Purpose: Studies of later-life families have revealed that sibling tension often increases in response to parents’ need for care. Both theory and research on within-family differences suggest that when parents’ health declines, sibling relations may be affected by which children assume care and whether siblings perceive that the parent favors some offspring over others. In the present study, we explore the ways in which these factors shape sibling tension both independently and in combination during caregiving. Design and Methods: In this article, we use data collected from 450 adult children nested within 214 later-life families in which the offspring reported that their mothers needed care within 2 years prior to the interview. Results: Multilevel analyses demonstrated that providing care and perceiving favoritism regarding future caregiving were associated with sibling tension following mothers’ major health events. Further, the effects of caregiving on sibling tension were greater when perceptions of favoritism were also present. Implications: These findings shed new light on the conditions under which adult children are likely to experience high levels of sibling tension during caregiving. Understanding these processes is important because siblings are typically the individuals to whom caregivers are most likely to turn for support when assuming care of older parents, yet these relationships are often a major source of interpersonal stress.
Caregiver stress; Caregiving—informal; Intergenerational relationships; Parent/child relationships
Purpose: We use data from a longitudinal, within-family study to identify factors that predict which adult siblings assumed caregiving responsibilities to older mothers over a 7-year period. Design and Methods: Data for the study were collected from 139 older mothers at 2 points 7 years apart regarding their expectations and experiences of care from 537 adult children. Results: Children whom mothers identified at T1 as their expected future caregivers were much more likely to provide care when a serious illness occurred. Caregiving offspring were also more likely at T1 to have shared their mothers’ values, lived in proximity, and to be daughters. Implications: The findings indicate the degree to which a mother’s expectations for care predict actual caregiving by that child. Practitioners working with older adults should explore parents’ expectations for future care that involves their adult children.
Caregiving; Parent–adult child relations; Family issues; Caregiver selection
Background: Substantial agreement has been achieved on research priorities in palliative care over the past 15 years, as evidenced by consensus conferences and systematic reviews. Despite the presence of a widely endorsed research agenda, however, addressing the gaps in scientific knowledge has progressed slowly, suggesting that researchers face significant obstacles to conducting high-quality research on the most pressing topics in the field.
Objective: To systematically identify barriers to improved and expanded palliative care research as reported by researchers.
Design: Semistructured telephone interviews to solicit barriers to research in palliative care.
Setting/Subjects: A purposive, interdisciplinary sample of 61 leading researchers in palliative care.
Measurements: Interviews were transcribed and analyzed using standard qualitative methods.
Results: Respondents named five barriers impeding progress: (1) funding, (2) institutional capacity, (3) researcher workforce, (4) challenges related to the topic and population (e.g., attrition, heightened human subjects protections), and (5) public and professional misunderstanding of palliative care and aversion to topics related to serious illness and end-of-life.
Conclusions: Research in palliative care is being held back by significant barriers that require the attention of institutions and funders. The consensus within the interdisciplinary sample indicates that concentrated effort to address barriers related to funding and researcher workforce could facilitate progress on established research priorities. More research is needed on viable strategies for overcoming the identified barriers.
Objectives: Although numerous studies have measured behaviors among individuals in congregate settings, few have focused on resident-to-resident elder mistreatment (R-REM). To our knowledge, there is no psychometrically developed measure of R-REM extant. The quantitative development of a measure of staff-reported R-REM is described. Methods: The design was a prevalent cohort study of residents of 5 long-term care facilities. The primary certified nursing assistant was interviewed about R-REM. Advanced measurement methods were used to develop a measure of R-REM. Results: The loadings on the general factor for the final 11-item scale were greater than those on the group factor except for the item “other physical behavior” (0.63 vs. 0.74), suggesting essential unidimensionality. Although the bifactor model fit was slightly better than that of the unidimensional model, the difference was trivial (bifactor comparative fit index [CFI] = 0.997, root mean square error of approximation [RMSEA] = 0.013, unidimensional CFI = 0.979, and RMSEA = 0.030). However, modest support was provided for use of verbal and physical subscales. The explained common variance statistics were 0.76 for the bifactor model compared with 0.63 for the unidimensional model. Discussion: The development of this R-REM measure will help to advance the measurement and ultimately evaluation of interventions associated with this important and under recognized problem facing residents in long-term care settings.
Elder abuse; Mistreatment; Congregate care; Item response theory; Latent variable models; Scale development
The mission of Cornell University's Edward R. Roybal Center, the Cornell Institute for Translational Research on Aging (CITRA) is to develop new ways to translate the findings of basic social science research into programs and policies that benefit vulnerable older persons and contribute to improved health outcomes. The overarching goal is the creation of a “research-ready” group of service agencies serving older people in New York City that can be linked to medical and behavioral investigators who seek engagement with service agencies for applied and intervention studies. The CITRA “model” consists of seven overlapping steps: (1) creation of a research-ready network of service agencies; (2) a community-based needs assessment to establish a research agenda for the program; (3) development of a pool of investigators who are available and willing to collaborate with service agencies; (4) development of a model pilot study program to connect investigators to community agencies; (5) investigator development; (6) seminars, events, and research-practice consensus workshops to facilitate researcher-community partner interaction; and (7) engaging researchers and practitioners on critical issues related to aging to invigorate and sustain the partnership.
Equity theory suggests that relationships are more harmonious when both members of a dyad believe that their exchanges are fair. However, the level and frequency of exchange, rather than perceptions of equity, have been the focus of most research on support and the quality of intergenerational relations. Using data from 1,426 mother–child dyads nested within 413 families collected as part of the Within-Family Differences Study, the authors explored whether mothers’ perceptions of equity are better predictors of closeness and tension than are mothers’ reports of balanced exchanges of support. Mixed-model analyses revealed that mothers’ perceptions of equity were more consistent predictors of relationship quality than were the balanced exchanges of support, though the results varied somewhat by gender of adult child. These findings contribute to a growing body of research demonstrating that the psychological processes that shape intergenerational relationships mirror those of other ties.
equity theory; intergenerational relations; relationship quality; social support
Well-known trust-building methods are routinely used to recruit and retain older African Americans into scientific research studies, yet the quandary over how to overcome this group’s hesitance to participate in research remains. We present two innovative and testable methods for resolving the dilemma around increasing older African Americans’ participation in scientific research studies. Certain specific and meaningful experiential similarities between the primary researcher and the participants, as well as clear recognition of the elders’ worth and dignity, improved older African Americans’ willingness to adhere to a rigorous research design. Steps taken in an intervention study produced a potentially replicable strategy for achieving strong results in recruitment, retention and engagement of this population over three waves of assessment. Sixty-two (n = 62) older African Americans were randomized to treatment and control conditions of a reminiscence intervention. Sensitivity to an African-American cultural form of respect for elders (recognition of worth and dignity), and intersections between the lived experience of the researcher and participants helped dispel this population’s well-documented distrust of scientific research. Results suggest that intentional efforts to honor the worth and dignity of elders through high level hospitality and highlighting meaningful experiential similarities between the researcher and the participants can improve recruitment and retention results. Experiential similarities, in particular, may prove more useful to recruitment and retention than structural similarities such as age, race, or gender, which may not in themselves result in the trust experiential similarities elicit.
Recruitment and retention; trust; older African American; experiential similarity; hospitality
Using an innovative approach, we identified research priorities in palliative care to guide future research initiatives. We searched 7databases (2005–2012) for review articles published on the topics of palliative and hospice–end-of-life care.
The identified research recommendations (n = 648) fell into 2 distinct categories: (1) ways to improve methodological approaches and (2) specific topic areas in need of future study. The most commonly cited priority within the theme of methodological approaches was the need for enhanced rigor. Specific topics in need of future study included perspectives and needs of patients, relatives, and providers; underrepresented populations; decision-making; cost-effectiveness; provider education; spirituality; service use; and inter-disciplinary approaches to delivering palliative care.
This review underscores the need for additional research on specific topics and methodologically rigorous research to inform health policy and practice.
We examine whether recently widowed mothers who needed assistance for a chronic condition, serious illness, or injury were more likely to receive care from the children they preferred as caregivers than were mothers who were divorced or had been widowed for a longer period of time.
Data were analyzed from 130 widowed or divorced mothers aged 72–83 in the second wave of the Within-Family Differences Study, all of whom reported needing assistance for a chronic condition or a serious illness or injury within 2 years prior to T2.
The findings provided evidence that recent widowhood shapes patterns of caregiving. Analyses revealed that mothers who had been widowed within 4 years were substantially more likely to receive care from adult children whom they had identified several years earlier as preferred caregivers than were mothers who were divorced or had been widowed 4 or more years.
Research has shown that mothers are at an increased risk for declining psychological well-being when caregiving preferences are not met. Findings from this study suggest that mothers who are divorced or have been widowed for several years may be at greater risk for violation of their caregiving preferences, increasing their vulnerability to declines in psychological well-being.
Widowhood; Caregiving; Parent; Adult child relations; Parental favoritism.
The emotional and physical health consequences of caring for a family member are well documented. However, although personality has been shown to affect dyadic interactions and been linked with individual outcomes for both care recipients (CRs) and caregivers (CGs), the influence of CR personality on CG health remains unexplored.
This study investigated cross-sectional associations between CRs’ five-factor personality traits and CGs’ physical and emotional health in 312 dyads of older adults with disability and their informal CGs who participated in the Medicare Primary and Consumer-Directed Care Demonstration.
Regression models controlling for CG personality, strain, and sociodemographic characteristics and CR physical impairment and pain found that agreeableness in CRs was associated with better physical health among CGs. Facet-level analyses showed specific associations between the trust and compliance facets of CR agreeableness and CG physical health. Investigation of CR personality styles revealed that the “easygoing” (N−, A+) and “well-intentioned” (A+, C−) styles predicted better CG physical health; the “leaders” (E+, A−) style had the opposite effect. No significant associations were found between CR personality and CG mental health.
Results from this study reveal the value of considering CR personality in relation to CG health and highlight the importance of assessing dispositional qualities within the context of care provision and informal assistance.
Caregiving; Chronic illness; Five-factor model personality traits; Subjective health.
Despite expansion of research on elder mistreatment, limited attention has been paid to the development of improved measurement instruments. This gap is particularly notable regarding measurement of mistreatment in long-term care facilities. This article demonstrates the value of qualitative methods used in item development of a Resident-to-Resident Elder Mistreatment (R-REM) measure for use in nursing homes and other care facilities. It describes the development strategy and the modification and refinement of items using a variety of qualitative methods.
A combination of qualitative methods was used to develop close-ended items to measure R-REM, including review by a panel of experts, focus groups, and in-depth cognitive interviews.
Information gathered from the multiple methods aided in flagging problematic items, helped to highlight the nature of the problems in measures, and provided suggestions for item modification and improvement.
The method employed is potentially useful for future attempts to develop better measures of elder mistreatment. The employment of previously established measurement items drawn from related fields, modified through an intensive qualitative research strategy, is an effective strategy to improve elder mistreatment measurement.
qualitative methods; measure development; resident-to-resident elder mistreatment; long-term care
This article describes an educational program to inform nursing and care staff in the management of resident-to-resident elder mistreatment (R-REM) in nursing homes, using the SEARCH approach. Although relatively little research has been conducted on this form of abuse, there is mounting interest in R-REM, as such aggression has been found to be extensive and can have both physical and psychological consequences for residents and staff. The aim of the SEARCH approach is to support staff in the identification and recognition of R-REM, and suggesting recommendations for management. The education program and the SEARCH approach are described. Three case studies from the research project are presented, illustrating how the SEARCH approach can be used by nurses and care staff to manage R-REM in nursing homes. Resident- and staff safety and well-being can be enhanced by the use of the evidence-based SEARCH approach.
This article examines the dialogue that occurred within the structure of a Research-to-Practice Consensus Workshop that critiqued academic research priorities regarding social isolation among community-dwelling older adults and identified practice-based suggestions for a social isolation research agenda. The investigators adapted the scientific consensus workshop model to include expert practitioners and researchers in a discussion of the current state and future directions of social isolation intervention research. The group’s critique resulted in several key recommendations for future research including the need for a social isolation measure with specific capacity to identify isolated older adults during a community crisis. This study demonstrates that the Research-to-Practice Consensus Workshop model can be used successfully to identify priority areas for research that have implications for community practice, construct an evidence base more relevant for community application, strengthen existing community–researcher partnerships, and build agency and practitioner capacity to take part in community-based participatory research.
research-to-practice; social isolation; consensus workshop
home-delivered meals; nutrition program; older persons; frailty
For home-delivered meals to have a beneficial impact on older persons, it is important that both delivery of services and use by older persons are adequate. From November 2004 to February 2005, we conducted a random-sample telephone survey of 1505 New York City home-delivered meals recipients, asking them about adequacy of and satisfaction with delivery of services and use of meal services. Fourteen percent of recipients relied solely on program food. Two-thirds prepared other foods themselves. Consumption of fruit, vegetables, and milk was low; 14–20% of recipients consumed each of these less than 1 time per day. Most recipients saw (and about half talked with) the meal deliverer most of the time. Most could contact the meal provider agency, but had not done so. A second stratified sample of 500 meal recipients was surveyed in June 2006 regarding satisfaction with food packaging and labels, food acquisition, meal delivery, and meal variety. About three-fourths of recipients reported satisfaction most of the time with the meals in terms of taste, variety, ease of preparation, healthfulness, and fit to religious or cultural needs. The most satisfied recipients were those who were receiving hot meals, food-secure, without hearing problems, frailer, in better emotional health, with informal social support, and more religious.
delivery; home-delivered meals; nutrition program; older persons
The authors examined how ambivalence toward adult children within the same family differs between mothers and fathers and whether patterns of maternal and paternal ambivalence can be explained by the same set of predictors. Using data collected in the Within-Family Differences Study, they compared older married mothers’ and fathers’ (N = 129) assessments of ambivalence toward each of their adult children (N = 444). Fathers reported higher levels of ambivalence overall. Both mothers and fathers reported lower ambivalence toward children who were married, better educated, and who they perceived to hold similar values; however, the effects of marital status and education were more pronounced for fathers, whereas the effect of children’s value congruence was more pronounced for mothers. Fathers reported lower ambivalence toward daughters than sons, whereas mothers reported less ambivalence toward sons than daughters.
ambivalence; families in middle and later life; intergenerational relations; parent – child relations
We examine the differential effects of perceived maternal and paternal favoritism in adulthood on sibling tension in adulthood.
Data used in the analysis were collected from 341 adult children nested within 137 later-life families as part of the Within-Family Differences Study.
Adult children’s perceptions that their fathers currently favored any offspring in the family predicted reports of tension with their siblings, whereas perceptions of mothers’ favoritism did not. Fathers’ favoritism was a stronger predictor of daughters’ than sons’ reports of sibling tension.
These findings contribute to a growing body of research demonstrating the consequences of parental favoritism in adulthood. Equally important, they demonstrate that perceptions of fathers’ current favoritism plays an even greater role in shaping their adult children’s sibling relations than do mothers’ favoritism.
Adult siblings; Parent-adult child relations; Parental favoritism; Within-family differences.
Purpose: Theory and research suggest that congruence between individuals’ preferences for future care and the patterns of care received will affect well-being. In this article, we explore whether older mothers’ psychological well-being was affected by the children they preferred as future caregivers and provide assistance at a later point when the mothers experience illness or injury. Design and Methods: In this article, we use a combination of quantitative and qualitative data collected from 234 older mothers at two points 7 years apart, beginning when the mothers were 65–75 years of age. Results: Multivariate analyses demonstrated that mothers who received assistance from children whom the mothers did not identify as their preferred future caregivers reported higher depressive symptoms at the second wave; receiving care from children identified as preferred caregivers did not affect well-being. Qualitative data suggested that these patterns occurred because the “alternate” caregivers did not possess the socioemotional attributes of preferred children. Implications: These findings contribute to a growing body of research demonstrating the consequences of violated preferences, particularly when individuals are in need of support in later life.
Caregiving; Parental favoritism; Inter-generational relationships; Parent-child; Social support
Little research has been conducted on aggression directed at staff by nursing home residents.
To estimate the prevalence of resident-to-staff aggression (RSA) over a 2-week period.
Prevalent cohort study.
Large urban nursing homes.
Population-based sample of 1,552 residents (80 % of eligible residents) and 282 certified nursing assistants.
Main Outcome Measures
Measures of resident characteristics and staff reports of physical, verbal, or sexual behaviors directed at staff by residents.
The staff response rate was 89 %. Staff reported that 15.6 % of residents directed aggressive behaviors toward them (2.8 % physical, 7.5 % verbal, 0.5 % sexual, and 4.8 % both verbal and physical). The most commonly reported type was verbal (12.4 %), particularly screaming at the certified nursing assistant (9.0 % of residents). Overall, physical aggression toward staff was reported for 7.6 % of residents, the most common being hitting (3.9 % of residents). Aggressive behaviors occurred most commonly in resident rooms (77.2 %) and in the morning (84.3 %), typically during the provision of morning care. In a logistic regression model, three clinical factors were significantly associated with resident-to-staff aggression: greater disordered behavior (OR = 6.48, 95 % CI: 4.55, 9.21), affective disturbance (OR = 2.29, 95 % CI: 1.68, 3.13), and need for activities of daily living morning assistance (OR = 2.16, 95 % CI: 1.53, 3.05). Hispanic (as contrasted with White) residents were less likely to be identified as aggressors toward staff (OR = 0.57, 95 % CI: 0.36, 0.91).
Resident-to-staff aggression in nursing homes is common, particularly during morning care. A variety of demographic and clinical factors was associated with resident-to-staff aggression; this could serve as the basis for evidence-based interventions. Because RSA may negatively affect the quality of care, resident and staff safety, and staff job satisfaction and turnover, further research is needed to understand its causes and consequences and to develop interventions to mitigate its potential impact.
nursing home; dementia-related behaviors; elder abuse; staff mistreatment
We developed an innovative pilot studies program to foster partnerships between university researchers and agencies serving older people in New York City. The development of researchers willing to collaborate with frontline service agencies and service agencies ready to partner with researchers is critical for translating scientific research into evidence-based practice that benefits community-dwelling older adults.
Design and Methods
We adapted the traditional academic pilot studies model to include key features of community-based participatory research.
In partnership with a network of 265 senior centers and service agencies, we built a multistep program to recruit and educate scientific investigators and agencies in the principles of community-based research and to fund research partnerships that fulfilled essential elements of research translation from university to community: scientific rigor, sensitivity to community needs, and applicability to frontline practice. We also developed an educational and monitoring infrastructure to support projects.
Pilot studies programs developing community-based participatory research require an infrastructure that can supplement individual pilot investigator efforts with centralized resources to ensure proper implementation and dissemination of the research. The financial and time investment required to maintain programs such as those at the Cornell Institute for Translational Research on Aging, or CITRA, may be a barrier to establishing similar programs.
Community-based participatory research; Investigator development; Research to practice
Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers’ prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program; and 3) ascertain perceived barriers/facilitators to program participation.
Six senior centers located in New York City.
We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain.
While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (p=.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers.
These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success.
A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) vs. baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed towards those who are currently (or have recently completed) caring for aging parents.
caregivers; successful aging; baby boomers; expectations
We employed community-based participatory research techniques to adapt an evidence-based Arthritis Self-Help Program (ASHP) for older African American, Hispanic and non-Hispanic white adults. Participants and instructors provided multiple recommendations for program changes in telephone interviews and focus groups. Recommendations were adjudicated and implemented through a collaborative, consensus-based process involving diverse stakeholders. Changes implemented show sensitivity to the preferences and needs of participants, as well as the strengths and constraints of program instructors and host sites. Improved fit for participants may extend the program’s reach and effectiveness for older adults of color. In addition, the adapted ASHP may make the program more feasible and therefore sustainable for the host sites.
Community-based participatory research; program adaptation; program implementation; race/ethnic minority populations
Chronic pain is a debilitating and pervasive health problem, particularly among older adults. Researchers and clinicians acknowledge that pain conditions do not occur in isolation, but rather exact a toll on the individual sufferer and the family system at large. No research, however, has explicitly explored the impact of older parents’ chronic pain symptoms on their adult children. In this article, we present relevant predictions from theoretical models that identify the interpersonal effects of chronic illness and pain on family relationships. Guided by theory and empirical research on these topics, we present a conceptual framework of hypothesized risk factors for adult children of parents with chronic pain. We conclude by offering an agenda for future research.
Intergenerational relationships; adult children; pain; chronic illness