Caregivers of dementia patients who were referred to a community-based comprehensive assessment program for demented and/or chronically ill older adults by physicians or community agencies were studied for this thesis.

In the United States, familial caregivers provide approximately 80% of the long term elderly care and are at risk for mental health problems. As family members provide care, relationships shift from mutual support to increasing dependency on the caregivers, who in turn often experience a shift in self-concept from their prior relational role to include identification as caregiver for the care recipient. Affectional solidarity, or emotional relationship quality, can influence how caregivers experience their shifting role in relationship to a loved one. The study examined whether role importance is associated with caregiver depression over time, and tested the moderating role of affectional solidarity in this association. A subset of caregivers (N = 57) from the Longitudinal Study of Generations constituted the sample from which role importance, affectional solidarity, and Center for Epidemiological Studies Depression reports were analyzed using longitudinal hierarchical regression. Findings did not support hypotheses. Results suggested that affectional solidarity may be important to consider among familial caregivers as a potential protective factor for depression. Implications for future research and practitioners are discussed.

The purpose of the study was to learn more about the ways in which caregivers perceive the effects of adult day services. The goal was to help inform adult day providers about services family caregivers find useful. An ecological model was used as a framework. Data were collected from focus groups consisting of spouse and nonspouse family caregivers of past and current participants in two different program models of adult day services: adult day care and adult day health services. There were few differences in the way caregivers of past and current participants perceived adult day services. One major difference was that some caregivers of past participants perceived that the programs had failed to provide support to them after their family member passed away. Although spouse and nonspouse caregivers used adult day services for different reasons, the main reason reported by both was to keep their family member active. The perceptions of caregivers using the adult day care model differed little from those of caregivers who used adult day health services. One difference was that some caregivers saw the staff at the adult day care center as role models who taught them how to care for and accept dependent family members. Talking to family caregivers about their experiences with adult day services can provide practitioners with valuable insights about the services and activities that family caregivers find useful and those they may need to assist them in their efforts to care for impaired family members. Adult day providers need to understand what effect services and activities have on caregivers and family members to enable them to create programs that benefit both. / Graduation date: 2001

The study focused on the attitudes and beliefs regarding perceived and actual burden experienced by Latino caregivers and their use of formal support services. It also looked at the needs of Latino caregivers and explored their beliefs about why they had taken on the caregiver role, the responsibilities the role entailed, and coping skills used by these caregivers. Participants were obtained from two Alzheimer's caregiver support groups in the East Los Angeles area, and an adult day health care center in the high desert area of San Bernardino county. The author used both qualitative interviews and quantitative questionnaires. The findings suggest that high beliefs about responsibility to the family and low levels of service use may contribute to the stress and strain that these caregivers feel. Latino caregivers have been providing a significant amount of care without the help of sufficient formal services. Recommendations for social work practice, policy and further research are provided. Statistics for the study were generated by using SPSS Graduate Pack 13 for Windows.

The purpose of this dissertation was to identify the components of women's domestic health work in networks surrounding poor Mexican American and Anglo households and compare women's experiences as domestic health workers. Women representing 10 Mexican American households and 10 Anglo households and their surrounding domestic networks were recruited for this study. Criteria for participation included the presence of at least one child in the household $\le$5 years of age and household income at or below the federally-defined weighted poverty threshold. Sources included, first, 66 interviews with women (n = 26) residing in the study households. Second, women kept 3-week daily health diaries on behalf of all household members. And third, women participated in an inventory of household medications. The study employed several analytic methods, including descriptive statistical analyses, phenomenological insight, taxonomic analyses of women's knowledge structures, life history analysis, thematic analysis, and narrative analyses. The results of the study emphasized several points, including the: (a) gendered but hotly contested nature of domestic responsibility for health, with responsibility negotiated between men and women in households, and disputed between households and social service agencies; (b) significant role played by women's informal networks in defining and evaluating the enactment of maternal responsibility; (c) workings of women's coalitions and cooperatives that protect women's threatened interests and redistribute resources among women; (d) influences governing the transmission of child health and illness knowledge and skills across generations of women; (e) double-edged nature of self-medication that appears as both a source of female autonomy and expertise, yet paradoxically and simultaneously can act as an inappropriate, self-palliating balm for the hurt incurred from inadequate accessibility to quality professional health care for poor women and children; and (f) cross-cutting influences of ethnicity and historical situation in each of the above domains. Women pieced together resources from their cultural background, femaleness, and sometimes their poverty; all these factors also entailed contradictory disadvantages in the production of household health. The health and social policy implications of this study were described in detail in the dissertation, as were the women's own visions for an approximation of utopia.

This dissertation is a qualitative study of six daughter-caregivers' narratives of their experiences in caring for their mothers who were afflicted with a progressive dementia such as Alzheimer's disease. Many correlational and experimental studies have attempted to show whether humor can be utilized to reduce stress, or promote wellbeing. Results are mixed. This outcome is due in part to the ways different kinds of humor may function in different circumstances for different individuals. Few studies have analyzed directly how humor may function in circumstances where it is generated in a natural context that is potentially threatening to highly relevant personal values. The family caregiving context provides a setting for generating narratives about how individuals cope with such circumstances. This study analyzes six caregiver narratives in terms of personal problem-solving processes and emotion regulation under conditions of chronic stress. This study addresses how caregiver-humor may function in this context. These caregivers exhibited and reported a variety of non-humorous coping strategies such as problem-solving to change aspects of the situation where appropriate. They evaluated and changed thoughts, feelings, and attitudes to develop new meaning, to find benefits, and to develop more integrated frames of reference for meeting caregiving challenges. Caregiver humor was embedded in this natural problem-solving process. This study extends support for the contentions from prior research and theory that humor can, under certain conditions, support stress relief and the development of attitudes that are conducive to promoting increased well-being in situations that seriously challenge or threaten valued outcomes. The personal experience narratives of these participants provide evidence that supports many humor theories and extends the range of their application. Participants utilized humor in ways that confront and to some extent resolve the incongruities of caregiving by regulating emotion and motivation, and by celebrating mastery and adaptation to life's challenges. The data support the proposition that, specifically, humor may diminish the impact of negative affect, and boost the motive power of positive affect in problem-solving processes. / text

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Decreasing mortality rates and increasing life expectancy are contributing factors in a trend currently referred to as the "graying" of America. Some members of this aging population will require caregiving support from their families. Because women tend to outlive men, adult daughters generally assume this important role for their widowed mothers. As the health of the care recipient declines, the caregiver often suffers from stress or frustration. Some current research links health declines with decreases in elders' abilities to reciprocate instrumentally for care received. Other research suggests elders compensate for their inabilities to give instrumental aid such as advice and money by continuing to give socioemotional aid such as support and love. It is not known how caregiver stress levels relate to the exchange of socioemotional aid. Thus, this study examined the association among care given, perceived reciprocity, and frustration with daughters' caregiving. The question asked was: Does perceived socioemotional aid moderate the impact of the level of caregiving on frustration with caregiving for daughters? Social exchange theory was the perspective utilized for this research. This theory posits that an individual's desire to reciprocate is due to a general moral norm of obligation and that when people can/do reciprocate, the relationship costs decline. The sample for this study consisted of 164 dependent-mother/caregiving-daughter pairs. Frequencies, means, and standard deviations of background characteristics of all study participants were reported. A correlation matrix showed the relationships among variables. A series of multiple regressions were performed to examine the relationships among the variables as well as the predicted interaction. Results indicated that increased care given to mothers was a significant predictor of increased frustration with caregiving for daughters, and increased perceived socioemotional aid to daughters was a significant predictor of decreased frustration with caregiving for daughters. There was no interaction effect, however. That is, the effect of the amount of care given on frustration was not moderated by socioemotional aid from care recipients. Limitations, implications, and recommendations for further research are discussed. These recommendations include the need for additional research in the area of lifespan or generalized reciprocity and intergenerational relationships. / Graduation date: 1997

The purpose of this study was to explore how Korean American caregivers view dementia caregiving and analyze the role of culture in their attitude toward caregiving. Demographic characteristics, stressor factors, social support factors, and cultural factors were examined in the model. Stressor factors were measured by care receivers' problem behaviors, duration of caregiving, and amount of caregiving. Social support factors were composed of the amount of social support and the quality of social support. Cultural factors included level of acculturation, years in the U.S., filial piety, and familism. The study compared a group of spouse caregivers with a group of children providing care in order to investigate the differences in their attitude toward caregiving. In addition, the interaction effect between social support and acculturation on dementia caregiver's attitude toward caregiving was examined. Eighty five Korean American dementia caregivers participated in the survey through a convenience sampling method. Among the Korean American dementia caregivers, child caregivers showed a more positive attitude toward caregiving then spouse caregivers. The effects of social support on caregivers' attitude toward caregiving did not vary with the level of acculturation. Hierarchical multiple regression analysis indicated that, among the study factors including stressor factors, social support factors, and cultural factors, only social support factors contributed significantly to Korean American dementia caregivers' positive attitude toward caregiving. Among the predictors of Korean American dementia caregivers' attitude toward caregivng, the amount of caregiving per day was the most significant variable, followed by the quality of social support and care receivers' problem behaviors. Higher levels of daily caregiving and higher quality of social support were positively related to positive attitude toward caregiving. A higher level of care receivers' problem behaviors was negatively related to positive attitude toward caregiving. Comparison of the beta coefficients from the spouse caregiver group and nonspouse caregiver group revealed that there was a discrepancy of predictors of Korean American caregivers' attitude toward caregiving between the two caregiving groups. The model had a better fit for immigrant spouse caregiver groups indicated by significantly different R² from spouse caregivers and non-spouse caregivers, 85% and 33%, respectively. The results of this study imply the importance of incorporating cultural diversity in social policy. Because of the salient findings in this study, inclusion of content on increasing and enhancing quality of social support is recommended for social work practice with Korean American dementia caregivers.

This study explored the caregiving styles of 306 grandparents raising grandchild across three ethnic groups (164 European Americans, 65 Latinos, and 77 African Americans). Significant differences were found in caregiving styles between European Americans and African Americans. Caregiver appraisal (burden, satisfaction, and Mastery) was found to be predictive of caregiving style across the entire sample, and differentially by ethnic group. Caregiver style was predictive of grandchild functioning across the entire sample, and differentially by ethnic group. Lastly, caregiver style was found to be predictive of grandparent well-being across the entire sample, and differentially by ethnic group. Implications are discussed in terms of the complex, multidimensional and culturally embedded nature of the caregiving experience and the importance of considering culture for optimal outcomes.