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Health professionals as well as families are being confronted with long-term care and caregiver issues that accompany the increasing incidence of individuals surviving traumatic brain injury. A sample of parents and brain-injured offspring from 20 families served as informants. The purpose of this study was to identify a qualitatively generated theory describing the parent's experience following a brain-injured child's return to the home setting. An exploratory qualitative design using grounded theory methodology was used during data collection and analysis. All the brain-injured offspring had survived a moderate-to-severe traumatic brain injury; were living with at least one parent; and were ages 17 to 34. A three-phase theory, Investing in the Comeback, was generated using grounded theory methodology. The theory's three stages, centering on fostering independence and seeking stability, describe the work of the parent living with a brain-injured offspring. The first phase, Centering On, involves the parent's focusing attention and behavior primarily on the brain-injured offspring. During Fostering Independence, the second phase, the parent initiates and maintains efforts to promote the offspring's resumption of independent functioning. The final phase, Seeking Stability, consists of the parent working to establish a regime that maintains the brain-injured offspring's optimal performance, while minimizing the strain on other family members. Theoretical sampling guided the identification of categories, properties, conditions, and consequences of each phase. Four quantitative measures supplied descriptions of sample characteristics and included demographics, cognitive deficit ratings of the child by the parent and the investigator, and the parent's perception of the family's functioning.

Personality characteristics of spousal and adult children and active potential caregivers of persons with Alzheimer's Disease were studied in order to better predict caregiver burden and aspects of well-being. Contrary to prediction, no differences were found between spouse and adult children active caregivers on measures of well-being. Additionally, adult children potential caregivers indicated feeling less control over their lives than spouse potential caregivers. When social desirability was controlled, active caregivers reported greater fluctuations in affect than did potential caregivers. As predicted, personality characteristics of individuals were found to have the biggest role in determining which individuals experience stress or burden.

The purpose of the present cross-sectional study was to examine the effects of ambiguity of loss and type of caregiver-to-patient relationship on anticipatory grief, negative physical and psychological outcomes associated with grief, and boundary ambiguity in family caregivers of chronically ill patients. Questionnaires were completed by 23 parents of ill children and 30 spouses of ill mates. Using an original and a revised concept for level of ambiguity, partial support was found for the prediction that parents and spouses in high ambiguity of loss circumstances would report more anticipatory grief than those in low ambiguity ones. Contrary to prediction, a slight but nonsignificant trend occurred for parents and spouses in low ambiguity situations to report more negative physical and psychological effects associated with grief as well. Level of ambiguity was not found to impact boundary ambiguity as had been hypothesized. Spouses reported more boundary ambiguity than parents, regardless of level of ambiguity of the loss. Contrary to prediction that parents would report less anticipatory grief and more negative physical and psychological outcomes than spouses, generally, no significant differences were found between the two groups. However, using the original concept of ambiguity, parents did tend to recall more past grief than spouses. The study highlighted several methodological concerns which impact research on loss and grief, particularly the difficulty involved in recruiting participants with subsequent occurrence of sampling bias, rudimentary status of available measurement tools, and a host of potentially confounding personal and sociodemographic variables. The present study supports a view of the loss which occurs in families dealing with chronic illness as a complex process whose impact on grief, distress, and family upheaval is influenced by multiple factors. Such factors include both the ambiguity of the loss and the type of family relationship involved. Complex research of a longitudinal nature using psychosocial models of illness is needed to better delineate the impact of factors such as these.

Structural equation modeling was utilized in studying the voluntariness of the assumption of caregiving status. A model hypothesizing the stress flow that occurs when assuming a new life schema was presented. Utilizing three groups of caregiving populations, Home Caregivers, Intermediate Care Facility Aides, and Intensive Care Units and Emergency Room Nurses (N = 66), measures were administered to determine the voluntariness of the assumption of the role of caregiver. Path analysis and causal interpretation were utilized to determine outcomes. The involuntary assumption of the role of caretaker was shown to significantly affect depression and burnout rates negatively when perceived feelings of burden were high. When caretaker age was greater upon assumption of the role, self-esteem was low and family support was perceived to be lacking. When the role of caretaker is assumed on a voluntary basis and support from outside sources is perceived as helpful (i.e., social or financial support from the family), job stress and the subjective manageability of the symptoms were viewed as manageable. Implications for those assuming the role of caretaker with the elderly were examined, and recommendations for further training and interventions within the caretaker population were offered.

Current literature regarding caregiver bereavement adjustment has advanced two competing models explaining adjustment in relation to caregiver interrole conflict: the Relief Model and Complicated Grief Model. This research has primarily focused on the experience of those providing care to dementia patients. This study tests these competing models of bereavement adjustment for husband and daughter caregivers of breast cancer hospice patients. For husbands, greater psychological strain and health strain were predictive of greater difficulty with bereavement adjustment, supporting the Complicated Grief Model of bereavement adjustment. For daughters, strain was not a significant predictor of bereavement adjustment, and thus did not support either bereavement adjustment model. While daughter caregivers experienced more role strain than husband caregivers during patient care, the degree of role strain was predictive of bereavement adjustment for husbands but not for daughters, suggesting that relationship type (husbands versus daughters) between caregiver and patient impacts which factors influence bereavement adjustment.

A sample of 22 persons who care for relatives exhibiting initial symptoms of senile dementia were administered paper-and- pencil questionnaires to determine their level of subjective burden and psychological symptomatology. Each participant's attributional style was measured on an internal-external dimension, and their causal attributions regarding their relative's symptomatic behaviors were assessed. Results indicated that attributional style did not predict specific attributions about illness-related behaviors, but the tendency to not blame an afflicted relative for their behavior was predictive of subjective burden and symptoms of depression and anxiety. Subjective burden was found to predict feelings of hostility in caregivers.

The purpose of this study was to examine the relationship between life stressors, resources, and psychological symptomatology of 20 family caregivers of Alzheimer's patients. Stressors were categorized as stressors specific to the caregiving role and general life stressors. Resources were also categorized as resources specific to the caregiving role and general life resources. Multiple regression determined which stressors, resources, and demographic variables predicted psychological symptomatology. Specific stressors that were significant predictors included: caregiving events, caregiving event chronicity, and mean burden scores. Significant general stressors included: size of caregivers' household, non-caregiving events and non-caregiving event chronicity. Significant resources included: other caregivers, the duties other caregivers provided, and caregiver's educational level. No Other Demographic Variables were found to be significant predictors.

The purpose of this study was to examine the effect of an intervention program for Alzheimer's patients on coping efficacy of their family caregivers. Using a pre-post repeated measures design, 16 family caregivers were interviewed before and after a medical, nursing, and social service intervention. Self-report measures, adjusted for caregiver satisfaction and caregiver mastery, were used to determine if there was a change in: resources, burden, and coping efficacy with caregiver specific and general life events. Results showed a marginal effect [F = 2.6, df(4,10), p<.10] for the omnibus MANCOVA. Most of this change was due to an increase in resources. Covariates of caregiver satisfaction and mastery were correlated with average burden. Results suggest that interventions such as this will be helpful for family caregivers of Alzheimer's patients.

Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.