Metropolitan Jewish Health System

Abstract Hispanic and Latino (H&L) family dementia caregivers experience high levels of stress, increasing their risk for depression and anxiety. However, caregiver resilience may mitigate these risks. We examined associations between daily caregiving stress, psychological distress, and resilience using data from the Nuestros Dias (Our Days) Study. Participants (N = 155; 2,679 daily observations) completed daily diary surveys for 21 days, reporting on caregiving stress, depression, and anxiety symptoms using the Neuropsychiatric Inventory–Questionnaire distress ratings and the PROMIS Short Form Depression and Anxiety measures adapted for daily diaries. Resilience factors (perception of self, planned future, and structured style) were measured at baseline using the Resilience Scale for Adults. Data were analyzed using multilevel logistic regression models. On days when caregivers reported higher-than-average caregiving stress, daily odds increased by 7% for depression (OR = 1.07, 95% CI: 1.05–1.09, p < .001) and 9% for anxiety (OR = 1.09, 95% CI: 1.06–1.11, p < .001). For each one-point increase in planned future resilience, daily odds decreased by 25% for depression (OR = 0.75, 95% CI: 0.69–0.83, p < .001) and 21% for anxiety (OR = 0.79, 95% CI: 0.72–0.86, p < .001). Combined effects were examined using mean predicted probabilities based on dichotomized stress and resilience levels. Low resilience/high stress probabilities were 43% and 59% for depression and anxiety, respectively. For high-resilience/high-stress caregivers, probabilities were 14% and 28%, respectively. Findings highlight the need for culturally responsive interventions that foster planned future resilience to enhance H&L caregiver well-being.

This article examines the challenges and opportunities inherent in the idea that home care organizations may be able to reinvent themselves into managed care systems for the frail elderly and chronically ill. Data come from three sources: (a) existing literature, (b) a survey with experts, and (c) insights from an organization with direct experience in designing and implementing first- and second-generation managed care programs. The authors conclude that although even the best-positioned home care organizations will face significant challenges in transitioning to managed care systems (e.g., establishing medical linkages, building managed care capacity, securing funding, dealing with regulatory hurdles), changes in the environment may enable these challenges to be overcome. Home care organizations are beginning to use innovative techniques to manage care, and those with a strong commitment to the chronically ill may be interested and capable of pursuing the option of becoming home-based managed chronic care programs.

Western populations are experiencing a progressive increase in median life span, and it is predicted that the percentage of individuals aged 60 years and older will reach 15.2% in 2030. With aging, there is a decline of organ reserves and functional impairment, contributing to a decreased adaptability to both disease and its treatment. The aging of the population and advances in modern medicine have resulted in chronicity of some illnesses, such as cancer, end-stage heart and lung diseases, and renal insufficiency. Older cancer patients may experience a number of devastating physical and psychosocial symptoms before they die. When symptoms are not recognized and treated appropriately, there is an increase in suffering among elderly patients and their primary caregivers. Cancer pain management in the elderly is truly a public health and quality-of-care issue. Pain in cancer patients is not yet treated effectively.– Most of the cancer patients and cancer survivors are 65 years old or older. Approximately 60% of the estimated 10.8 million cancer survivors in the United States today are older than 65 years. Multidisciplinary evaluation of the malignancy and its distressing symptoms and an interdisciplinary approach to the host's symptoms, including pain, constitute the most effective approach to assessing and treating elderly cancer patients to maximize the best possible quality of life. This book chapter highlights the important issues concerning pain management in elderly cancer patients, the appropriate assessment tools and therapeutic options, and their impact on quality of life.

No abstract available for this article.