Aloen L. Townsend's research while affiliated with Case Western Reserve University and other places
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Publications (64)
Purpose:
The goal of this study was to explore predictors of discrepancy between reports of caregivers (CGs) and care recipients (CRs) with mild-to-moderate dementia about CRs' quality of life (QOL).
Design and methods:
This study was a secondary analysis of cross-sectional data drawn from a study of 200 care dyads of CRs with mild-to-moderate d...
Purpose of the study:
This dyadic study investigated incongruence in care recipients' (CRs') and caregivers' (CGs') perceptions of (a) CRs' involvement in decision making and (b) how much CRs value social relations as predictors of subjective quality of life (QOL) of CRs with mild-to-moderate dementia and their primary family CGs.
Design and meth...
Purpose: Despite the capability of care recipients (CRs) with early- stage dementia, they are frequently excluded from their own care processes because of stereotypes about their cognitive function, resulting in CR preferences and perceptions being frequently ignored by caregivers (CGs) and health-care providers. Dementia research on CR quality of...
Objectives: This study examined the effects of retirement on self-rated health for married couples, using interdependence and social stratification theoretical frameworks. Method: Dyadic multilevel modeling of data (N = 2,213 non- Hispanic couples) from 1992 to 2010 of the Health and Retirement Survey.
Results: Retirement was associated with worse...
Background and Purpose: This study examines the longitudinal relationship between smoking behavior and depressive symptomatology. Multiple studies suggest that depression plays a role in smoking behaviors and vice versa. Both are significant public health problems and can have especially adverse consequences among older adults in South Korea. Howev...
Background and Purpose: Pain is estimated to affect more Americansroughly 76.5 millionthan diabetes, heart disease, stroke, and cancer combined (APF, 2007). Pain is a major public health issue, costing the US over $100 billion annually. Pain is also implicated in the onset of disability and emotional distress. Estimates suggest that 30-90% of commu...
Purpose Care recipients' (CRs') perspectives on the caregiving situation and their quality of life (QoL) have been neglected in the research of caregiving. Few studies have examined the differences between CRs with early-stage dementia and family caregivers (CGs) in their perspectives about CRs' daily care, and the effect on CGs' and CRs' QoL. The...
Multiple, complex factors influence end-of-life (EOL) decisions for all persons. In the African American population, these factors include history of disparities and discrimination in health care, which may affect the individual and the family, family system beliefs, values, and practices, and health care system issues. Family dynamics have an espe...
Academic researchers and professionals from a hospice organization collaborated to assess physical, emotional, social, economic, and spiritual strain stemming from providing care to a terminally ill older relative among 162 family caregivers to older adults newly admitted to hospice home care. The study investigated predictors of the different type...
This study addresses an unexplained finding in the alcoholism treatment field: despite the health and socioeconomic disparities that exist between blacks and whites at intake, blacks and whites achieve equivalent treatment outcomes. Using Project MATCH data, this study explores religiousness and spirituality as strengths in the African American com...
To investigate differences between older married female cancer survivors and a matched comparison sample on physical health and on effects of health on depressive symptomatology.
National survey data from the 1992 Health and Retirement Study.
Married women who reported having been diagnosed with cancer (N=245) and married women who did not report a...
PURPOSE: Information visualization, such as quantitative visualization advocated by Edward Tufte, has been used as a powerful tool for data exploration in a range of disciplines including epidemiology, economics, and genomics, but has been underutilized in social work research. This study demonstrates how quantitative visualization methods were use...
Background and Purpose
Because some developmental theories give the transition to parenthood a unique place in the family life cycle, understanding this transition is vital to social workers' interventions with women or couples entering this stage of development. A vast literature on married couples who transition to parenthood generally reveals...
Background and Purpose: The purpose of this longitudinal study was to investigate the impact of retirement on physical health of older married couples. The intersection of health and retirement is increasingly relevant due to the increase in life expectancy rates and the approaching retirement of the Baby Boom generation. Social work can play a key...
Purpose
Many studies document that dementia caregiving is demanding. Consequently, most dementia caregivers use some paid help. Yet, few studies have examined perceived benefits and drawbacks of using paid services among dementia caregivers. This study examined the types of benefits and drawbacks reported by daughter and daughter-in-law caregiver...
Objectives: The quality of relationship between family caregivers and care recipients with dual disorders can impact care recipients’ well-being and treatment outcomes as well as caregivers’ well-being and involvement in care. This paper examines the impact of caregiver stressors and well-being on relationship quality of family caregivers of women...
This cross-sectional study utilized a stress-process model to examine the impact of caregivers' (N = 82) perceptions of their relationship quality with a female family member (i.e., care-recipient) with substance-use or co-occurring substance and mental disorders on caregivers' perceived burden. Regression findings indicate that relationship qualit...
This study reviews extant measures of cultural competence from many disciplines and evaluates their suitability for social work education based on 8 criteria: validity, reliability, relevance to social justice, item clarity, definition of diversity, coherence, social desirability, and appropriateness for social work. Nineteen instruments met inclus...
Retirement is often viewed as an event when someone completely withdraws from paid employment. The purpose of the present study was to examine the patterns of retirement transitions evidenced in married couples in the Health and Retirement Study over an 8-year period (1992 to 2000). The sample consisted of White and Black married couples (N = 1,118...
Research focused on the psychosocial aspects of the experience of persons with cancer and their family caregivers is hampered by the methodological challenges inherent in quality of life research. A data registry offers a potential solution to many of these problems in providing a large, comprehensive database, using standardized instruments. We re...
This article reports on a research partnership between a community-based hospice and a graduate school of social work. The purpose of the collaboration was to design and test a tool for assessing caregiver strain and resources in families caring for older adults receiving hospice home care services. Eighteen hospice home care social workers intervi...
Objectives: The quality of relationship between family caregivers and care recipients with dual disorders can impact care recipients' well-being and treatment outcomes as well as caregivers' well-being and involvement in care. This paper examines the impact of caregiver stressors and well-being on relationship quality of family caregivers of women...
There are significant knowledge gaps concerning the experiences of families of persons with co-occurring substance and mental disorders and the impact of families on treatment of individuals with these disorders. This paper presents a conceptual framework for examining family involvement of adults in treatment for co-occurring substance and mental...
There is a strong connection between marriage and well-being, with evidence suggesting that the well-being of one spouse is closely correlated with that of the other. However, among older Mexican Americans, there is little information about this phenomenon. To address this, we explore two research questions: Does one spouse's well-being predict the...
This study examines the associations between transitions in paid home care and stress appraisals and psychological well-being of family caregivers of dementia relatives. The sample consisted of 264 caregivers who completed up to 3 interviews during 1 year. Longitudinal analyses (i.e., generalized estimating equations) showed that the onset of paid...
Family caregivers of persons with dementia rely on a range of resources to provide care and cope with caregiving stressors. Informal (unpaid) and formal (paid) instrumental support contribute to diverse caregiver outcomes. Previous research of caregiver support has focused on subjective measures of help or has compared caregivers receiving formal s...
Although research suggests that stress and rewards experienced in a social role are associated with changes in the centrality (or personal importance) of that role over time, little attention has been given to the mechanisms that account for this relationship. This study was conducted to examine change in role mastery as a mediator in the relations...
Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarch...
Theorists have suggested that optimistic expectations can be modified by stress. The present longitudinal study predicted that stress in women’s roles would reduce optimism over one year for 182 women who occupied the roles of caregiver, mother, wife, and employee. Results revealed that while 62% of participants reported little or no change in opti...
Little is known about how marital dissatisfaction and health may influence changes in the mood and somatic symptoms associated with depressive symptomatology in older wives and husbands. This study asks if depressive symptomatology, marital dissatisfaction, and physical health change over time; if changes in marital dissatisfaction and physical hea...
The objective of this study was to determine whether adult day service use was related to decreases in primary caregiving hours (i.e., the time caregivers spent on activities of daily living/instrumental activities of daily living and behavior problems for care recipients) and care recipient function for these domains. Three-month longitudinal data...
This study analyzes the short- (3 months) and long-term (1 year) cost implications of adult day care, a community-based program that has gained attention for its positive impact on dementia caregivers. A variety of costs (e.g., adult day services, formal service use, informal sources of care, employment changes) were estimated for caregivers (n = 3...
The objective of this study was to determine whether adult day service use interacts with decreases in primary caregiving hours (i.e. the time caregivers spent on activities of daily living/instrumental activities of daily living, memory problems, and behavior problems for patients) to alleviate caregiver stress and negative mental health over time...
This paper compares employed and non-employed caregivers of cognitively impaired elderly family members. Using two competing positions derived from role theory, role conflict and role expansion, we explored whether holding the positions of both caregiver and worker led to greater role overload and psychological role conflict, or provided an outlet...
The present investigation examined the effects of role stress and dispositional optimism on the well-being of 296 adult daughter caregivers who simultaneously occupied mother, wife, and employee roles. It was predicted that dispositional optimism would buffer the effects of stress in each of the four roles on psychological well-being (depressive sy...
To examine (a) change versus stability over one year in four social roles occupied by 182 midlife women (parent care provider, mother, wife and employee), (b) increases in role stress and increases in role rewards as predictors of change in centrality, and (c) whether increases in stress or increases in rewards were stronger predictors when the 2 w...
Depressive symptomatology has been frequently conceptualized as an individual matter, but social contextual models argue that symptom levels are likely to covary in close relationships. The present study investigated correlation between spouses' depressive symptomatology in middle-aged and older married couples, the influence of gender and race/eth...
Prior studies have conceptualized and operationalized social support in different ways, making it difficult to determine if the inconsistencies in findings are due to differences in study design, samples, conceptualization, or measurement. The present study examined the replicability of models of social support and caregiver distress across 4 commu...
This investigation evaluates the differences between medical and social adult day service models (ADS) on three levels: the program level, the client level, and the caregiver level. Two hundred sixty-one older adults with dementia and their family caregivers participated in the investigation, representing 36 ADS programs in New Jersey. The few mode...
This study examined interrole conflict experienced by 278 women who simultaneously occupied 4 roles: parent care provider, mother to children at home, wife, and employee. Compared with women who experienced no conflict between parent care and their other roles, women reporting parent care conflict tended to have fewer socio-economic resources, to h...
Little is known about African American women's experiences providing care to impaired older relatives. This study investigated potential differences in depressive symptomatology, parent care stress and rewards, parent care mastery, and the quality of the parent care relationship between 261 White and 56 African American daughters and daughters-in-l...
Adult day service (ADS) programs provide caregivers with a block of time away from their relative but may not reduce the overall time they spend caregiving. The current study addresses time estimates of caregiving activities among employed and non-employed caregivers of relatives with dementia who attended an ADS program for 3 months. ADS restructu...
Understanding the relationship between formal and informal support is becoming increasingly important for those involved in caring for the elderly (Bass et al., 1996; McAuley et al., 1990). As the elderly become more dependent on formal services and changes in demographics result in more women in the workforce and fewer available informal caregiver...
Although predictors of nursing home placement have attracted a good deal of attention in gerontological research, the type and amount of family assistance offered to caregivers prior to institutionalization has not been extensively examined. This study analyzed the impact of family help on the timing of placement among cognitively impaired care rec...
Theorists have proposed that greater centrality (personal importance) of a social role is associated with better psychological well-being but that role centrality exacerbates the negative effects of stress in that same social role on well-being. The present study found evidence to support both hypotheses in a sample of 296 women who simultaneously...
Low service use by family caregivers of dementia patients was examined by comparing brief and sustained users of Adult Day Services (ADS). Caregivers whose relative used ADS briefly were more likely to be spouses, had less education, and were caring for more severely impaired relatives than sustained users. They also were experiencing more role cap...
Caregivers typically report high levels of satisfaction with adult day service (ADS) programs. However, studies of satisfaction are often limited by methodological problems. For example, items may only assess global satisfaction rather than caregivers’ feelings about specific aspects of ADS use. Additionally, caregivers’ responses may reflect their...
The present study examined how patterns of risk for depression over 1 year in 188 dementia caregivers (consistently asymptomatic, n = 88; consistently symptomatic, n = 40; changing risk, n = 60) could be predicted by objective (behavior problems of the relative) and subjective (role captivity and overload) primary stress. Results reveal that all pr...
This study reports the findings of an evaluation of the psychological benefits of use of adult day care by family caregivers assisting a relative with dementia.
The study used a quasi-experimental design in which caregivers in the treatment group used substantial amounts of services, whereas caregivers in a control group did not use day care at any...
This study examined the relationships among emotional support, mastery, and well-being for 258 women who simultaneously occupied the roles of wife, mother, parent care provider, and employee. Its primary aim was to determine if a greater sense of mastery in each of these 4 roles could explain the relationship between emotional support from the part...
This study examined the relationships among emotional support, mastery, and well-being for 258 women who simultaneously occupied the roles of wife, mother, parent care provider, and employee. Its primary aim was to determine if a greater sense of mastery in each of these 4 roles could explain the relationship between emotional support from the part...
This study examined whether self-esteem mediated the effects of both self-reported positive and negative marital interactions on depressive symptoms and whether the relationships among marital interactions, self-esteem, and depressive symptoms were stronger for individuals (n = 90) coping with arthritis compared with individuals (n = 90) not coping...
The current study focused on 296 adult daughter caregivers who were simultaneously providing care to an impaired parent, mothers to children living at home, wives, and employees. How mastery (perceived competence and control) in each of these 4 roles was related to well-being was examined. Women experienced higher levels of mastery in the employee...
The present study focused on 296 women who were primary caregivers to an ill or disabled parent or parent-in-law and who simultaneously occupied 3 other roles as mother, wife, and employee. All women lived in separate households from their impaired parent and had at least 1 child 25 years of age or younger living at home. It was predicted that stre...
A path model of the mediational effects of the quality of relationships between spouse caregivers (N = 75) and their impaired partners was tested. Emotional closeness between spouses mediated the impact of the partner's cognitive impairment, but not functional impairment, on the caregiver's subjective effectiveness. In contrast to closeness, confli...
The authors used a path model to test the hypothesis that emotional closeness and conflict between adult-child caregivers (N = 90) and their impaired parents mediated the impact of the parents' functional and cognitive impairment on the caregivers' subjective stress, subjective effectiveness, and depression. Closeness mediated the relationship betw...
To examine elderly outpatients' understanding of advance directives (ADs), cardiopulmonary resuscitation (CPR), and artificial nutrition and hydration (ANH) with and without the benefit of a physician-initiated discussion.
Randomized controlled trial.
University-affiliated, community-based, urban family practice residency training program.
One hund...
This research examined stress and rewards experienced by 95 women who were simultaneously occupying the roles of caregiver, mother, and wife. The study examined role-specific stress and rewards as predictors of well-being (physical health, positive affect, negative affect, and role overload) and examined the effects of an accumulation of role stres...
This research examined stress and rewards experienced by 95 women who were simultaneously occupying the roles of caregiver, mother, and wife. The study examined role-specific stress and rewards as predictors of well-being (physical health, positive affect, negative affect, and role overload) and examined the effects of an accumulation of role stres...
Research has shown that physicians are poor predictors of patients' life-sustaining treatment preferences. Our study examined the association between three aspects of physician experience and their ability to accurately predict patients' preferences for two different life-sustaining treatments in the event of two serious medical conditions.
Sevente...
Little is known about the emotional impact of physician-initiated advance directive discussions.
One hundred ambulatory patients aged 65 years and older were randomly assigned to receive either a physician-initiated discussion of advance directive choices of a discussion of health promotion issues. Prediscussion, immediate postdiscussion, and 1-wee...
Citations
... Among women returning to work following a maternity leave, self-efficacy has been identified as a mediating factor in the relationship between childcare responsibilities and well-being (Ozer, 1995). Martire et al. (1998) found that self-efficacy as a sense of mastery, in the roles of wife, mother, and worker, mediated the effects of social support on employed parents' well-being. ...
... Nonetheless, studies designed to examine the outcomes and effectiveness of ADPs remained scarce and lacked rigour ( Lee and Cameron 2004;Edelman et al., 2004;Jeon et al., 2005). These studies also have mixed results due to differences in case mix, program emphases, inadequate sample size, low usage of services and the lack of control groups ( Gaugler and Zarit, 2001;Ross-Kerr et al., 2003;Zarit et al., 2003). Most of the evaluations also focused on caregivers, rather than on the clients ( Bartfay and Bartfay, 2013;Miyamoto et al., 2002;Zank and Schacke 2002;McCann et al., 2005;Marvall and Thorslund, 2007). ...
... Family caregiving for individuals with dementia has a serious emotional, physical, and financial toll [1][2][3][4][5][6][7][8]. Most individuals with dementia live at home and are cared for by their relatives [9]. ...
... Better understanding the relationship between care partner and patient ratings is a critical first step to determine whether care partner ratings are valid proxies for ratings made by patients with neurodegenerative diseases and for what subtype of patient (e.g., speech, language, or motor challenges) that might be most appropriate. There is growing evidence about the complex relationship between patient and care partner perception of impairment in the broader dementia (Huang et al., 2009;Moon et al., 2016;Reamy et al., 2011) and stroke-related aphasia literature (Hernandez et al., 2021). There is mixed evidence, but discrepancies frequently exist between care partner and patient judgments about day-to-day limitations. ...
... Role-related stress and reward were calculated from a self-administered, adapted version of the Multiple Role Questionnaire (MRQ) by Stephens et al. 17 This version of the scale was modified to accommodate 4 social roles: employee, mother or stepmother, wife or partner, and caregiver to an older or disabled adult relative. For each social role, a woman was asked if she occupied that role, and if she occupied that role, she was then asked to rate how stressful she perceived that role using a Likert scale from 1 to 5, with 1 representing "not at all" and 5 representing "extremely." ...
... While two of them found that the only significant path was from initial depression to later declines in marital quality (Pruchno, Wilson-Genderson, & Cartwright, 2009;Ulrich-Jakubowski, Russell, & O'Hara, 1988), the third found that both directions were significant, suggesting a bidirectional association (Whisman & Uebelacker, 2009). Finally, the fourth longitudinal study found that marital lower marital quality predicted depressed mood (Miller, Townsend, & Ishler, 2004). The authors did not test the inverse path. ...
Reference: Marital quality and depression: a review
... A feeling of detachment builds as emotional bonds wear down. [16] Wearing down of emotional bonds, higher perceived caregiver burden, reduced relational contentment, upsetting caregiving experiences, [7,22] reduced time for oneself and leisure activities, feelings of isolation due to caretaking, [50] greater stress, and fewer social resources, [10] all contribute to increased feelings of depression in the relationship. Women, in general, face more stress than males. ...
... One reason is that many of these interventions have not presented delay of placement as a goal, and so it may be that at least some caregivers in those studies did not share that goal. Bolstering this point, there is evidence that some caregivers use services as a way of transitioning care from home to institution (Zarit et al. 1999). ...
Reference: Caregivers' Outcomes
... For approximately 87% of the sample, religiousness declined over time. This leaves a small subset of the sample (about 6%) for whom religiousness increased (Krentzman, Farkas, & Townsend, 2009). This, combined with the relatively small number of African American participants in the sample, may account for the lack of differences by race for religiousness. ...
... Higher scores indicate high levels of strain. The scale has exhibited high reliability and construct validity with patient physical function and spouse depression [66][67][68]. ...