Insomnia is a common problem in older people, especially in patients with mild cognitive impairment (MCI) whose circadian rhythm is often compromised. Insomnia exerts such a toll on caregivers that it is frequently the primary reason for seeking to institutionalize their loved ones. Three different types of insomnia are recognized: sleep-onset or initial insomnia, sleep maintenance or middle insomnia, and early morning awakening or late insomnia. Nocturnal hypoglycemia, as a cause of middle insomnia, is the main focus of this case study. Other types of insomnia are also briefly reviewed. The management of insomnia is then discussed including sleep hygiene, the usefulness and potential drawbacks of dietary supplements, nonprescription over-the-counter preparations and prescription hypnotics. Sleep architecture is then briefly reviewed, emphasizing the importance of its integrity and the role of each sleep stage.

Driving is a symbol of autonomy and independence, eagerly awaited during adolescence, cherished during adulthood and reluctantly rescinded during old age. It is nevertheless an individual’s privilege, not right, especially as driving may affect other drivers and pedestrians on the road. It is therefore not only the individual patient who is at stake but essentially the entire community. In this case scenario, we describe the situation that arose when a patient with multi-infarct dementia wanted to go for a drive and his son and grandson tried to convince him that he could no longer drive. What went wrong in the caregivers/patient interaction is presented. The futility of arguing with patients who have dementia is highlighted as well as the suspiciousness it may generate. Alternate actions that can be useful to avoid/avert the situation from escalating and having a catastrophic ending are discussed. Testing/evaluating patients with dementia for fitness to drive is also reviewed and a list of select resources is included.

Mild cognitive impairment (MCI) is the middle ground between normal, age-appropriate memory impairment, and dementia. Whereas patients with MCI are able to cope with the memory deficit, those with dementia are not: Their memory impairment and other cognitive deficits are of sufficient magnitude to interfere with the patients’ ability to cope independently with daily activities. In both MCI and dementia, there is evidence of declining cognitive functions from a previously higher level of functioning. In both the conditions, there is also an evidence of dysfunction in one or more cognitive domains. There are two subtypes of MCI depending on whether memory is predominantly affected: amnestic type and nonamnestic/behavioral type. Not all patients with MCI transition to dementia, some recover. In this case scenario, we present a 68-year-old man with MCI who lives with his wife. They are getting ready to host dinner. His wife asks him to vacuum the dining room while she runs an urgent errand. We describe how this simple task vacuuming a room ended in a catastrophe with the patient spending the night in jail and his wife hospitalized. We discuss what went wrong in the patient/wife interaction and how the catastrophic ending could have been avoided.

This study focuses on how terminal diagnoses impact individuals and families within the Hispanic/Latino community. Hispanic/Latino hospice caregivers, Hispanic/Latino non-hospice caregivers and physicians participated in the study, which explores the utilization of hospice by Hispanic/Latino terminally ill individuals. The data collected from 30 semi-structured interviews, ethnographic participant observations, and archival data were analyzed using structured and statistical analysis. Verbatim transcripts were examined through a combination of ethnographic and content analysis. Barriers related to language and culture, as well as immigration, are critical themes that impact access to healthcare. The physicians' discourses relate patients' responses to terminal diagnoses, including the Hispanic/Latino patients' perceptions of hospice services. My research also ascertains how caregivers of Hispanic/Latino hospice patients cope with their loved ones' terminal diagnoses, structural organizational barriers to hospice utilization as well as cultural factors that contribute to the under-utilization of hospice services by this population. The findings indicate that higher incomes, higher education, and fewer years in the United States mainland directly affect healthcare decisions and treatment choices at end of life. Female gender and identity also directly impact access to health care, especially hospice services, at the end of life.

Parkinson’s Disease (PD) is a common progressive neurodegenerative disorder that leads to both physical and cognitive impairment over time. Eventually, these impairments may include the loss of autonomy, and the individual may require the assistance of an informal caregiver. Informal caregivers are critical in the care of individuals with PD and spend substantial time providing care, which may be associated with negative caregiver outcomes such as burden, mental health issues, as well as poor family dynamics. Although research in the United States and Europe has generally supported these relations, there is very limited research on PD caregiving in Latin America. Given the rapidly aging population of Latin America, research suggests that the prevalence of PD is likely to increase substantially. Although cultural values such as familism may encourage informal caregiving in Latin America, very little is known about either PD patient or caregiver experiences in the region and how they may differ from those in the United States and Europe. As such, the current study built upon Pearlin’s caregiving stress process model to examine how PD-related impairments, caregiver burden and mental health, and family dynamics may differ between the United States and Mexico and to examine connections among the following variables in a sample of PD caregivers from the United States and Mexico: (a) PD-related impairments (motor and non-motor symptoms) and caregiver burden, (b) caregiver burden and caregiver mental health, (c) PD-related impairments and mental health through caregiver burden, and (d) family dynamics which may moderate these relations. The current study consisted of caregivers of individuals with PD (total N = 253) from the United States (N = 105) and Mexico (N = 148). A series of t-tests and mediational models were conducted to determine the connections among PD-related impairments, caregiver burden and mental health, and family dynamics. Results suggested that caregivers from the United States site experienced higher levels of caregiver burden, although there were no significant differences in caregiver mental health. Further, caregiver burden fully mediated the relation between PD-related impairments and caregiver mental health at both study sites, although family dynamics did not moderate these mediational models as hypothesized. Despite the importance of cultural values such as familism in Latin America, family dynamics explained more variance in the model at the United States site than at the Mexico site. Exploratory analyses found that caregivers from the Mexico site more frequently reported suicidal and self-injurious thoughts but did not find a significant disparity in self-reported gender of the caregiver. Overall, the current study identified significant relations among PD-related impairments, caregiver burden and mental health, and family dynamics among caregivers of individuals with PD from the United States and Mexico. Findings from the current study highlight a number of important interventions for caregivers and families, including caregiver burden and mental health, as well as family dynamics.

Numerous quantitative studies have assessed caregiver burden in multiple chronic diseases, but an identified gap and underrepresentation exists in the literature regarding studies using an inductive approach that allow informal caregivers to describe the lived experiences of caring for Black men receiving hemodialysis. The transactional model of stress and coping and the stress process model guided this study. The key research questions centered on the experiences, psychological, physical, and financial limitations associated with caregiving. This phenomenological study used a purposive sample of 15 unpaid primary caregivers over the age of 18 caring for a Black male on hemodialysis from Mecklenburg County. Semi-structured face-to-face interviews were audio-recorded, transcribed, and analyzed for significant themes. The findings indicated majority of the participants experienced psychological reactions, a decline in their physical health, and financial stressors. The participants noticed a change in their loved one and felt caregiving was hard work but found the experience meaningful from a cultural perspective. Although, majority of the participants had family and healthcare providers supported them, they reported the need for additional resources to assist with providing adequate care for their loved one. This study can contribute to social change by providing healthcare professionals with the knowledge to better identify changes in practice necessary to support the needs of informal caregivers. Further research should include implementing informal caregiver support programs, studies addressing the cultural differences and needs of informal caregivers, and the perceptions of Black male patients receiving hemodialysis to address the underrepresentation of Black men in research.

As the U.S. population ages the number of family caregivers is expected to rise. Family caregivers are a valuable source of informal healthcare services for patients and the public, in terms of reducing healthcare costs. However, research suggests family caregiving is not only financially costly for individuals, but associated with a number of medical and mental health risks, with spouses at higher risk for negative outcomes compared to other family members. Traditional evidence-based therapies for stress in family caregivers have been shown to be minimally efficacious with spouses. No therapies take into account the existential nature of spouse caregiver stress, including the potential nonconscious role of loss of life meaning/purpose and death anxiety. This study of multiple baseline design preliminarily explored the effects of a novel 8-week Terror Management Theory integrated existential psychotherapy (TIE) on stress and nonconscious mechanisms believed to function as buffers for existential anxiety, in five women with spouses receiving cancer treatment. Methods included ecological momentary assessment (EMA) of anxiety and self-esteem states via text message sent three times daily – and intermittent assessment of death anxiety, self-compassion, meaning in life, and quality of life at baseline, intervention, immediate post, and 1-month follow-up. Visual and statistical analyses indicated significant between-phase trend changes in anxiety and self-esteem within participants, although direction of changes varied across participants. Additionally, changes in death anxiety, self-compassion, meaning in life, and quality of life between phases varied across participants in directions inconsistent with intervention aims and participants’ subjective impressions of intervention-related changes. Mixed findings point to the complexity of spouse caregiver psychology and highlight the need for more effective therapies with this population. Results may also guide future research and development of existentially-informed therapies.

Severe traumatic brain injury (TBI) is a pervasive and devastating condition, often resulting in permanent alterations in cognition, behavior, and personality. As such, survivors of severe TBI usually rely on the assistance of caregivers to navigate situations of daily living throughout their life span. Spouses of individuals with TBI have been shown to experience greater levels of burden than parental caregivers of TBI survivors (Kreutzer et al., 1994; Mauss-Clum & Ryan, 1981) and subsequently rates of divorce and separation have been documented within the research literature to be high (Thomsen, 1984; Wood et al., 2005). Although marital breakdown has been frequently studied, research on marital satisfaction and coping within long-term marriages where one spouse has survived a severe TBI remains insufficient. The purpose of this study was to provide a descriptive analysis of long-term spousal caregivers of individuals with severe TBI. First, demographic variables of caregiving spouses of individuals with severe TBI, who remained married at least 10 years post injury, were described and comparisons to other spousal caregiver samples were addressed. Second, the relationship between marital adjustment and demographic variables, coping, and quality of life was examined. Finally, an analysis of primary stressors was conducted to better understand the caregiving spouses' continued experience of stressors. Twenty-one spousal caregivers who remained married for at least 10 years post injury to their spouse who sustained a severe TBI participated in the study. Analyses revealed that spouses had remained married an average of 19 years post-injury and in general were mildly dissatisfied within their marriages. Furthermore, marital adjustment (Dyadic Adjustment Scale total score) of long-term spousal caregivers of severe TBI was not significantly different than spousal caregivers of individuals with chronic illness. Higher marital satisfaction scores were associated with higher endorsement of emotion-focused coping strategies and greater mental health quality of life. In addition, marital satisfaction was positively associated with the longevity of the marital relationship, the age of the spouse at the time of the injury, and the length of the marriage at the time when the injury was sustained. As expected, higher scores of marital satisfaction were associated with higher levels of mental health quality of life. There were no significant relationships between physical health quality of life and marital satisfaction. An analysis of primary stressors show that long-term caregiving spouses continue to report similar types of stressors as indicated in the research literature from caregiving spouses during the first 5 to 8 years post injury. Findings were discussed in relation to implications for practice and additional research.

No description available.

Mothers care for their infants in various ways, many similar and others more unique, and are influenced by a variety of factors. Influences such as doctors' advice, attending prenatal and child development classes, reading books and magazines, and learning from personal experience contribute to the caregiving decisions mothers make. A type of parenting that focuses on the responsiveness and sensitivity of the mother to the infant's needs is known as natural parenting. Natural parenting involves caregiving practices that are expected to co-occur, such as breastfeeding and frequently maintaining close physical contact with the infant. Two other practices that some mothers find "intuitive" and natural are co-sleeping and singing. Singing, in particular, may or may not be related to natural parenting, but has been found to be culturally universal and offers benefits to the infant's health and development. In this study mothers of 2- to 6-month-old infants were asked about specific caregiving practices, such as feeding, sleeping, carrying, and singing. Mothers' responses were analyzed using quantitative and qualitative methods. The quantitative responses show how one kind of caregiving decision, such as feeding method, is related to other caregiving decisions, such as where the baby sleeps or whether to sing to the infant. The qualitative ratings delve further into the sources of information and decisions mothers make in their caregiving practices. Practitioners and health agencies may benefit in promoting practices that are beneficial to mothers and infants by knowing how caregiving practices and decisions are related.