*We also certify that written approval has been obtained for any proprietary materials contained ... more *We also certify that written approval has been obtained for any proprietary materials contained therein iii DEDICATION This dissertation is dedicated in loving memory of my two guardian angels, Grandmother-Clara M. Barnes & Godmother-Margaret D. Boling. Two virtuous women whose presence left profound and lasting impressions on my heart and in my life and you are both greatly missed! iv
The question of what motivates elders to seek medical advice is explored among a random sample of... more The question of what motivates elders to seek medical advice is explored among a random sample of 467 persons aged 65 and over living in Ohio, USA. The effect of physical and psychological variables on an initial physician visit was analysed for particular bodily changes the subjects had experienced. Unlike the situation in many other utilization studies, these specific complaints could be identified as leading to physician contact in a causal sequence. Multiple regression revealed limited effects of self-assessed health, body awareness, depression and anxiety on the decision to consult a physician, but significant effect of the perceived seriousness of the complaint. The findings cast doubt on the utility of self-assessed health and psychological distress as predictors of physician use in major archival studies. This research is unique among utilization studies in that it provides a cross-sectional opportunity to explain a health behavior prospectively in the presence of a specific prior health problem. KEYWORDS elders; perceived illness; physician use ACKNOWLEDGEMENT Support for this research was provided by funding from the National Institute on Aging, NIH, to Case Western Reserve University. AG08557.
This study examined whether support from care recipients' primary care providers affects the ... more This study examined whether support from care recipients' primary care providers affects the stress and health of caregivers. This two-year longitudinal study addressed changes in caregivers' mental and physical health, both self-assessed and evaluated by professional nurse practitioners in physical examinations, and the effects of provider support on caregivers' health. Randomly selected participants from three previous studies plus a group of volunteer Alzheimer's caregivers constituted the sample. Of 254 eligible individuals, 150 agreed to participate, but by time 2, care recipient deaths and other reasons had reduced the number of caregivers to 99. Participants showed significant increases in stress and service use but declines in all areas of health and in provider support. Provider support did not materially affect caregivers' health but had an indirect effect on caregivers' self-assessed health through rewards. Despite the need for bolstering caregivers' health, perceived support from care recipients' providers is limited.
Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and d... more Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women (N = 138) with at least one chronic illness (M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to
Many grandmothers experience transitions in their caregiving roles to grandchildren as living arr... more Many grandmothers experience transitions in their caregiving roles to grandchildren as living arrangements change and parents assume more or less responsibility. The meanings of these transitions have received little attention, yet life transitions can be stressful. This qualitative study focuses on learning how grandmothers perceive these changes in household composition and the meanings these changes have. Analysis of semistructured telephone interviews with 26 transitioning grandmothers identified themes, including mixed feelings, changes in personal freedom, flexibility with unpredictable changes, spirituality as strength, commitment to grandchildren, and role transformation. The majority of status changes were from multigenerational or primary caregiving homes to non-co-resident status. The meaning of the changes differed by status groups. The frequency of caregiving changes and the unique meanings of such changes extend our understanding of grandmothers as caregivers. Increased awareness and understanding of these meanings are important for nurses as they provide health care for this increasing population.
The Journals of Gerontology: Series B, Mar 1, 2006
Objectives-We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (McCub... more Objectives-We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin, Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. Methods-A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother's age, race, marital status, and employment), family stressful life events and strain, grandmother's resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. Results-The models did not differ significantly by grandmother group; therefore we assessed the composite model using a multisample analysis. We found general support for the resiliency model and equivalence of the models across grandmother groups. Less support, resourcefulness, and reward, and more intrafamily strain and stressful family life events contributed to perceptions of worse family functioning. Discussion-Findings demonstrate the importance of the quality of family functioning for grandmothers in all types of families. HOW do grandmothers who raise grandchildren perceive their families as functioning? Do their perceptions differ from those of grandmothers who live apart from grandchildren or who live with grandchildren and the children's parents in multigenerational homes? This article addresses these questions and examines family functioning (e.g., the way family members interact, solve problems, respond to one another, and communicate; Miller, Epstein, Bishop, & Keitner, 1985). Poor family functioning is associated with problems of individual family members and the family as a whole (
Risk models that aim to predict the future course and outcome of disease processes are increasing... more Risk models that aim to predict the future course and outcome of disease processes are increasingly used in health research, and it is important that they are accurate and reliable. Most of these risk models are fitted using routinely collected data in hospitals or general practices. Clinical outcomes such as short-term mortality will be near-complete, but many of the predictors may have missing values. A common approach to dealing with this is to perform a complete-case analysis. However, this may lead to overfitted models and biased estimates if entire patient subgroups are excluded. The aim of this paper is to investigate a number of methods for imputing missing data to evaluate their effect on risk model estimation and the reliability of the predictions. Multiple imputation methods, including hotdecking and multiple imputation by chained equations (MICE), were investigated along with several single imputation methods. A large national cardiac surgery database was used to create simulated yet realistic datasets. The results suggest that complete case analysis may produce unreliable risk predictions and should be avoided. Conditional mean imputation performed well in our scenario, but may not be appropriate if using variable selection methods. MICE was amongst the best performing multiple imputation methods with regards to the quality of the predictions. Additionally, it produced the least biased estimates, with good coverage, and hence is recommended for use in practice.
Although many grandmothers raising grandchildren experience transitions in their roles as family ... more Although many grandmothers raising grandchildren experience transitions in their roles as family strains and circumstances change, little longitudinal data has been examined. This qualitative study assessed the relationships between custodial grandmothers' appraisals of their family conflicts and concerns and family circumstances across eight years. Participants were 35 Ohio grandmothers who were raising their grandchildren in 2006-2007 and provided additional self-report survey data in 2008-2009 and 2014-2015. Data were gathered from open-ended questions that were analyzed through conventional content analysis. The reported concerns were financial and emotional difficulties, grandchildren outcomes, mental and physical health of the grandchild and other family members, and difficulties coping with visitations and custody issues. Concurrently, grandmothers experienced several transitions in their caregiving status and family circumstances over time. Implications of the results are also discussed.
This mixed-methods study examined the subjective experience of living with chronic illness and id... more This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to selfmanagement included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.
Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resour... more Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. Methods. A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother’s age, race, marital status, and employment), family stressful life events and strain, grandmother’s resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. Results. The models did not differ significantly by grandmother group; ...
ÐResearch on elders' health behavior has largely ignored the stage between experiencing a bodily ... more ÐResearch on elders' health behavior has largely ignored the stage between experiencing a bodily change and de®ning it as an illness. This paper addresses the question of what explains such de®nitions of bodily complaints as illness symptoms. The issue is examined in a longitudinal study with a random sample of 350 community dwelling persons aged 65 and over. Multiple regression was used to analyze the eects of external stresses, psychological factors and health attitudes as well as contextual variables, on three types of illness representations. These consisted of giving the bodily changes an illness label, initiating contact with a physician, and/or using some form of self care. These illness representations were treated as outcome variables singularly and in combination. The ®ndings revealed that the overall frequency of a person's bodily changes was the best predictor of an illness designation. Other signi®cant predictors at Time 4 of the study included belief in the seriousness of a complaint, the occurrence of prior illness representations and self-assessed health. This research study on the elderly is unique in that it seeks to explain, within a longitudinal design, the intermediate step between the experience of a bodily change and the de®nition of the change as an illness.
This study examined the health problems and health actions reported by a sample of older adults (... more This study examined the health problems and health actions reported by a sample of older adults (N = 60) who maintained health diaries over a 4-week period. The diary sample was 78% (n = 47) White; 52% (n = 31) were women, with a mean age of 75 years (SD = 5.3). Content analysis was used to examine the types of health problems reported in the diaries, which health problems were likely to be considered an illness, and what health actions were reported. Respondents reported an average of four different types of health problems over the 4-week diary period. There were differences in symptom reports related to gender, age, or race. The most frequently reported health problems were musculoskeletal problems (n = 38), mnny nose and respiratory problems (n = 24), gastrointestinal problems (n = 22), and headaches (n = 22). Only 36% of all health problems were considered to be illnesses. Subjects recorded a number of health actions in response to their health complaints, including over-the-counter (OTC) medication use (83%), prescription medication use (53%), self-care activities (72%), and professional consultation (43%). Specific strategies that subjects used to deal with various health problems, implications of the findings, and the usefulness of health diaries as a clinical tool are discussed.
*We also certify that written approval has been obtained for any proprietary materials contained ... more *We also certify that written approval has been obtained for any proprietary materials contained therein iii DEDICATION This dissertation is dedicated in loving memory of my two guardian angels, Grandmother-Clara M. Barnes & Godmother-Margaret D. Boling. Two virtuous women whose presence left profound and lasting impressions on my heart and in my life and you are both greatly missed! iv
A recent increase in children living with grandparents places more children at increased risk for... more A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children’s living situation, parental monitoring, child’s resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insig...
Health:: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
The question of what motivates elders to seek medical advice is explored among a random sample of... more The question of what motivates elders to seek medical advice is explored among a random sample of 467 persons aged 65 and over living in Ohio, USA. The effect of physical and psychological variables on an initial physician visit was analysed for particular bodily changes the subjects had experienced. Unlike the situation in many other utilization studies, these specific complaints could be identified as leading to physician contact in a causal sequence. Multiple regression revealed limited effects of self-assessed health, body awareness, depression and anxiety on the decision to consult a physician, but significant effect of the perceived seriousness of the complaint. The findings cast doubt on the utility of self-assessed health and psychological distress as predictors of physician use in major archival studies. This research is unique among utilization studies in that it provides a cross-sectional opportunity to explain a health behavior prospectively in the presence of a specific...
Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and d... more Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women ( N = 138) with at least one chronic illness ( M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.
This mixed-methods study examined the subjective experience of living with chronic illness and id... more This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to self-management included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.
*We also certify that written approval has been obtained for any proprietary materials contained ... more *We also certify that written approval has been obtained for any proprietary materials contained therein iii DEDICATION This dissertation is dedicated in loving memory of my two guardian angels, Grandmother-Clara M. Barnes & Godmother-Margaret D. Boling. Two virtuous women whose presence left profound and lasting impressions on my heart and in my life and you are both greatly missed! iv
The question of what motivates elders to seek medical advice is explored among a random sample of... more The question of what motivates elders to seek medical advice is explored among a random sample of 467 persons aged 65 and over living in Ohio, USA. The effect of physical and psychological variables on an initial physician visit was analysed for particular bodily changes the subjects had experienced. Unlike the situation in many other utilization studies, these specific complaints could be identified as leading to physician contact in a causal sequence. Multiple regression revealed limited effects of self-assessed health, body awareness, depression and anxiety on the decision to consult a physician, but significant effect of the perceived seriousness of the complaint. The findings cast doubt on the utility of self-assessed health and psychological distress as predictors of physician use in major archival studies. This research is unique among utilization studies in that it provides a cross-sectional opportunity to explain a health behavior prospectively in the presence of a specific prior health problem. KEYWORDS elders; perceived illness; physician use ACKNOWLEDGEMENT Support for this research was provided by funding from the National Institute on Aging, NIH, to Case Western Reserve University. AG08557.
This study examined whether support from care recipients' primary care providers affects the ... more This study examined whether support from care recipients' primary care providers affects the stress and health of caregivers. This two-year longitudinal study addressed changes in caregivers' mental and physical health, both self-assessed and evaluated by professional nurse practitioners in physical examinations, and the effects of provider support on caregivers' health. Randomly selected participants from three previous studies plus a group of volunteer Alzheimer's caregivers constituted the sample. Of 254 eligible individuals, 150 agreed to participate, but by time 2, care recipient deaths and other reasons had reduced the number of caregivers to 99. Participants showed significant increases in stress and service use but declines in all areas of health and in provider support. Provider support did not materially affect caregivers' health but had an indirect effect on caregivers' self-assessed health through rewards. Despite the need for bolstering caregivers' health, perceived support from care recipients' providers is limited.
Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and d... more Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women (N = 138) with at least one chronic illness (M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to
Many grandmothers experience transitions in their caregiving roles to grandchildren as living arr... more Many grandmothers experience transitions in their caregiving roles to grandchildren as living arrangements change and parents assume more or less responsibility. The meanings of these transitions have received little attention, yet life transitions can be stressful. This qualitative study focuses on learning how grandmothers perceive these changes in household composition and the meanings these changes have. Analysis of semistructured telephone interviews with 26 transitioning grandmothers identified themes, including mixed feelings, changes in personal freedom, flexibility with unpredictable changes, spirituality as strength, commitment to grandchildren, and role transformation. The majority of status changes were from multigenerational or primary caregiving homes to non-co-resident status. The meaning of the changes differed by status groups. The frequency of caregiving changes and the unique meanings of such changes extend our understanding of grandmothers as caregivers. Increased awareness and understanding of these meanings are important for nurses as they provide health care for this increasing population.
The Journals of Gerontology: Series B, Mar 1, 2006
Objectives-We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (McCub... more Objectives-We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation (McCubbin, Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. Methods-A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother's age, race, marital status, and employment), family stressful life events and strain, grandmother's resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. Results-The models did not differ significantly by grandmother group; therefore we assessed the composite model using a multisample analysis. We found general support for the resiliency model and equivalence of the models across grandmother groups. Less support, resourcefulness, and reward, and more intrafamily strain and stressful family life events contributed to perceptions of worse family functioning. Discussion-Findings demonstrate the importance of the quality of family functioning for grandmothers in all types of families. HOW do grandmothers who raise grandchildren perceive their families as functioning? Do their perceptions differ from those of grandmothers who live apart from grandchildren or who live with grandchildren and the children's parents in multigenerational homes? This article addresses these questions and examines family functioning (e.g., the way family members interact, solve problems, respond to one another, and communicate; Miller, Epstein, Bishop, & Keitner, 1985). Poor family functioning is associated with problems of individual family members and the family as a whole (
Risk models that aim to predict the future course and outcome of disease processes are increasing... more Risk models that aim to predict the future course and outcome of disease processes are increasingly used in health research, and it is important that they are accurate and reliable. Most of these risk models are fitted using routinely collected data in hospitals or general practices. Clinical outcomes such as short-term mortality will be near-complete, but many of the predictors may have missing values. A common approach to dealing with this is to perform a complete-case analysis. However, this may lead to overfitted models and biased estimates if entire patient subgroups are excluded. The aim of this paper is to investigate a number of methods for imputing missing data to evaluate their effect on risk model estimation and the reliability of the predictions. Multiple imputation methods, including hotdecking and multiple imputation by chained equations (MICE), were investigated along with several single imputation methods. A large national cardiac surgery database was used to create simulated yet realistic datasets. The results suggest that complete case analysis may produce unreliable risk predictions and should be avoided. Conditional mean imputation performed well in our scenario, but may not be appropriate if using variable selection methods. MICE was amongst the best performing multiple imputation methods with regards to the quality of the predictions. Additionally, it produced the least biased estimates, with good coverage, and hence is recommended for use in practice.
Although many grandmothers raising grandchildren experience transitions in their roles as family ... more Although many grandmothers raising grandchildren experience transitions in their roles as family strains and circumstances change, little longitudinal data has been examined. This qualitative study assessed the relationships between custodial grandmothers' appraisals of their family conflicts and concerns and family circumstances across eight years. Participants were 35 Ohio grandmothers who were raising their grandchildren in 2006-2007 and provided additional self-report survey data in 2008-2009 and 2014-2015. Data were gathered from open-ended questions that were analyzed through conventional content analysis. The reported concerns were financial and emotional difficulties, grandchildren outcomes, mental and physical health of the grandchild and other family members, and difficulties coping with visitations and custody issues. Concurrently, grandmothers experienced several transitions in their caregiving status and family circumstances over time. Implications of the results are also discussed.
This mixed-methods study examined the subjective experience of living with chronic illness and id... more This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to selfmanagement included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.
Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resour... more Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. Methods. A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother’s age, race, marital status, and employment), family stressful life events and strain, grandmother’s resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. Results. The models did not differ significantly by grandmother group; ...
ÐResearch on elders' health behavior has largely ignored the stage between experiencing a bodily ... more ÐResearch on elders' health behavior has largely ignored the stage between experiencing a bodily change and de®ning it as an illness. This paper addresses the question of what explains such de®nitions of bodily complaints as illness symptoms. The issue is examined in a longitudinal study with a random sample of 350 community dwelling persons aged 65 and over. Multiple regression was used to analyze the eects of external stresses, psychological factors and health attitudes as well as contextual variables, on three types of illness representations. These consisted of giving the bodily changes an illness label, initiating contact with a physician, and/or using some form of self care. These illness representations were treated as outcome variables singularly and in combination. The ®ndings revealed that the overall frequency of a person's bodily changes was the best predictor of an illness designation. Other signi®cant predictors at Time 4 of the study included belief in the seriousness of a complaint, the occurrence of prior illness representations and self-assessed health. This research study on the elderly is unique in that it seeks to explain, within a longitudinal design, the intermediate step between the experience of a bodily change and the de®nition of the change as an illness.
This study examined the health problems and health actions reported by a sample of older adults (... more This study examined the health problems and health actions reported by a sample of older adults (N = 60) who maintained health diaries over a 4-week period. The diary sample was 78% (n = 47) White; 52% (n = 31) were women, with a mean age of 75 years (SD = 5.3). Content analysis was used to examine the types of health problems reported in the diaries, which health problems were likely to be considered an illness, and what health actions were reported. Respondents reported an average of four different types of health problems over the 4-week diary period. There were differences in symptom reports related to gender, age, or race. The most frequently reported health problems were musculoskeletal problems (n = 38), mnny nose and respiratory problems (n = 24), gastrointestinal problems (n = 22), and headaches (n = 22). Only 36% of all health problems were considered to be illnesses. Subjects recorded a number of health actions in response to their health complaints, including over-the-counter (OTC) medication use (83%), prescription medication use (53%), self-care activities (72%), and professional consultation (43%). Specific strategies that subjects used to deal with various health problems, implications of the findings, and the usefulness of health diaries as a clinical tool are discussed.
*We also certify that written approval has been obtained for any proprietary materials contained ... more *We also certify that written approval has been obtained for any proprietary materials contained therein iii DEDICATION This dissertation is dedicated in loving memory of my two guardian angels, Grandmother-Clara M. Barnes & Godmother-Margaret D. Boling. Two virtuous women whose presence left profound and lasting impressions on my heart and in my life and you are both greatly missed! iv
A recent increase in children living with grandparents places more children at increased risk for... more A recent increase in children living with grandparents places more children at increased risk for emotional, psychological, or behavioral problems. This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to examine how children’s living situation, parental monitoring, child’s resourcefulness, and perceived support affect depressive symptoms and perceived family functioning. Of participants, 36% ( n = 56) lived with their parents only, 44% ( n = 69) lived with a grandmother as their primary caregiver, and 20% ( n = 31) lived in a multigenerational household. Results indicate parental monitoring and support affected perceptions of family functioning. Subjective support and resourcefulness affected depressive symptoms. No effects were found from living situation and demographic factors. Resourcefulness had the strongest effect on depressive symptoms, with a 3-point decrease in symptoms for each incremental increase in resourcefulness. This study provides insig...
Health:: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine
The question of what motivates elders to seek medical advice is explored among a random sample of... more The question of what motivates elders to seek medical advice is explored among a random sample of 467 persons aged 65 and over living in Ohio, USA. The effect of physical and psychological variables on an initial physician visit was analysed for particular bodily changes the subjects had experienced. Unlike the situation in many other utilization studies, these specific complaints could be identified as leading to physician contact in a causal sequence. Multiple regression revealed limited effects of self-assessed health, body awareness, depression and anxiety on the decision to consult a physician, but significant effect of the perceived seriousness of the complaint. The findings cast doubt on the utility of self-assessed health and psychological distress as predictors of physician use in major archival studies. This research is unique among utilization studies in that it provides a cross-sectional opportunity to explain a health behavior prospectively in the presence of a specific...
Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and d... more Chronic illness with its accompanying physical stressors poses a risk factor for loneliness and depression in later life. Testing a model of stress and coping, we examined the effects of three types of coping resources (religious coping; Selection, Optimization, and Compensation [SOC] adaptive strategies; and perceived social support) on the deleterious effects of chronic illness among older women. Community-dwelling older women ( N = 138) with at least one chronic illness ( M = 3.9, SD = 2.1) completed mailed questionnaires. Respondents reported multiple morbidities and 90% reported interference with daily life. Social support was associated with less loneliness and depression and mediated the relationship between physical health and loneliness. Our study demonstrates two distinct pathways to depressive symptoms: one through physical symptoms, pain, and disability, and another through the experience of loneliness. Findings support intervention approaches that address disability-related issues and loneliness, and assist older women with chronic illness in identifying and marshaling social support.
This mixed-methods study examined the subjective experience of living with chronic illness and id... more This mixed-methods study examined the subjective experience of living with chronic illness and identified barriers to self-care. Community-dwelling older women with chronic illness completed an initial (N = 138) and follow-up mailed survey 6 months later (N = 130). On average, participants reported four comorbid health conditions and the corresponding physical pain, activities curtailed or relinquished, and time and energy focused on managing health. Only 34% of participants practiced all 10 key self-care behaviors. Reported barriers to self-management included pain, lack of financial resources, and worry. In the regression analysis, having more depressive symptoms was a significant predictor of challenges with self-care behaviors.
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Papers by Camille Warner