Advertisement

Behavioral Programs for Families of Dependent Elderly

  • Judy M. Zarit
  • Steven H. Zarit
Part of the Applied Clinical Psychology book series (NSSB)

Abstract

In the past few years, there has been increased public awareness of Alzheimer’s disease and other disabling conditions of later life, including the sometimes extreme stresses that these problems create for family caregivers. The presence of involved family members often makes the difference between whether or not an elder is institutionalized, but caregiving can also take its toll, affecting the social, physical, or mental well-being of family members. All too frequently, however, the family is given little assistance or training to help reduce the burdens associated with their involvement, or to improve management of everyday tasks and problems caused by the elder’s disability. In this chapter the authors summarize the problem of chronic disability in old age as it affects families, discuss assessment issues, and outline a treatment strategy to alleviate some of the stress that often accompanies active caregiving. Of particular importance in working with families of older persons are issues of identifying the client and clarifying the initial request, which are often neglected in the treatment literature. Recent research suggests that behavior management techniques used in the context of the family system can be effective in reducing the sense of burden and distress of caring for a frail older person, whether he or she lives in the community or in a nursing home or other institution. The implementation of these approaches for problems of elders and their families will be emphasized.

Keywords

Primary Caregiver Family Caregiver Dementia Patient Senile Dementia Behavioral Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams, M., Caston, M. A., & Danis, B. C. (1979). A neglected dimension in home care of elderly disabled persons: Effect on responsible family members. Paper presented at the meeting of the Gerontological Society, Washington, D.C.Google Scholar
  2. Albert, W. C., & Zarit, S. H. (1977). Income and health care of the aging. In S. H. Zarit (Ed.), Readings in aging and death: Contemporary perspectives (pp. 120–127). New York: Harper & Row.Google Scholar
  3. Anthony, J. C., LaResche, L., Niaz, U., Von Korff, R., & Folstein, M. F. (1982). Limits of the Mini-Mental State as a screening test for dementia and delirium among hospital patients. Psychological Medicine, 12, 397–407.PubMedCrossRefGoogle Scholar
  4. Anthony-Bergstone, C. R., Zarit, S. H., & Gatz, M. (1988). Symptoms of psychological distress among caregivers of dementia patients. Psychology and Aging, 3, 245–248.PubMedCrossRefGoogle Scholar
  5. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.PubMedCrossRefGoogle Scholar
  6. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford.Google Scholar
  7. Bergmann, K., Foster, E. M., Justice, A. W., & Mathews, V. (1979). Management of the demented elderly patient in the community. British Journal of Psychiatry, 132, 441–449.CrossRefGoogle Scholar
  8. Birkel, R. C. (1987). Toward a social ecology of the home care household. Psychology and Aging, 2, 294–301.PubMedCrossRefGoogle Scholar
  9. Brink, T. L., Yesavage, J. A., Lum, O., Heersema, P. H., Adey, M., & Rose, T. L. (1982). Screening tests in geriatric depression. Clinical Gerontologist, 1, 37–43.CrossRefGoogle Scholar
  10. Brody, E. M. (1985). Parent care as a normative family stress. Gerontologist, 25, 19–29.PubMedCrossRefGoogle Scholar
  11. Brotman, H. (1982). Every ninth American: An analysis for the chairman of the select committee on aging. House of Representatives. Ninety-seventh Congress (Publication No. 97–332). Washington, DC: U.S. Government Printing Office.Google Scholar
  12. Cantor, M. H. (1983). Strain among caregivers: A study of experience in the United States. Gerontologist, 23, 597–604.PubMedCrossRefGoogle Scholar
  13. Cummings, J. L., & Benson, D. F. (1983). Dementia: A clinical approach. Boston: Butterworth.Google Scholar
  14. Derogatis, L. R., & Spencer, P. M. (1982). The Brief Symptom Inventory (BSI): Administration and procedures manual—I. Baltimore: Johns Hopkins University School of Medicine, Clinical Psychometric Research Unit.Google Scholar
  15. D’Zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of Abnormal Psychology, 78, 107–126.PubMedCrossRefGoogle Scholar
  16. Fitting, M., Rabins, P., Lucas, M. J., & Eastham, J. (1986). Caregivers for dementia patients: A comparison of husbands and wives. Gerontologist, 26, 248–252.PubMedCrossRefGoogle Scholar
  17. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.PubMedCrossRefGoogle Scholar
  18. Gallagher, D., Nies, G., & Thompson, L. W. (1982). Reliability of the Beck Depression Inventory with older adults. Journal of Consulting and Clinical Psychology, 50, 152–153.PubMedCrossRefGoogle Scholar
  19. George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: A multidimensional examination of family caregivers of demented adults. Gerontologist, 26, 253–259.PubMedCrossRefGoogle Scholar
  20. Gilhooly, M. L. M. (1984). The impact of caregiving on caregivers: Factors associated with the psychological well-being of people supporting a dementing relative in the community. The British Journal of Medical Psychology, 57, 35–44.PubMedCrossRefGoogle Scholar
  21. Goldfried, M. R., & Davison, G. C. (1975). Clinical behavior therapy. New York: Holt, Rinehart & Winston.Google Scholar
  22. Grad, J., & Sainsbury, P. (1963). Mental illness and the family. The Lancet, 1, 544–547.CrossRefGoogle Scholar
  23. Grad, J., & Sainsbury, P. (1968). The effects that patients have on their families in a community care and a control psychiatric service: A two year follow up. British Journal of Psychiatry, 114, 265–278.PubMedCrossRefGoogle Scholar
  24. Hoenig, J., & Hamilton, M. W. (1969). The desegregation of the mentally ill. London: Routledge & Kegan Paul.Google Scholar
  25. Kahn, R. L. (1975). The mental health system and the future aged. Gerontologist, 15 (1, Pt. 2), 24–31.PubMedCrossRefGoogle Scholar
  26. Kahn, R. L., & Miller, N. E. (1978). Assessment of altered brain function in the aged. In M. Storandt, I. C. Siegler, & M. F. Elias (Eds.), The clinical psychology of aging (pp. 43–70). New York: Plenum.CrossRefGoogle Scholar
  27. Kahn, R. L., Goldfarb, A. I., Pollack, M., & Peck, R. (1960). Brief objective measures for determination of mental status in the aged. American Journal of Psychiatry, 117, 326–328.PubMedGoogle Scholar
  28. Kerson, T. S., & Kerson, L. A. (1985). Understanding chronic illness. New York: The Free Press.Google Scholar
  29. Lawton, M. P. (1971). The functional assessment of elderly people. Journal of the American Geriatrics Society, 1(9), 465–481.Google Scholar
  30. Lowenthal, M. F., & Robinson, B. (1976). Social networks and isolation. In R. H. Binstock & E. Shanas (Eds.), Handbook of aging and the social sciences (pp. 432–456). New York: Van Nostrand Reinhold.Google Scholar
  31. Lowenthal, M. F., Berkmann, P., & Associates. (1967). Aging and mental disorder in San Francisco. San Francisco: Jossey-Bass.Google Scholar
  32. Macmillan, D. (1968). Problems of a geriatric mental health service. British Journal of Psychiatry, 113, 175–181.CrossRefGoogle Scholar
  33. Mortimer, J. A., Schuman, L. M., & French, L. R. (1981). Epidemiology of dementing illness. In J. A. Mortimer & L. M. Schuman (Eds.), The epidemiology of dementia (pp. 3–23). New York: Oxford University Press.Google Scholar
  34. Morycz, R. K. (1980). An exploration of senile dementia and family burden. Clinical Social Work Journal, 8, 16–27.CrossRefGoogle Scholar
  35. Morycz, R. K. (1985). Caregiving strain and the desire to institutionalize family members with Alzheimer’s disease. Research on Aging, 7, 329–361.PubMedCrossRefGoogle Scholar
  36. Neugarten, B. L. (1975). The future and the young old. Gerontologist, 15, (1, Pt. 2), 4–9.PubMedCrossRefGoogle Scholar
  37. Pinkston, E. M., & Linsk, N. L. (1984). Care of the elderly: A family approach. New York: Pergamon Press.Google Scholar
  38. Poulshock, S. W., & Deimling, G. T. (1984). Families caring for elders in residence: Issues in the measurement of burden. Journal of Gerontology, 39, 230–239.PubMedCrossRefGoogle Scholar
  39. Rabins, P. V., Mace, N. L., & Lucas, M..J. (1982). The impact of dementia on the family. Journal of the American Medical Association, 248, 333–335.PubMedCrossRefGoogle Scholar
  40. Radloff, L. S. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  41. Reever, K. E., & Bach-Peterson, J. (1979). The older person with senile dementia in the community and their primary caregiver. Unpublished master’s thesis, University of Southern California, Los Angeles.Google Scholar
  42. Ross, H. E., & Kedward, H. B. (1977). Psychogeriatric hospital admissions from the community and institutions. Journal of Gerontology, 32, 420–427.PubMedCrossRefGoogle Scholar
  43. Sainsbury, P., & Grad de Alarcon, J. (1970). The psychiatrist and the geriatric patient: The effects of community care on the family of the geriatric patient. Journal of Geriatric Psychiatry, 1, 23–41.Google Scholar
  44. Sanford, J. F. A. (1975). Tolerance of debility in elderly dependents by supporters at home: Its significance for hospital practice. British Medical Journal, 3, 471–473.PubMedCrossRefGoogle Scholar
  45. Shanas, E. (1979a). The family as a social support system in old age. Gerontologist, 19, 196–174.CrossRefGoogle Scholar
  46. Shanas, E. (1979b). Social myth as hypothesis: The case of the family relations of old people. Gerontologist, 19, 3–9.PubMedCrossRefGoogle Scholar
  47. Stone, R., Cafferata, G. L., & Sangl, J. (1987). Caregivers of the frail elderly: A national profile. Gerontologist, 27, 616–626.PubMedCrossRefGoogle Scholar
  48. Troll, L. E., Miller, S. F., & Atchley, R. C. (1979). Families in later life. Belmont, CA: Wadsworth.Google Scholar
  49. U.S. Bureau of the Census (1982). Statistical abstract of the United States, 1982–83 (103d edition). Washington, DC: U.S. Government Printing Office.Google Scholar
  50. Wilder, C. S. (1971). Chronic conditions and limitations of activity and mobility: United States, July 1965 to June 1967. Vital and Health Statistics, Series 10, No. 61.Google Scholar
  51. Zarit, J. M. (1982). Predictors of burden and distress for caregivers of senile dementia patients. Unpublished doctoral dissertation, University of Southern California, Los Angeles.Google Scholar
  52. Zarit, S. H. (1980). Aging and mental disorders. New York: Free Press.Google Scholar
  53. Zarit, S. H., & Zarit, J. M. (1982). Families under stress: Interventions for caregivers of senile dementia patients. Psychotherapy: Theory, Research and Practice, 19, 461–471.CrossRefGoogle Scholar
  54. Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. Gerontologist, 20, 649–655.PubMedCrossRefGoogle Scholar
  55. Zarit, S. H., Orr, N. E., & Zarit, J. M. (1985). The hidden victims of Alzheimer disease: Families under stress. New York: New York University Press.Google Scholar
  56. Zarit, S. H., Todd, P., & Zarit, J. M. (1986). Subjective burden of husbands and wives as caregivers: A longitudinal study. Gerontologist, 26, 561–571.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1991

Authors and Affiliations

  • Judy M. Zarit
    • 1
  • Steven H. Zarit
    • 2
  1. 1.Child, Adult, and Family Psychological CenterState CollegeUSA
  2. 2.Department of Individual and Family StudiesPennsylvania State UniversityUniversity ParkUSA

Personalised recommendations