Caregiving in Older Adulthood and Meaning in Life

Abstract While most of the literature on caregiving in adulthood focuses on grandparenting, there is an increasing trend of older adults providing care to an adult care recipient. Older caregivers are often females who are providing care to a spouse with medical conditions and are often doing so while coping with their own functional limitations, with limited support. Within the older adult literature, studies have captured the strain experienced by caregivers of older adults, who are often burdened by the loss of time and opportunity as a result of caregiving. For caregivers in older adulthood however, caregiving may be an avenue to remain engaged and active, and a way to have purpose in life. Therefore, the purpose of this study was to examine the association between caregiving in older adulthood and meaning in life. Data from the 2018 National Health and Aging Trends study were used, which is an annual longitudinal panel survey of Medicare beneficiaries in the United States. Chi square tests were used for bivariate analyses and a logistic regression model was used to predict meaning in life based on caregiving status. After accounting for all other explanatory variables, caregivers were 50% more likely to have meaning in life compared to non-caregivers (OR=1.501, CI= 1.493-1.510). This indicates that caregiving can be a form of meaningful/productive engagement for older adults and interventions should focus on providing adequate emotional and financial support to older caregivers.

endall Weber 
University of Colorado at Colorado Springs
University of Colorado at Colorado Springs
ColoradoUnited States

Sara Qualls 
University of Colorado Colorado Springs
University of Colorado at Colorado Springs
ColoradoUnited States
6978F7D453FDA90F51344D419D61EB35
interventions are informed by mindfulness-and acceptancebased approaches, such as Acceptance and Commitment Therapy (ACT).In addition to standard outcomes, like burden and depressive symptoms, these interventions/therapies seek improvements in individuals' psychological flexibility (e.g., cognitive defusion, present moment awareness, values-based living).Less is known how these constructs interact within well-established caregiver stress processes.We examined a moderated mediation model (N=161 dementia caregivers; PROCESS Procedure; SPSS Release 2.16.1), with BPSD frequency (Revised Memory and Behavior Problems Checklist) predicting depressive symptoms (10-item CES-D), mediated via caregiver burden (short Burden inventory).The moderator was the Values Questionnaire (Progress scale), and we controlled for gender, caregiver duration, age, income, and education.Results revealed that the indirect effect of BPSD on depressive symptoms through caregiver burden was weakened through higher progress toward values (moderated mediation significant at p<.05).In essence, greater levels of living according to values dampened the effect of BPSD on depressive symptoms, through care-related burden.These findings are important because caregivers often cannot leave this role, requiring them to learn to live with the caregiving role in healthy ways.Value-based living and committed action toward values signify caregivers' success at balan

ng care-related stress with other priorities, and psychologically adju
ting to difficulties.Interventions that emphasize valuesbased living, like ACT, have promise for caregivers, offering healthy ways to psychologically adjust to, and live with, the experience.

validity.Discussion: The ACS fills a gap in the current literature by providing a comprehensive, multidimensional assessment examining expectations about one's potential caregiving experience, specific to the adult child-parent dyad.Future studies should examine the psychometric properties of the ACS in a more diverse population of adults across different settings and assess the temporal stability and criterion validity of the scale.


CAREGIVERS' MEDICAL CARE PROVISION AT PATIENT END-OF-LIFE: ASSOCIATIONS WITH EMOTIONAL DIFFICULTY AND GAINS

Amanda Leggett, 1 Hyun Jung Koo, 2 Elaina Baker, 2 and Hannah Lee, 2 1.The University of Michigan, Ypsilanti, Michigan, United States, 2. University of Michigan, Ann Arbor, Michigan, United States Family caregivers play crucial roles in patient care and medical decision making, especially at end-of-life (EOL).Yet, most research focuses on caregivers' burden, with little attention to rewards that make for a fulfilling EOL care experience.We consider caregiver involvement at EOL and associations with caregiver stress and gains.Data are drawn from the 2017 National Study of Caregiving's last month of life and core interviews which includes caregivers (n=283) for a nationally representative sample of Medicare eligible older adults, and questions caregivers about their care provision and EOL experience.We consider indicators of caregivers' involvement in medical decision making and support received from providers as predictors of caregivers' emotional difficulty and gains at EOL utilizing linear regressions controlling for demographic characteristics.Caregivers were 60.7 years of age on average, 72.5% female, 21.3% non-white, and 11% were spousal partners.Making medical decisions was associated with increased emotional difficulty at EOL (B=0.93,SE=0.24, p<.001).In contrast, more caregiving gains were associated with having care decisions align with the CG's wishes (B=-0.64,SE=0.30, p<.05), being more informed by providers (B=0.41,SE=0.16, p<.05), helping the care recipient with anxiety or sadness (B=0.69,SE=0.28, p<.05), and surprisingly, feeling that care decisions were made without their input (B=0.82,SE=0.29, p<.01).Being more involved and informed in care was associated with both positive and negative caregiver outcomes at EOL. Understanding caregiver emotional difficulty and gains at EOL are critical for identifying how clinicians can better support caregivers at EOL and improving the caregiving experience.


CAREGIVING IN OLDER ADULTHOOD AND MEANING IN LIFE Zainab Suntai, University of Alabama, Tuscaloosa, Alabama, United States

While most of the literature on caregiving in adulthood focuses on grandparenting, there is an increasing trend of older adults providing care to an adult care recipient.Older caregivers are often females who are providing care to a spouse with medical conditions and are often doing so while coping with their own functional limitations, with limited support.Within the older adult literature, studies have captured the strain experienced by caregivers of older adults, who are often burdened by the loss of time and opportunity as a result of caregiving.For caregivers in older adulthood however, caregiving may be an avenue to remain engaged and active, and a way to have purpose in life.Therefore, the purpose of this study was to examine the association between caregiving in older adulthood and meaning in life.Data from the 2018 National Health and Aging Trends study were used, which is an annual longitudinal panel survey of Medicare beneficiaries in the United States.Chi square tests were used for bivar validity.Discussion: The ACS fills a gap in the current literature by providing a comprehensive, multidimensional assessment examining expectations about one's potential caregiving experience, specific to the adult child-parent dyad.Future studies should examine the psychometric properties of the ACS in a more diverse population of adults across different settings and assess the temporal stability and criterion validity of the scale.

CAREGIVERS' MEDICAL CARE PROVISION AT PATIENT END-OF-LIFE: ASSOCIATIONS WITH EMOTIONAL DIFFICULTY AND GAINS
Amanda Leggett, 1 Hyun Jung Koo, 2 Elaina Baker, 2 and Hannah Lee, 2 1.The University of Michigan, Ypsilanti, Michigan, United States, 2. University of Michigan, Ann Arbor, Michigan, United States Family caregivers play crucial roles in patient care and medical decision making, especially at end-of-life (EOL).Yet, most research focuses on caregivers' burden, with little attention to rewards that make for a fulfilling EOL care experience.We consider caregiver involvement at EOL and associations with caregiver stress and gains.Data are drawn from the 2017 National Study of Caregiving's last month of life and core interviews which includes caregivers (n=283) for a nationally representative sample of Medicare eligible older adults, and questions caregivers about their care provision and EOL experience.We consider indicators of caregivers' involvement in medical decision making and support received from providers as predictors of caregivers' emotional difficulty and gains at EOL utilizing linear regressions controlling for demographic characteristics.Caregivers were 60.7 years of age on average, 72.5% female, 21.3% non-white, and 11% were spousal partners.Making medical decisions was associated with increased emotional difficulty at EOL (B=0.93,SE=0.24, p<.001).In contrast, more caregiving gains were associated with having care decisions align with the CG's wishes (B=-0.64,SE=0.30, p<.05), being more informed by providers (B=0.41,SE=0.16, p<.05), helping the care recipient with anxiety or sadness (B=0.69,SE=0.28, p<.05), and surprisingly, feeling that care decisions were made without their input (B=0.82,SE=0.29, p<.01).Being more involved and informed in care was associated with both positive and negative caregiver outcomes at EOL. Understanding caregiver emotional difficulty and gains at EOL are critical for identifying how clinicians can better support caregivers at EOL and improving the caregiving experience.

CAREGIVING IN OLDER ADULTHOOD AND MEANING IN LIFE Zainab Suntai, University of Alabama, Tuscaloosa, Alabama, United States
While most of the literature on caregiving in adulthood focuses on grandparenting, there is an increasing trend of older adults providing care to an adult care recipient.Older caregivers are often females who are providing care to a spouse with medical conditions and are often doing so while coping with their own functional limitations, with limited support.Within the older adult literature, studies have captured the strain experienced by caregivers of older adults, who are often burdened by the loss of time and opportunity as a result of caregiving.For caregivers in older adulthood however, caregiving may be an avenue to remain engaged and active, and a way to have purpose in life.Therefore, the purpose of this study was to examine the association between caregiving in older adulthood and meaning in life.Data from the 2018 National Health and Aging Trends study were used, which is an annual longitudinal panel survey of Medicare beneficiaries in the United States.Chi square tests were used for bivariate analyses and a logistic regression model was used to predict meaning in life based on caregiving status.After accounting for all other explanatory variables, caregivers were 50% more likely to have meaning in life compared to non-caregivers (OR=1.501,CI= 1.493-1.510).This indicates that caregiving can be a form of meaningful/productive engagement for older adults and interventions should focus on providing adequate emotional and financial support to older caregivers.Potentially harmful behaviors (PHB), such as wanting to scream at or hit a care recipient, are more likely when caregivers experience higher levels of stress.The current study expands on this research and identifies caregiving self-efficacy (SE) for dealing with disruptive behaviors as a mediator of the relationship between caregiver distress and PHB.Multilevel mediation models were tested using a sample of 244 caregivers of persons with dementia assessed three times over a one year period.In two separate models, SE mediated the relationship between caregiving burden/depression and the frequency of wanting to yell or scream at the care recipient in the past six months.Individuals with higher levels of depression and burden had lower levels of SE for dealing with disruptive behaviors.As SE decreased, the risk of potentially harmful behaviors increased.This mediation effect occurred at the within and between subject levels of the model.A significant indirect effect at the within-person level suggests that at timepoints where caregivers experienced more distress, they had lower self-efficacy and increased PHBs.Similar effects were observed at the between person level.These data suggest that both caregiver distress and self-efficacy are important intervention targets for minimizing PHBs.While Stress Process Models of family caregiving have been examined extensively, little focus has been placed on caregiver's actual management of care.We consider whether caregiving style classified previously through k-modes machine learning models and based on cognitive-behavioral approaches to care impact caregivers' experiences of carerelated stress and well-being.The three previously identified styles include: Adapters-strong dementia understanding and adaptability, encouraging behavioral approach; Managerspoor dementia understanding and adaptability, critical behavioral approach; and Avoiders-moderate dementia understanding and adaptability, passive behavioral approach.Participants included 100 primary family caregivers for PWDs who were on average 64 years old, 74% female, and 18% non-White.Utilizing linear regressions, each caregiving style was considered a key predictor (reference: Adapters) of the Zarit Burden Interview (ZBI), Caregiver Assessment of Function and Upset (CAFU) upset score, Neuropsychiatric Inventory (NPI-C) distress scale, and Positive and Negative Affect scale (PANAS) controlling for dementia severity, care duration, co-residency, and demographics.Relative to Adapters, Managers had more CAFU upset (β=0.4,p<.001), more NPI-C distress (β=0.4,p<.001), and greater burden (ZBI) (β=0.3,p<.001).Avoiders showed significantly greater CAFU upset than Adapters (β=0.2, p<.05).Positive affect was not associated with caregiving style.Caregiving styles associated with less understanding and adaptability and a more critical behavioral approach showed worse caregiving outcomes accounting for dementia severity.Results can inform a nuanced approach to tailoring and targeting interventions based on caregiver styles with the goal of reaching caregivers at risk for poor outcomes and ultimately leading to significant public health impact.Sleep is critical for health and well-being among both persons with dementia (PwD) and their family caregivers (CG).This study described sleep characteristics for dementia family care dyads, then examined the associations with sleep quality, daytime functioning, and mood in the context of Adult Day Services (ADS) use.Caregivers (n = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons with dementia across 8 consecutive days (N = 1,359), where PwD attended ADS at least 2 days of the week.They also reported their own fatigue and affect and PwD's daytime and nighttime sleep and behavior problems on each day.Findings from multilevel models suggested that bedtime was earlier and total time in bed was shorter before an ADS day for the dyad, and also on an ADS day for PwD; wake time was earlier for the dyad on and following an ADS day.Using ADS related to better prior night sleep quality for PwD; it also weakened the association between nighttime

er accounting for all other explanatory variables, caregivers were 50% more likely to have meaning in life compared to non-
aregivers (OR=1.501,CI= 1.493-1.510).This indicates that caregiving can be a form of meaningful/productive engagement for older adults and interventions should focus on providing adequate emotional and financial support to older caregivers.Potentially harmful behaviors (PHB), such as wanting to scream at or hit a care recipient, are more likely when caregivers experience higher levels of stress.The current study expands on this research and identifies caregiving self-efficacy (SE) for dealing with disruptive behaviors as a mediator of the relationship between caregiver distress and PHB.Multilevel mediation models were tested using a sample of 244 caregivers of persons with dementia assessed three times over a one year period.In two separate models, SE mediated the relationship between caregiving burden/depression and the frequency of wanting to yell or scream at the care recipient in the past six months.Individuals with higher levels of depression and burden had lower levels of SE for dealing with disruptive behaviors.As SE decreased, the risk of potentially harmful behaviors increased.This mediation effect occurred at the within and between subject levels of the model.A significant indirect effect at the within-person level suggests that at timepoints where caregivers experienced more distress, they had lower self-efficacy and increased PHBs.Similar effects were observed at the between person level.These data suggest that both caregiver distress and self-efficacy are important intervention targets for minimizing PHBs.While Stress Process Models of family caregiving have been examined extensively, little focus has been placed on caregiver's actual management of care.We consider whether caregiving style classified previously through k-modes machine learning models and based on cognitive-behavioral approaches to care impact caregivers' experiences of carerelated stress and well-being.The three previously identified styles include: Adapters-strong dementia understanding and adaptability, encouraging behavioral approach; Managerspoor dementia understanding and adaptability, critical behavioral approach; and Avoiders-moderate dementia understanding and adaptability, passive behavioral approach.Participants included 100 primary family caregivers for PWDs who were on average 64 years old, 74% female, and 18% non-White.Utilizing linear regressions, each caregiving style was considered a key predictor (reference: Adapters) of the Zarit Burden Interview (ZBI), Caregiver Assessment of Function and Upset (CAFU) upset score, Neuropsychiatric Inventory (NPI-C) distress scale, and Positive and Negative Affect scale (PANAS) controlling for dementia severity, care duration, co-residency, and demographics.Relative to Adapters, Managers had more CAFU upset (β=0.4,p<.001), more NPI-C distress (β=0.4,p<.001), and greater burden (ZBI) (β=0.3,p<.001).Avoiders showed significantly greater CAFU upset than Adapters (β=0.2, p<.05).Positive affect was not associated with caregiving style.Caregiving styles associated with less understanding and adaptability and a more critical behavioral approach showed worse caregiving outcomes accounting for dementia severity.Results can inform a nuanced approach to tailoring and targeting interventions based on caregiver styles with the goal of reaching caregivers at risk for poor outcomes and ultimately leading to significant public health impact.Sleep is critical for health and well-being among both persons with dementia (PwD) and their family caregivers (CG).This study described sleep characteristics for dementia family care dyads, then examined the associations with sleep quality, daytime functioning, and mood in the context of Adult Day Services (ADS) use.Caregivers (n = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons with dementia across 8 consecutive days (N = 1,359), where PwD attended ADS at least 2 days of the week.They also reported their own fatigue and affect and PwD's daytime and nighttime sleep and behavior problems on each day.Findings from multilevel models suggested that bedtime was earlier and total time in bed was shorter before an ADS day for the dyad, and also on an ADS day for PwD; wake time was earlier for the dyad on and following an ADS day.Using ADS related to better prior night sleep quality for PwD; it also weakened the association between nighttime


CAREGIVING SELF-EFFICACY AS A MEDIATOR OF NEGATIVE EMOTIONAL STATES AND POTENTIALLY HARMFUL BEHAVIORS


COGNITIVE-BEHAVIORAL DEMENTIA CAREGIVING STYLES: ASSOCIATIONS WITH CARE STRESS AND WELL-BEING


DAILY SLEEP, WELL-BEING, AND ADULT DAY SERVICES USE AMONG DEMENTIA CARE DYADS



David Hancock, 1 Sara Czaja, 2 and Richard Schulz, 3 1.Weill Cornell Medicine, New York City, New York, United States, 2. Weill Cornell Medicine/Center on Aging and Behavioral Research, New York, New York, United States, 3. University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Innovation inAging, 2021, Vol. 5, No. S1

DAILY SLEEP, WELL-BEING, AND ADULT DAY SERVICES USE AMONG DEMENTIA CARE DYADS
David Hancock, 1 Sara Czaja, 2 and Richard Schulz, 3 1.Weill Cornell Medicine, New York City, New York, United States, 2. Weill Cornell Medicine/Center on Aging and Behavioral Research, New York, New York, United States, 3. University of Pittsburgh, Pittsburgh, Pennsylvania, United States