among those who did not consume alcohol at baseline, individuals who suffered involuntary job loss were twice as likely as continuously employed individuals to start drinking by follow-up (OR = 2.01; CI = 1.06–3.80). The majority of those who began drinking at follow-up reported drinking less than 1 drink per day. Discussion. The findings provide evidence of a significant relationship between job loss and subsequent alcohol use among baseline nondrinkers. However, the magnitude of the changes in drinking was quite modest.

Who Expects to Continue Working After Age 62? The Retirement Plans of Couples
A Mehraban Pienta and MD Hayward (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:S199-S208

Objectives. This study examines the individual, spousal, and household characteristics associated with the retirement expectations of husbands and wives. Methods. Using data from the 1992 Health and Retirement Study, subjective probabilities of working full-time after reaching age 62 and age 65 are used to measure retirement expectations. The retirement expectations of husbands and wives are modeled simultaneously using a joint-generalized least-squares approach. Results. Within a marriage, retirement expectations are shaped by individual, spousal, and household characteristics. We observe some gender differences in cross-spousal influence with wives' retirement expectations being more influenced by husbands' resources and constraints than vice versa. Nonetheless, individual and household factors associated with retirement expectations are widely shared by husbands and wives. Discussion. Husbands and wives both respond to individual and joint constraints and opportunities when planning for retirement. Findings support that there is considerable overlap in retirement planning of husbands and wives during early parts of the retirement decision-making process. However, inequity in cross-spousal influences is a defining characteristic of retirement decision making. Implications for both policy makers and practitioners are briefly discussed.

Impact of Husbands' Involuntary Job Loss on Wives' Mental Health, Among Older Adults
M Siegel, EH Bradley, WT Gallo and SV Kasl (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S30-S37

Objectives. This study estimates the consequences of older husbands' involuntary job loss for their wives' mental health. Methods. Using longitudinal data from the 1992, 1994, and 1996 waves of the Health and Retirement Study, multivariate regression models were estimated to measure the impact of older husbands' involuntary job loss on wives' mental health. We created two longitudinal data sets of two waves each to use in our analysis. The first data set, or period, combined Waves 1 and 2 of the Health and Retirement Study and described the 1992–1994 experience of spouse pairs in our sample. It included the wives of 55 husbands who experienced involuntary job loss between these survey dates and a comparison group of wives of 730 continuously employed husbands. The second data set described the 1994–1996 experience of couples. In particular, it included the wives of an additional 38 husbands who were displaced from their jobs between Waves 2 and 3, and a comparison group of wives of 425 husbands who were continuously employed from 1994 to 1996. Results. Husbands' involuntary job loss did not have a statistically significant effect on wives' mental health. We found no evidence that changes in husbands' depressive symptoms modified the effect of his job loss on wives' mental health. In the first period only, the effect of husbands' job loss on wives' mental health was more pronounced for wives who were more financially satisfied at baseline. Discussion. There is limited evidence among this cohort that husbands' job loss increases wives' subsequent depressive symptoms. However, the effect of husbands' job loss on wives' mental health appears to be magnified when wives report being financially satisfied pre-job loss. This suggests that, for subgroups of older couples, mental health services specifically targeted at displaced men should also be made available to wives.

Born to Retire: The Foreshortened Life Course
DJ Ekerdt (2004) The Gerontologist 44:3-9

Retirement is no longer a concern solely for the second half of life. Rather, the idea that we will someday retire is increasingly present to all adults and it is even urged on adolescents. The earliest reaches of adulthood are being colonized by frequent reminders that it takes individual effort to achieve retirement. The changing nature of pensions, the identification of retirement saving with financial markets, the politics of Social Security, the aging baby boom generation, and the interests of a powerful industry and of government are daily compelling people's attention to retirement as a lifelong goal. With retirement as adulthood's great project of deferred gratification, the result could be greater personal readiness to retire but also some ironic outcomes, such as a stronger retirement norm, reluctance to spend on children, and outsized expectations for later life.

Work at Older Ages in Japan: Variation by Gender and Employment Status
JM Raymo, J Liang, H Sugisawa, E Kobayashi and Y Sugihara (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:S154-S163

Objectives. This study describes the correlates of labor force participation among Japanese men and women aged 60–85 and examines differences by gender and employment status. Methods. Using four waves of data collected from a national sample of older Japanese between 1990 and 1999, we estimate multinomial logistic regression models for three measures of labor force participation (current labor force status, labor force exit, and labor force re-entry) as a function of individual and family characteristics measured 3 years earlier. Results. Labor force participation is significantly associated with socioeconomic status, longest occupation, and family structure. The strength and nature of these relationships differ markedly for men and women and for wage employment and self-employment. Discussion. The emphasis on life course experiences and work–family interdependence characterizing recent research on retirement in the United States is clearly relevant in Japan as well. To better understand later-life labor force participation in Japan, subsequent research should incorporate more direct measures of life course experiences and family relationships and attempt to make explicit cross-national comparisons of these relationships.


Time use of old and very old Berliners: Productive and consumptive activities as functions of resources
PL Klumb and MM Baltes (1999) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 5 S271-S278

OBJECTIVES: The aims of this study were to examine time use of elderly women and men and to explain age- and gender-related variance in activity levels in terms of differences in available resources. METHODS: Activities reported in an elderly sample stratified for age and gender (N = 485, Age: 70-103 years) were aggregated into three classes: regenerative, productive, and consumptive activities and regressed on income, presence of a partner in the household, education, walking mobility, and labor force participation. RESULTS: Levels in productive and consumptive activities were decreased in the old-old. Moreover, young-old women spent more time working in the household than any other group. Most of the age- and gender-related variance in activity levels could be explained by differences in available resources. For men, living with a partner was associated with less time spent for productive activities and enhanced leisure time, whereas for women, the reverse was observed. The expected reduction of unpaid work time as a function of income (income effect) was not observed. DISCUSSION: Elderly individuals do contribute to societal production. Allocation of time to productive and consumptive activities is a function of available resources, amounts and effects of which differ for young-old and old-old as well as for women and men.

Multiple roles and well-being among midlife women: testing role strain and role enhancement theories
J Reid and M Hardy (1999) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 6 S329-S338

OBJECTIVE: Research on women's multiple roles frequently adopts one of two perspectives: role strain, which argues that assuming multiple roles is detrimental to mental well-being, or role enhancement, which argues that engaging in multiple roles enhances mental well-being. We argue that the relationship between role occupancy and well-being is manifested through multiple dimensions of role experiences. We investigate the association between depressive symptomatology and various dimensions of the roles of wife, mother, paid worker, and informal caregiver to aging parents. METHODS: Data are from the 1992 wave of the Health and Retirement Study. Depressive symptomatology, measured by a subset of the CES-D scale, is the dependent variable. To assess the robustness of findings relative to different functional forms of the dependent variable, we estimate multiple regression, log- linear regression, and multinomial logit models. Independent variables include demographic characteristics, measures of role occupancy, role demands, and role satisfaction. RESULTS: Although the number of roles women assume affects their reports of depressive symptoms, once the demand and satisfaction associated with these roles is controlled, number has no effect; that is, the effect of the number of roles is indirect. DISCUSSION: Our results highlight the importance of women's perceptions of the quality of their roles in relation to their overall well-being. Future investigations of women's multiple roles should examine how roles may provide rewards, impose constraints, or generate conflict, as well as the extent to which the willingness to assume multiple roles and the reported levels of role satisfaction and mental well-being may be jointly endogenous.

Stress and the devaluation of highly salient roles in late life
N Krause (1999) Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Vol 54, Issue 2 S99-108

OBJECTIVE: To see whether older adults cope with stress in highly salient roles by devaluing the importance of the role in which the event emerged. METHODS: Interviews were conducted with a nationally representative sample of elderly people at two points in time: 1992- 1993 and 1996-1997. Complete data are available for 589 older adults. Respondents were asked to identify which of eight roles they value most highly at both points in time. Information on the number of stressful events arising in each role was also obtained. RESULTS: The findings indicate that elderly people are less likely to devalue highly salient roles when stressful events are encountered in them. DISCUSSION: The results suggest that instead of turning away from highly cherished roles when stressful life events arise, older adult may become more committed to them.

Racial differences in the multiple social roles of older women: implications for depressive symptoms
DL Cochran, DR Brown and KC McGregor (1999) The Gerontologist, Vol 39, Issue 4 465-472

The relationship between multiple role participation and depressive symptoms experienced by African American (n = 547) and White (n = 2,152) women aged 55-61 was explored. Data were obtained from the Health and Retirement Study (HRS). Racial differences in the social roles of marriage, employment, grandmother, care provider, and volunteer and their influence on level of depressive symptoms were examined. African Americans reported higher levels of depressive symptoms than Whites. Additionally, marriage, employment, and total number of social roles were the most powerful predictors of depressive symptoms for both African American and White women. However, employment was more important in diminishing depressive symptoms among African American than White women occupying multiple social roles.

Change in the Centrality of Women's Multiple Roles: Effects of Role Stress and Rewards
TR Norton, MA Parris Stephens, LM Martire, AL Townsend and A Gupta (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:S52-S62

Objectives. To examine (a) change versus stability over one year in four social roles occupied by 182 midlife women (parent care provider, mother, wife and employee), (b) increases in role stress and increases in role rewards as predictors of change in centrality, and (c) whether increases in stress or increases in rewards were stronger predictors when the 2 were considered simultaneously. Method. Interviews were conducted at 2 time points approximately 1 year apart. Participants were asked to rate the personal importance of each role on a scale of 1 to 10. Stress and rewards in each role were also assessed. Results. Analyses revealed considerable change in role centrality, especially in the parent-care and employee roles. Increases in wife and employee stress were associated with decreases in the centrality of these roles, whereas increases in rewards in each of the four roles were related to increases in the centrality of the respective roles. When considered simultaneously, role rewards were stronger predictors of change in centrality than role stress. Discussion. These findings suggest that the centrality of a social role can change over time in response to stressful and rewarding role experiences.


Changes and Continuities in the Determinants of Older Adults' Voter Turnout 1952–1996
M. Jean Turner, Todd G. Shields, and Darinda Sharp, (2001) The Gerontologist 41:805-818

Purpose: The goal of this project was to examine the factors related to the high level of voter turnout among older adults and how these factors have changed across the past 50 years. The study builds on previous research efforts by combining individual level analyses from three nationally representative surveys. Design and Methods: We examined voter turnout among older citizens using the American National Election Studies (ANES) 1952–1996, the Current Population Studies (CPS) 1972–1996, and the General Social Surveys (GSS) 1972–1996. Logit regression identified significant factors that contribute to or detract from voting in presidential elections. Results: Included in the extensive results, we found that being married, attending church, and contact by political operatives (since the 1980 election) contributed positively to older voters' turnout, whereas living in the South was a negative predictor. Implications: Triangulating data sources, we are able to utilize the strengths of each study—providing an overview of the determinants of voter turnout and understanding of the changes related to older Americans' turnout in presidential elections.

Older people and voting participation: Past and future
RH Binstock (2000) The Gerontologist, Vol 40, Issue 1 18-31

Contemporary politicians and their advisors focus on older voters as a pivotal segment of the American electorate. Some analysts predict that this preoccupation will intensify in the years ahead and the demands of older persons will dominate American politics. One reason for this focus on older voters is that they constitute a substantial proportion of voters today, largely because of age-group differences in voting turnout rates, and they will be a considerably larger proportion in the future because of the aging of the baby boom cohort. This article examines the voting participation of age groups in past presidential elections and explores what the voting participation of older persons could be like when the baby boom cohort reaches old age. The political significance of older persons being a large percentage of voters is considered with respect to both the past and the future.


Age Differences in Voluntary Association Memberships: Fact or Artifact
SJ Cutler and J Hendricks (2000) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 55:S98-S107

Objectives. To determine if the curvilinear relationship between age and voluntary association memberships is due to compositional differences between age groups. Methods. Data are drawn from 12 nationally representative surveys covering the period 1974–1994 and including items on membership in 16 types of associations. Age is categorized into 14 groups ranging from 18–24 through 85+. Patterns of age differences in number of association memberships are examined before and after controlling for several variables related both to age and to memberships. Results. At the bivariate level, number of memberships increases through ages 40–44 and then declines fairly steadily. When controls for compositional differences are introduced, the curvilinear pattern of age differences is replaced by one showing an increasing number of memberships through ages 55–59, a slight decrease in the 60–64 age group, and then generally stable membership levels through the 85+ age group. Discussion. The lower levels of voluntary association memberships of older persons consistently identified in bivariate analyses appear to be largely due to differences in compositional characteristics between the older and other age groups.

The Effects of Membership in Church-Related Associations and Labor Unions on Age Differences in Voluntary Association Affiliations
J Hendricks and SJ Cutler (2001) The Gerontologist 41:250-256

Purpose: When compositional differences between age groups are controlled, the bivariate, curvilinear pattern of age differences in voluntary association memberships is replaced by one in which peak membership levels occur in late middle age and remain relatively stable thereafter. We sought to determine if this adjusted pattern persists when widespread memberships in two types of associations are removed: (1) church-related organizations, in which membership increases with age but may be confounded with church membership per se; and (2) labor unions, in which membership is also widespread but may not be "voluntary." Design and Methods: Total memberships in 14 types of associations were examined using aggregated data from 12 national surveys conducted between 1974 and 1994. Results: The familiar curvilinear relationship at the bivariate level appears, but in the multivariate analysis, membership levels rise from ages 18–24 through 55–59 and persist close to that level through ages 85 and older. Implications: The results reaffirm that age differences in voluntary association affiliations are due to age-based compositional differences; they also show, however, that the pattern observed with controls is neither driven by membership in church-related "associations" nor altered when membership in labor unions is excluded.

Religion and Cognitive Dysfunction in an Elderly Cohort
PH Van Ness and SV Kasl (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S21-S29

Objectives. This study examines whether attendance at religious services has an inverse association with cognitive dysfunction in an elderly cohort in whom it has already been shown that religious attendance has an inverse association with physical disability and that social engagement has an inverse association with cognitive decline. Methods. The study population is a racially and religiously diverse sample of 2,812 community-dwelling men and women from New Haven, Connecticut; it was representative of New Haven in 1982, but not of the United States then or now. The primary study hypothesis proposes that attendance at religious services as measured in 1982 contributes to the prediction of lower levels of cognitive dysfunction in 1985 and 1988. A multivariate logistic regression analysis controlling for seven sociodemographic, four behavioral, and seven biomedical covariables is conducted. Results. Study results show an inverse association between religious attendance in 1982 and cognitive dysfunction in 1985 (odds ratio = 0.64; 95% confidence interval = 0.49, 0.85). Religious attendance as measured in 1982 no longer contributes to the prediction of cognitive dysfunction in 1988. Discussion. The short-term nature of the effect is partially explained by differential mortality. Persons with infrequent religious service attendance and with high levels of cognitive dysfunction in 1982 were more likely to die in the period from 1985 to 1988.

Common Facets of Religion, Unique Facets of Religion, and Life Satisfaction Among Older African Americans
N Krause (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:S109-S117

Objectives. Common facets of religion are those aspects of religion that can be shared by people from any racial group. In contrast, unique facets of religion are available only to people in specific racial groups. The purpose of this study is to evaluate the interface among common facets of religion, unique facets of religion, and life satisfaction in a nationwide sample of older Black people. Methods. Interviews were conducted with a nationally representative sample of older African Americans. Survey items were administered to assess common religious factors (e.g., the frequency of church attendance) and unique religious factors (i.e., the belief that religion sustains Black people in the face of racial adversity). Subjective well-being was measured with a life satisfaction index. Results. The findings reveal that both the common and the unique aspects of religion contribute to life satisfaction among older African Americans. Discussion. Most studies on race differences in religion focus solely on common religious factors that may enhance the subjective well-being of older Whites as well as older Blacks. The findings from this study are important because they call attention to the insight that can be obtained by also taking the unique facets of religion for older Black people into consideration.

Religious Attendance and Mortality: An 8-Year Follow-Up of Older Mexican Americans
TD Hill, JL Angel, CG Ellison and RJ Angel (2005) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60:S102-S109

Objectives. Studies in the area of religion and mortality are based primarily on data derived from samples of predominantly non-Hispanic Whites. Given the importance of religion in the lives of Hispanics living in the United States, particularly older Hispanics, we examine the effects of religious attendance on mortality risk among Mexican Americans aged 65 and older.
Methods. We employ data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly to predict the risk of all-cause mortality over an 8-year follow-up period.
Results. Overall, the results show that those who attend church once per week exhibit a 32% reduction in the risk of mortality as compared with those who never attend religious services. Moreover, the benefits of weekly attendance persist with controls for sociodemographic characteristics, cardiovascular health, activities of daily living, cognitive functioning, physical mobility and functioning, social support, health behaviors, mental health, and subjective health.
Discussion. Our findings suggest that weekly church attendance may reduce the risk of mortality among older Mexican Americans. Future research should focus on identifying other potential mediators of the relationship between religious involvement and mortality risk in the Mexican-origin population.


The economic and fiscal impact of aging retirees on a small rural region
JI Stallmann, SC Deller and M Shields (1999) The Gerontologist, Vol 39, Issue 5 599-610

The literature on the economic and fiscal impacts of in-migrating retirees on rural communities tends to concentrate on the younger, more affluent newly retired. This article addresses an issue not systematically addressed: the impacts on communities as these retirees age. Households that vary by age have different income levels and expenditure patterns. A county-level, conjoined input- output/econometrics simulation model is used to assess the impacts of an aging rural population. As hypothesized, the magnitude and nature of impacts is in direct proportion to relative household size and income level. The increased local government expenditures are covered by the increased revenues, even as retirees age.

Introduction: Why Study Age Integration?
P Uhlenberg (2000) The Gerontologist 40:261-266

The Forum is pleased to publish the following essays on age integration, which are adapted from a working paper issued in May 1999 by the National Institute on Aging. The working paper, one component of NIA's Program on Age and Structural Change (PASC), was edited by Matilda White Riley and Peter Uhlenberg from contributions to conferences at the International Sociological Association (in Montreal) and the American Sociological Association (in San Francisco). Our purpose is to introduce to a broader readership this important area of inquiry, as well as to provide specialists with a summary of the current state of the field.

The Effect of Widowhood on Older Adults' Social Participation: An Evaluation of Activity, Disengagement, and Continuity Theories
RL Utz, D Carr, R Nesse, and CB Wortman (2002) The Gerontologist 42:522-533

Purpose: This study evaluated how levels of social participation change as a result of late-life widowhood. Social participation is a multidimensional construct incorporating both formal (e.g., meeting attendance, religious participation, and volunteer obligations) and informal (e.g., telephone contact and social interactions with friends) social roles. Design and Methods: Using data from the Changing Lives of Older Couples study, analyses compared widowed persons to continuously married control participants to evaluate whether widowhood affects older adults' levels of social participation. Results: Widowed persons had higher levels of informal social participation than nonwidowed persons, whereas formal social participation levels were comparable between the two groups. Social participation levels decrease before the death of a spouse, primarily because of poor spousal health, and increase following the loss, because of increased support from friends and relatives. Implications: Maintaining continuity in the realm of social participation is a strategy older adults use to cope with spousal loss; however, not all widowed persons have the same resources to alter their levels of social participation.

Social Factors and Mortality in the Old-Old in Israel: The CALAS Study
A. Walter-Ginzburg, T. Blumstein, A. Chetrit and B. Modan (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:S308-S318

Objectives. Using a theoretical framework that divided social factors measures into structure, function, and social engagement, this study determined those aspects of social networks most significantly associated with 8-year, all-cause mortality among the old-old in Israel.
Methods. Jews (n = 1,340) aged 75–94 living in Israel on January 1, 1989, were randomly selected from the National Population Register; stratified by age, sex, and place of birth; and interviewed in person. Mortality was determined according to the National Death Registry (December 1997). Results. After controlling for sociodemographics and measures of health, cognitive status, depressive symptoms, and physical function, the measures of social engagement that explicitly involved others were associated with a lower risk of mortality. No measure of the function of the social network was associated with risk of mortality. Living in the community without a spouse and with a child and living in an institution were significantly associated with a higher risk of mortality. Discussion. The finding that participating in activities with people outside of the immediate family is associated with a lower risk of death has practical implications for helping the aging population and their families in their decision-making process. Lack of support for the hypothesis that those with more social support would show reduced risk of mortality may indicate that the positive effect of perceiving support and the negative effect of needing support may cancel each other out and result in no perceived effect. In this population, the association between socioeconomic status (SES) and the risk of mortality seems to be expressed through the living arrangements, with the sick and frail, both in institutions (higher SES) and in the community with a child or other (lower SES), having a higher risk of mortality. These findings are consistent with the use of children as a substitute for institutionalization, and imply that at least some cohabitation was the caretaking solution for the noninstitutionalized old-old who were of low SES, frail, and close to death.

Giving Up and Replacing Activities in Response to Illness
J Duke, H Leventhal, S Brownlee and EA Leventhal (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P367-P376

Data from a longitudinal study of 250 older adults were used to examine activity loss and replacement as a consequence of an important illness episode. Multiple regression analyses revealed that reductions in activity were predicted by physical factors, specifically illness chronicity and severity. In contrast, replacing lost activities was facilitated by social support and optimism and inhibited by a belief in the need to conserve physical resources. An examination of the long-term benefits of replacing activities revealed that older adults who replaced a lost activity had higher positive affect levels 1 year after illness onset than those who did not replace activities. Continuing activity during illness episodes can help maintain positive well-being over time.

Longitudinal Predictors of Proactive Goals and Activity Participation at Age 80
CK Holahan and JR Chapman (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P418-P425

This study investigated longitudinal predictors of proactive goals and activity participation at age 80 among members of the Terman Study of the Gifted. The participants were 242 individuals between the ages of 75 and 84 (M = 79.53) who responded to questionnaires in 1992, 1972, and 1950. Proactive goals included goals for involvement and achievement. Activity participation included intellectual, cultural, and social service activities. LISREL 8 was used to test an integrative longitudinal latent variable model of the associations among the variables. The results showed that purposiveness at age 40 predicted proactive goals at age 80 indirectly through satisfaction with cultural life and service to society measured at age 60. Satisfaction with culture and service at age 60 was related to activity participation at age 80 through proactive goals. Women rated proactive goals as more important to them and indicated greater participation in the activities in this study than did men, but the structural equation model was invariant across the two groups. The results are discussed in terms of contemporary research and theory concerning the self-concept and life span development.

Social Participation in Very Old Age: Cross-Sectional and Longitudinal Findings from BASE
A Bukov, I Maas and T Lampert (2002) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57:P510-P517

Social participation, defined as socially oriented sharing of individual resources, is often regarded as an important criterion of quality of life in old age. We distinguished three types of participation with respect to content, context, and resources required to participate: collective, productive, and political participation. Data from the multidisciplinary Berlin Aging Study were used to describe social participation of a very old population and to examine individual differences and changes over time. Analyses showed that social participation is cumulative. Individuals who engaged in political activities also took part in the other two types, and those who engaged in productive activities also participated in collective activities. Although many persons changed their social participation over the 4-year period, the cumulative pattern within the population remained unchanged. Educational and occupational resources were positively related to the intensity of social participation in old age, but changes in social participation could be better explained by age and health.

The Relation Between Everyday Activities and Successful Aging: A 6-Year Longitudinal Study
VH Menec (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S74-S82

Objectives. Activity has long been thought to be related to successul aging. This study was designed to examine longitudinally the relation between everyday activities and indicators of successful aging, namely well-being, function, and mortality. Methods. The study was based on the Aging in Manitoba Study, with activity being measured in 1990 and function, well-being, and mortality assessed in 1996. Well-being was measured in terms of life satisfaction and happiness; function was defined in terms of a composite measure combining physical and cognitive function. Results. Regression analyses indicated that greater overall activity level was related to greater happiness, better function, and reduced mortality. Different activities were related to different outcome measures; but generally, social and productive activities were positively related to happiness, function, and mortality, whereas more solitary activities (e.g., handwork hobbies) were related only to happiness. Discussion. These findings highlight the importance of activity in successful aging. The results also suggest that different types of activities may have different benefits. Whereas social and productive activities may afford physical benefits, as reflected in better function and greater longevity, more solitary activities, such as reading, may have more psychological benefits by providing a sense of engagement with life.

Social Networks, Social Integration, and Social Engagement Determine Cognitive Decline in Community-Dwelling Spanish Older Adults
MV Zunzunegui, BE Alvarado, T Del Ser and A Otero (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S93-S100

Objectives. To examine the influence of social networks and social engagement on cognitive decline in a population-based cohort of elderly people, and to assess gender differences in the effect of social relations on cognition. Methods. A longitudinal study of community-dwelling people over 65 was carried out. Cognitive function (orientation and memory) in 1997 and cognitive decline (absent, mild, and severe) over 4 years (1993–1997) were assessed using an instrument previously validated for populations with a low level of education. The effect of social networks, social integration, and social engagement with friends, children, and relatives on cognitive function and cognitive decline was estimated by multiple linear and logistic regressions after adjusting for age, sex, education, depressive symptoms, systolic and diastolic blood pressure, and functional status. Results. Poor social connections, infrequent participation in social activities, and social disengagement predict the risk of cognitive decline in elderly individuals. The probability of cognitive decline was lower for both men and women with a high frequency of visual contact with relatives and community social integration. Engagement with friends seemed to be protective for cognitive decline in women but not in men. Discussion. This longitudinal study indicates that few social ties, poor integration, and social disengagement are risk factors for cognitive decline among community-dwelling elderly persons. The nature of the ties that influence cognition may vary in men and women.

Age-Related Declines in Activity Level: The Relationship Between Chronic Illness and Religious Activities
M Reindl Benjamins, MA Musick, DT Gold and LK George (2003) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 58:S377-S385

Objectives. When they are faced with major life transitions such as worsening health, older adults may selectively withdraw from activities. Because of the importance of religion to a large proportion of the elderly population, research is needed to determine whether levels of religious involvement are affected by serious health problems such as the onset of a chronic disease. Methods. Multiple waves of data from the Duke Established Populations for Epidemiologic Studies of the Elderly were used to analyze the effects of five different chronic conditions on two religious activities: service attendance and religious media use. Results. Findings show that broken hip, cancer, and stroke were significantly related to levels of religious attendance. Furthermore, the combined conditions also significantly predicted religious attendance, with more conditions being associated with lower attendance. Neither the individual or summed conditions were significantly related to religious media use. Discussion. The study finds some evidence to support the idea that older adults withdraw from social activities such as religious involvement when faced with declining health. In contrast, levels of religious media use remain stable following the onset of one or more new chronic conditions.

Subjective Usefulness and 6-Year Mortality Risks Among Elderly Persons in Japan
K Okamoto and Y Tanaka (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:P246-P249

Several studies have demonstrated that the loss of a sense of one's own self-worth has an influence on the health status, psychological functioning, and quality of life in the aged. We used longitudinal data from 784 elderly residents (mean age = 73 years) to examine the relationship between subjective usefulness and 6-year mortality. We hypothesized that subjective usefulness is an important indicator of quality of life among the elderly population, and subsequently of mortality. We elicited information on subjective usefulness at baseline by using a self-administered questionnaire. Results of longitudinal analyses showed that subjective usefulness may be significantly associated with self-rated health and subsequent mortality. This indicates that subjective usefulness plays an important role in enhancing survival in the elderly population.

A Longitudinal Study of Black–White Differences in Social Resources
LL Barnes, CF Mendes de Leon, JL Bienias and DA Evans (2004) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 59:S146-S153

Objectives. This study examined the differences in levels of social networks and social engagement between older Blacks and Whites and racial differences in rates of change in social resources over time. Methods. The sample consisted of 5,102 Blacks and Whites, aged 65 and older, from the Chicago Health and Aging Project, who underwent up to three interviews during an average of 5.3 years of follow-up. Repeated measures of social networks were based on the number of children, relatives, and friends seen at least once a month. Social engagement was measured at each interview with four items related to social and productive activity. Random effects models were fitted to test the effect of race on social resources and change in resources over time. Results. Blacks had smaller social networks and lower levels of social engagement than Whites. Racial differences in these resources were stable during follow-up. Socioeconomic status reduced racial differences in social engagement but not social networks. Discussion. The findings provide evidence for lower levels of social resources among older Blacks. There was little evidence that racial differences were the result of greater decline during old age itself.

Linking the Two Ends of Life: What Gerontology Can Learn From Childhood Studies
RA Settersten, Jr., (2005) The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 60:S173-S180

This paper extends provocative ideas from the emerging interdisciplinary field of childhood studies to the field of gerontology. These ideas constitute a framework for building new kinds of theories and research on old people and old age—gathered around rights and responsibilities of and for old people; focused on their agency and social participation; concerned with the social problems of old people, as well as how old people are constructed to be social problems; anchored in their perspectives and voices; dedicated to describing and explaining both commonness and difference in their experiences and statuses; devoted to understanding old people as beings and becomings; and attentive to the interdependence of generations within families and societies. These commitments will require gerontology to strengthen its treatment of sociocultural phenomena, prompt more genuinely interdisciplinary scholarship, and advocate a wider range of research methods and data. A "new social studies of old people and old age," nurtured around these ideas, will also raise the visibility of old people and old age in science, public policy, and social life.