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Yes / This paper sets out to capture the missing voices of fathers in discussions around gender, parenting and work. Using Critical Discursive Psychology (CDP), a qualitative methodology that frames discourse, language and action as socially situated, the paper sets out to understand the complexities of involved fatherhood. Using data from two distinct research projects that considered managing tensions around parenting and paid work, alongside the move to ‘involved fatherhood’, we examine the ways in which different discourses are operating in order to construct stories around gender and parenting. We are particularly interested in the ways in which participants use language and, specifically, discourses of parenting, working and caring. Through the interview excerpts we analysed how simultaneously participants position themselves in the discourses and were also being positioned by the wider societal discourses. We consider how CDP can contribute rich insights into the ways in which fathers are arranging sharing parenting caregiving responsibilities, using these insights to inform the policy landscape. We finish the paper by suggesting that CDP methodology can be mobilised by researchers wanting to capture missing voices in shifting policy landscapes.

Yes / Many children caring for ill or disabled family members remain ‘hidden’ and ‘invisible’ in our communities. This study is the first to explore patterns of change, over time and throughout austerity, for children with caregiving roles to better understand how their lives differ from those of their non-caregiving peers. A survey of 2154 children, aged 9–18 years in the general population, and a further 21 children, aged 8–18 years and known to be young carers from the same English unitary authority, was conducted to gain an in-depth understanding of children’s perceptions and experiences of what they do to help at home. This study shows that children with caregiving roles remain a distinctive group who assume more domestic and caring responsibilities than their peers, and who also perform many of these activities more frequently than young caregivers in 2001. Approximately 19% of the respondents in the general population showed signs of being in a caring role, double the percentage identified by the author in 2001, 72% of whom were from Black and Minority Ethnic backgrounds. Indicating over time higher levels of unmet needs among parents and other family members who are ill or disabled, these findings have important implications for professional policy, planning and practice across adult and children’s services.

Prospective analyses suggest that young mothers may not be capable of perceptually discriminating between different infant cry stimuli. The purpose of the present study was to investigate the perceptual and caregiving responses of adolescent mothers to different infant cry stimuli. Twenty-five primiparous adolescents and 39 nulliparous adolescents listened to segments of three different infant cry types that varied in the amount of high-pitched, hyperphonation contained in the acoustic structure. Participants rated their responses to the low- and high-risk cries on perceptual rating scales, and selected a caregiving behavior in response to these same cries. Analyses of Variance showed that both groups of participants perceived the infant cry segments as more arousing, annoying, distressing, loud, and sick-sounding as the amount of hyperphonation increased across cries. Results also showed that adolescent mothers did not perceive high-risk cries as more arousing, annoying, urgent, loud, and sick-sounding than adolescents who were not mothers. However, primiparous participants perceived hyperphonated and partially-hyperphonated cries as less annoying and less loud than nulliparous adolescents. This study did not find significant differences between primiparous adolescents' and nulliparous adolescents' caregiving experiences. Chi-square analyses indicated no significant differences between the participant groups' caregiving response choice frequencies to all three infant cry types. / Ph. D.

The diagnosis of Alzheimer's disease (AD) is stressful for both patients and their family caregivers (FCG). As the disease progresses, the patient's memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. This research examines the impact of the subjective burden with the objective stressors on FCG's depression and to determines which psychosocial resources can be used to either mediate or moderate this relationship. I examine the baseline data that was collected from 670 family caregivers of Alzheimer's patients in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II clinical trial (REACH II), 2001-2004. The measurements used in the current study are caregivers' background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Three research questions will be investigated in this study: (1) How do the caregivers' background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs'depressive symptoms? (3) How do psychosocial resources mediate and or moderate the relationship between the primary stressors and FCGs'depression experiences? / Master of Science / The diagnosis of Alzheimer’s disease (AD) is stressful for both patients and their family caregivers (FCG). In 2018, an estimated 5.7 million Americans have been diagnosed with Alzheimer’s disease (Alzheimer’s Association 2018). As the disease progresses, the patient’s memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. As Aneshensel, Carol S., Leonard I. Pearlin, Joseph T. Mullan, Steven H. Zarit, and Carol J. Whitlatch (1995) noted in their book Profiles in Caregiving: The Unexpected Career, the role of caregiving is generally an ‘unexpected job’ for FCGs (Aneshensel et al. 1995). Based on Pearlin’s stress process model (SPM), the primary goal of my thesis is to compare the impact of the subjective burden of caregiving with that of objective stressors on FCG’s depression, and to determine whether psychosocial resources can either mediate or moderate this relationship. Objective stressors refer to the AD patient’s memory and behavior problems, his or her cognitive impairment, self-care activities, and functional status. Subjective burden is the FCG’s emotional response to objective stressors. Objective stressors and subjective burden are associated with each other, and they are primary stressors in the SPM. Psychosocial resources include FCG’s religious coping, their positive experiences of caregiving, their social networks and whether they were satisfied with social support that they received from others. The present study is important for two reasons. First, rather than focusing on subjective burden alone, the model examined how objective stressors (i.e. burden) influence mental health through their impact on subjective burden. Second, previous influential studies of the stressors of caregiving either did not include the moderating effects of psychosocial resources (Pearlin et al., 1999), or included a limited number of resources and found that they did not play a significant role in how caregiving stress influences caregivers mental health (Aneshensel et al. 1995). In my thesis, I will explore both of the mediating and moderating effects of four types of psychosocial resources. I examine the baseline data that was collected from 670 family caregivers of Alzheimer’s patients from the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) II clinical trial (REACH II), 2001–2004 (Schulz, Burgio, and Stevens 2006). The study participants target on FCGs who are vulnerable to the caregiving stressors. The purpose of the baseline data was to describe the AD patients’ cognitive impairment and behavior problems at the initial stage of the REACH II study, the demands caused by the impairments imposed upon FCGs, the psychosocial resources adopted by FCGs to relieve the caregiving stress, and the consequences of the primary stressors on FCGs’ daily lives. I will explore three research questions in the current study: (1) How do the caregivers’ background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs’ depressive symptoms? (3) How do psychosocial resources mediate or moderate the relationship between the primary stressors and FCGs’ depression experiences? The measurements used in the current study are caregivers’ background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Data analysis is primarily based on multiple linear regression. I will also use the post-hoc probing methods to specifically test the significance of the moderating test. There are four key findings in the present study. First, caregivers’ background and context factors have some significant associations with objective stressors and subjective burden, but overall, their impact is minimal. Second, subjective burden has a stronger impact on depressive symptoms than all of the objective stressors do. Third, subjective burden undermines all four psychosocial resources tested in the current study. Fourth, the mediating and moderating effects of psychosocial resources have a negligible impact in the caregiving stress process. Surprisingly, the effect of subjective burden on depressive symptoms among FCGs remained largely unchanged after all psychosocial resources were included in the model as mediators and moderators. In the mediational test, the effects of subjective burden on depression decreased by only 14 percent after all psychosocial resources were taken into account. Likewise, each of these psychosocial resources had only a negligible effect on moderating the impacts of stressors. The study suggests that unless there is a full understanding of the effects of these stressors on caregivers’ well-being, any interventions or preventive actions will be of limited utility. Future research should pay more attention to exploring the relationships between the subjective burden and objective stressors, and examining their different impacts on FCGs’ depression experience. Additionally, the fact that none of the psychosocial resources have a buffering effect in the caregiving process suggests that there is little in the lives of caregivers that mitigates the deleterious effects of caregiving stress on Alzheimer’s caregivers. Policymakers and mental health providers should consider the stress of caregiving, as reflected in both its objective and subjective aspects, as a major risk factor in the lives of those who care for family members with Alzheimer’s disease. Those factors may play a causal role in caregivers’ mental disorders and suicidal ideation.

Although there is abundant research on the etiology of Alzheimer's disease and its impact on primary caregivers, there is relatively little research that examines the consequences of the disease for entire families, and no literature that exclusively studies the experiences of non-caregiving family members. Seeking to explore the experience of non-caregivers, this qualitative study examined how adult children of an Alzheimer's patient who were not the caregiver for their parent experienced the onset and progression of the disease. Using the guiding theoretical frameworks of phenomenology, family systems theory, and ambiguous loss, in-depth interviews were conducted with three individuals and were coded for themes. The main themes found included externalization of symptoms, belief in the Alzheimer's diagnosis, acceptance, flexibility, sibling and parental relationships, communication, planning, shared family philosophy, family of origin roles, and boundary ambiguity. Implications for clinical practice and suggestions for future research are included. / Master of Science

Caregiving research on heterosexual couples suggests that though husbands and wives generally perform the same care tasks for their spouses, wives report higher levels of mental stress, depression, and general frustration (Swinkles et al., 2017; Polenick and DePasquale 2019). Caregiving literature is unclear on why a gender difference exists regarding stress or burden when husbands and wives are largely performing the same tasks. Using gender relations theory, this study considers whether the performance of intimate tasks creates different levels of emotional stress and overall health outcomes for older, heterosexual husbands and wives caring for a spouse with Alzheimer's or related dementias. Intimate tasks (ITs) refer to tasks that likely infringe on the bodily autonomy of the care receiver and include dealing with incontinence and assisting with bathing/showering. To explore this, I conducted logistic regressions using the 2015 and 2020 "Caregiving in the U.S.'' surveys from the AARP. My results showed IT performance has a negative effect on the stress and overall health of both husbands and wives, but comparatively, there is no consistent gender difference in effect. Additional analysis found that when separating the Its, dealing with incontinence had a more negative effect on emotional stress while assisting with bathing/showering had a more negative effect on health outcomes. / Master of Science / Older spousal caregivers are responsible for completing many different tasks to properly care for their spouse. Husbands and wives typically approach completing these tasks in different ways. Husbands tend to focus strictly on completing the care tasks, while wives tend to additionally factor in their husband's emotions. Care tasks can include things such as managing medications, taking over household chores, or more intimate tasks like dealing with urinary and bowel movements or assisting with bathing. This study considers whether there is a gender difference in the effect of intimate task performance between older caregivers that care for a spouse with Alzheimer's disease or dementia. My findings show that completing these intimate tasks negatively affects husbands' and wives' emotional stress levels and overall health. When separating the two intimate tasks, dealing with urinary and bowel movements was more likely to affect levels of emotional stress. Alternatively, assisting with bathing or showering was more likely to affect overall health.

The concept of resilience, which indicates people's capability of using resources in difficult circumstances in order to reduce or prevent negative effects and achieve positive outcomes, has given a new perspective to the scientific literature on the experience of late-life memory loss and the experience of caring for persons with memory loss. The current research was guided by incorporation of resilience into the stress process model for assessing personal and caregiver burden associated with mild and more severe memory loss. I conducted two studies to investigate the association of protective factors with the well-being of people with dementia or mild cognitive impairment and their caregivers. The first study focused on the well-being of older persons with dementia (PwDs). I employed data from a large national sample of older adults to examine how the perceived social cohesion of neighborhoods affects quality of life among people with and without cognitive impairment in conjunction with their engagement in valued leisure activities. Findings revealed that, regardless of cognitive health status, all participants who perceived high neighborhood social cohesion reported better quality of life along with more participation in valued activities. However, PwDs reported significantly lower perceived neighborhood social cohesion, less involvement in valued activities, and poorer quality of life than persons without cognitive impairment. The second study focused on the well-being of caregivers for older persons with mild cognitive impairment (PwMCIs). I used dyadic data from families dealing with mild cognitive impairment to examine how well-being of caregivers for PwMCIs differed according to whether PwMCI-caregiver dyads had similar or different perceptions of the PwMCIs' cognitive impairment severity. Caregivers reported lower caregiving burden when they and PwMCIs had a similar cognitive impairment representation, or when caregivers rated the PwMCIs’ cognitive functioning more positively than the PwMCIs rated themselves. Also, PwMCIs’ and caregivers' perceptions, and their concordance or discrepancy in those perceptions, varied across the multiple domains related to MCI symptoms. These findings demonstrate that care dyads' perception of MCI-related deficits is not a unitary construct, and that the context of PwMCIs’ and caregivers’ dyadic illness appraisals is significantly associated with the caregivers' well-being. Taken together, the results of these two studies illustrate the value of considering resilience processes in people with cognitive impairment and their caregivers. Examining dimensions of resilience, in association with assessment of the intersecting effects of personal, interpersonal, and environmental factors, provides additional information about the effects of cognitive impairment on older adults’ well-being and the effects of assisting someone with cognitive impairment on caregiver well-being. / Ph. D. / Resilience indicates people's ability to successfully adapt to or bounce back from life adversity by using personal, social, and environmental resources. Resilience helps explain what makes some people with dementia and their caregivers tolerant of changes in memory functioning and able to adapt to difficulties associated with dementia. I conducted two studies to investigate the role of protective resources in buffering negative effects of memory loss on people with dementia and their caregivers. The first study compared people with and without dementia to find out how their sense of belonging to the community and their participation in valued leisure activities influenced their quality of life. Regardless of whether they had memory loss or not, all the people with a stronger sense of belonging in the community participated in more leisure and valued activities and, in turn, had better quality of life. However, compared to cognitively healthy people, those with dementia had lower sense of belonging, less participation in leisure activities, and poorer quality of life. These findings indicate that people with dementia may feel excluded from their community and experience barriers to participation in valued activities. Nevertheless, feeling that one belongs in the neighborhood and participating in valued leisure activities is important for well-being of older adults both with and without cognitive impairment. The second study examined how the well-being of caregivers for persons with mild cognitive impairment (MCI) differed according to whether caregivers and their care recipients had similar or different views on the care recipients’ memory problems. When they both had similar views or the caregivers had a more positive view than their care recipients did, the caregivers reported higher well-being. This finding suggests that some caregivers for people with MCI understand how the person with MCI views their own memory loss, and others either are not aware of all the memory loss symptoms or choose to ignore some of them. In either case, these caregivers feel less burdened than those who think their loved one’s symptoms are worse than the person with memory loss believes. Support for these caregivers is needed to help them cope better with the memory loss in their loved one. The results from these two studies provided valuable evidence about resilience in older adults facing memory loss and their caregivers. Being resilient can help people with dementia and their caregivers manage or overcome the difficulties associated with dementia.

The purpose of this paper is to integrate and synthesize the literature from the fields of Horticulture Therapy (HT) and therapeutic activities for persons with dementia using the theory of environmental press Utilizing horticulture as a treatment modality, the therapist can either modify the environment or the person's competence level or both to assist persons to reach the desired Adaptation Level (AL). The AL represents an appropriate person-environment fit, and attainment of this zone is demonstrated by positive affect and adaptive behavior. At this time, research about HT for persons with dementia is limited. Applying theory to research is essential in order to clarify the appropriate outcome measures, independent variables, and research designs to the study. Therefore, research that fails to utilize theory often does little to contribute to the advancement of the field. This paper offers an environmental press perspective about HT for persons with cognitive impairment. / Master of Science