Scholarly Works, Center for Gerontology

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Caregivers of Persons with Mild Cognitive Impairment: Information and Support Needs
Wilcox, Karen L.; Roberto, Karen A.; Blieszner, Rosemary; Winston, Brianne L. (Virginia Tech, 2004-11)
One of the newer concepts of age-related memory deficit is mild cognitive impairment (MCI). MCI reflects self-reported changes in cognitive function that do not necessarily interfere with work or social relations; it is viewed as a transitional phase between normal cognitive aging and dementia. Researchers and practitioners lack a comprehensive understanding of what relatives of persons with MCI are actually experiencing and what they realistically believe would be helpful to manage their situation now and in the future. In a multi-method, mini-longitudinal design that incorporated quantitative and qualitative approaches, we collected information from patient charts and semi-structured family interviews to investigate the information and support needs of 20 (out of 100 to be interviewed) family members of older adults with MCI. We found that, apart from information available about potential later diagnoses such as dementia or Alzheimer’s disease, families reported having little information available to them to assist in decision making and caregiving for early stages of memory loss. Family members were hesitant to think about and plan very far into the future and were more likely to take things a day at a time. Past experiences with family members or friends with memory difficulties or other serious health conditions enabled some family members to feel more at ease and knowledgeable with the process of seeking help for themselves and the older adult they were supporting. Findings suggest that earlier identification of memory loss has implications for clinical practice and the delivery of health care and social services to older individuals and their relatives.
Community Connections and Sense of Community among Older Adults
Brossoie, Nancy; Mancini, Jay A.; Roberto, Karen A.; Blieszner, Rosemary (Virginia Tech, 2003)
The goal of this exploratory study is to identify what factors predict sense of community in older adult community members.
Daily Stressors and Marital Interactions Affect Diurnal Cortisol and Alpha-Amylase Rhythm in Spouses of Persons with Mild Cognitive Impairment
Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary (Virginia Tech, 2011)
Research aims: 1. To document daily symptoms and behaviors of persons with MCI 2. To assess how MCI-related symptoms, care needs and other stressors influence psychological well-being of care partners 3. To examine effects of MCI-related symptoms, care needs and other stressors on spouse care partner’s physiological indicators of health (Diurnal Rhythm of Coritsol and Alpha-Amylase)
Dual Caregivers of Persons Living with Dementia: The Added Stress of COVID-19 Pandemic
Atkinson, Emily; Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; McCann, Brandy R.; Knight, Aubrey L. (SAGE, 2022-02-17)
Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.
Extending Terror Management Theory to Increase Understanding of Older Adults’ Views of Death
Ogletree, Aaron M.; Blieszner, Rosemary (Virginia Tech, 2015-11-19)
We applied Baltes’ lifespan development perspective to TMT to examine how experiences influence worldview change over time. We argue that worldview adaptations can bolster older adults against death threat and ameliorate death anxiety.
Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use
Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; Knight, Aubrey L. (Oxford University Press, 2022-01-01)
Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver's rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.
Family Perceptions of Mild Cognitive Impairment
Roberto, Karen A.; Blieszner, Rosemary (Center for Gerontology, Virginia Tech, 2007-11)
Friendship in Later Life: A Research Agenda
Blieszner, Rosemary; Ogletree, Aaron M.; Adams, Rebecca G. (Oxford University Press, 2019-01-01)
Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.
In Sickness and In Health: Daily Stressors and Implications of Mild Cognitive Impairment for Care Partners
Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary (Center for Gerontology and Dept. of Human Development Virginia Polytechnic Institute and State University, 2009-11)
The Influence of Mild Cognitive Impairment on Marital Relationships
Winston, Brianne L.; Roberto, Karen A.; Blieszner, Rosemary; Wilcox, Karen L. (Virginia Tech, 2005)
Background: Mild cognitive impairment (MCI) signifies age-related memory decline that is less severe than with dementia. Most scholarship focuses on the clinical diagnosis and prevalence of MCI; the psychosocial aspects have been studied less often. Thus the purpose of this research was to examine the influence of MCI on interactions among long-term married couples. Methods: Using qualitative methodology, 10 spouses (5 wives, 5 husbands) of community-dwelling persons diagnosed with MCI reported on shared couple activities, amount of time spent together, division of household tasks, and management of everyday life. Transcripts were analyzed through an open coding process and results are represented by case studies. Results: The interviews revealed both stability and change within marital relationships when spouses are faced with MCI. Emergent themes focused on relational interactions (e.g., disclosure, negative and positive emotional outcomes, shared activities), relational dynamics (e.g., power, “couplehood”), socio-emotional intimacy (e.g., companionship, support, concern), and household responsibilities (e.g., external help, equal division of labor, spouse assumes most responsibility, person with MCI has assigned duties). Conclusions: Findings indicate that dealing with a spouse with MCI yields difficult emotional responses including helplessness, frustration, sadness, and worry. Spouses also expressed positive outcomes (e.g., commitment, love, emotional closeness) when discussing their relationship with their partner. Additional research is needed on the most effective coping strategies in the face of an uncertain prognosis and perceived changes in marital interactions. Practitioners should attend to the unique stressors and strains of having a spouse impaired by early memory loss and the potential for changing marital dynamics.
Influences on Psychological Well-being for Elders Receiving Family Assistance
Blieszner, Rosemary; Roberto, Karen A. (Virginia Tech, 2004-07-24)
We investigated the effects of personal and social resources on the psychological well being of 359 rural older adults living in their own homes with some functional limitations and receiving assistance from relatives or friends. Personal resources included health, importance of religion, endorsement of filial responsibility norms, and attitudes toward community services. Social resources were number of informal helpers, frequency and duration of receiving assistance, emotional closeness to helpers, availability of someone to check on the elder, and having someone to trust and confide in. Depression, 4 Ryff subscales, self-esteem, and quality of life were markers of psychological well being. The findings indicate that the interactional aspects of receiving help are not particularly influential on the elders’ well being. Rather, in the context of receiving informal support, their personal characteristics have fundamental impact on their happiness. This implies that the informal help that elders receive does not threaten their sense of self.
Innovative Care-partnering in Families Affected by Mild Cognitive Impairment
Blieszner, Rosemary; Roberto, Karen A. (Virginia Tech, 2010-11-04)
The purpose of this presentation was to examine the effects of memory-related changes in decision-making and ability to carry out daily tasks on family interactions and relationships over time when one member has mild cognitive impairment.
A Long and Winding Road: Dementia Caregiving With Grit and Grace
Roberto, Karen A.; McCann, Brandy R.; Blieszner, Rosemary; Savla, Jyoti S. (Oxford University Press, 2019)
Background and Objectives: Many dementia caregivers provide care for numerous years. Exhibiting grit, or commitment and persistence in the face of adversity, may bolster their ability to manage caregiving challenges. We explored grit in relationship to memory and behavior problems and response to stressors among women engaged in long-term dementia care. Research Design and Methods: Informed by a life course perspective, and guided by stress-process theory, we interviewed 10 women with a spouse or parent initially diagnosed with mild cognitive impairment 4 times over 10 years. Using Charmaz’s analysis methods and grit as a sensitizing concept, we employed an unfolding analytic strategy involving (a) thematic analysis to identify expressions of grit in response to caregiving stressors across interviews and (b) case-by-case comparisons to assess associations of grit with the use of care strategies across caregivers over time. Results: Dementia caregivers experienced unrelenting and changing psychosocial and physical challenges. Over time, most women exhibited a sustained commitment to the relationship through the ways in which they protected the identity of the person with dementia, modified their expectations for emotional intimacy, and managed their financial affairs. They persevered as their roles and relationships fluctuated, often finding purpose and relief through employment and leisure pursuits. As care intensified, women who took charge and consciously made decisions in the best interest of the care recipient and themselves minimized stress. Discussion and Implications: While some caregivers exhibited grit from the outset, all showed enhanced perseverance and commitment to the ways they managed memory-related changes over time. Developing confidence in their ability to manage and provide care helped the caregivers respond to stressors with purpose and sustain their roles and responsibilities. Enhancing grit in long-term dementia caregivers may result in better individual and relational outcomes.
“Nobody Likes to Admit What’s Going On”: Avoidance Behaviors of Families Coping with MCI
Brossoie, Nancy; Roberto, Karen A.; Blieszner, Rosemary (Virginia Tech, 2009)
Managing stress using avoidance coping strategies allows family members to manage their emotional responses as well as cope with changes in their relative’s memory, behavior, and sociability that manifest with mild cognitive impairment (MCI). The purpose of this study is to examine the use of avoidance coping behaviors by identifying conditions preceding an avoidance response and specific types of avoidance strategies used to cope with stresses of having a relative with MCI. This investigation is guided by Lazarus and Folkman's (1984) conceptualization of avoidance coping behaviors. Data analysis used Strauss and Corbin’s (1990) method of constant comparison.
Patient Views of Mild Cognitive Impairment
Blieszner, Rosemary; Roberto, Karen A. (Center for Gerontology, Virginia Tech, 2007-11)
Personal and Social Resources and Well Being among Informal Care Recipients
Blieszner, Rosemary; Roberto, Karen A. (Virginia Tech, 2004-07-31)
Moving beyond a focus on primary caregivers only, we examined the effects on older adults’ psychological well-being of having multiple family or friend helpers and of other elements of social support when receiving informal assistance. This research is grounded in a model of well being (Fisher et al., 1983) positing that most aid situations contain a mixture of positive and negative elements. If receiving help highlights inferiority or dependency, aid will be viewed as self-threatening; if assistance avoids contributing to negative self-images, it will be seen as self-supportive. Values held about support and dependency affect reactions to aid, as do social resources manifested in the helping situation. Data, from 359 community-residing elders, include 6 personal resources, 6 social resources, Depression (CES-D), 4 Ryff Well Being subscales, Rosenberg Self-esteem, and Quality of Life. Regression models explained between 9% and 28% of variance in indicators of psychological well being. Findings suggest that the social context of receiving help is not particularly influential in well being, but personal characteristics have fundamental influence on happiness. Informal assistance does not threaten sense of self.
The Role of Gender in Coping with Mild Cognitive Impairment
Blieszner, Rosemary; Roberto, Karen A. (Center for Gerontology and Deptartment of Human Development Virginia Polytechnic Institute and State University, 2009-11-29)
Rural Older Adults’ Previous Help and Support Experiences: Influences on Attitudes about Current and Future Assistance
Blieszner, Rosemary; Roberto, Karen A.; Love-Norris, Denise; Rogers, Sharon; Fruhauf, Christine A. (Virginia Tech, 2003-11)
We investigated the extent to which earlier life experiences with informal and formal services might influence older adults’ views of getting assistance in the future. In a short-term longitudinal follow up of telephone interviews with a representative sample of rural, community dwelling elders (N = 532), we conducted face-to-face interviews with a subsample (n = 84) who were originally receiving informal assistance only, formal services only, both forms of support, or no assistance. We examined changes in assistance over 18 months and inquired about previous and current use of community resources (restaurants, hired help, overnight travel), home-based nursing or personal care, and formal services, as well as plans for future care needs. Past and current acceptance of external (nonfamilial) sources of support are associated with willingness to rely on formal services in the future. However, most participants expressed a strong preference for maintaining as independent a lifestyle as possible, even while expecting a need for greater assistance in the future. Whereas a minority have made arrangements for some type of formal care such as long term care insurance or nursing home placement, most intend to rely on family members for help. Few endorse depending on friends, neighbors, or other informal helpers except for occasional assistance. The results of this study have implications for research and public education on family caregiving, as well as for planning and delivery of informal and formal community services in rural areas.
Safety vs. Autonomy: The Struggles of Adult Children Assisting Parents with Mild Cognitive Impairment
Pujari, Kristen; Blieszner, Rosemary; Roberto, Karen A. (Virginia Tech, 2009)
The purposes of this qualitative analysis were to understand when, why, and how adult children decide to provide more intense support when a parent has mild cognitive impairment (MCI) and to identify gender similarities and differences in their responses to the new challenges they face. At Time 1 we interviewed 43 adult children (33 daughters) aged 27-65 by phone using semi-structured questions; 18 of them (12 daughters) participated in multiple interviews over 56 months. Analyses revealed perceived risks to parental safety as the main reason adult children stepped in to assist parents in new ways. Adult children struggled with balancing parental autonomy vs. safety needs. They were uncertain how much to intervene when the parent with MCI developed problems with routine independent living activities such as driving, finances, home maintenance, medication management, or meal preparation. Sons typically provided indirect support relating to financial planning and household maintenance, laterally supporting parents while focused on promoting long-term independence. Sons also tended to receive information about the MCI condition through the parent assisting the person with MCI. Daughters provided more direct nurturing support such as daily visits or phone calls to both parents as well as more immediate chores such as grocery shopping and transportation. Findings confirm that gendered patterns of assisting with MCI are similar to those found in other care situations. With MCI diagnosis, adult children struggle with transitioning into care partner roles and balancing parental independence while actively adhering to safety concerns.
Taking Care of a Parent with Mild Cognitive Impairment: An Exploration of Coping Mechanisms
Ermann, Lauren S.; Brossoie, Nancy; Roberto, Karen A.; Blieszner, Rosemary (Virginia Tech, 2011)
Caregiving is a dynamic process of transitions and changes that evolves over time. Guided by Montgomery and Kosloski's Caregiver Identity Theory (2000), we explored the coping mechanisms employed by adult children providing support to a parent with Mild Cognitive Impairment (MCI) and changes in the use of coping strategies over time. In-depth qualitative interviews were conducted with 11 adult children soon after their parent received a diagnosis of MCI, and again approximately 12 and 24 months thereafter. Two primary findings emerged from our analysis: adult children of parents with MCI (1) employed a variety of coping mechanisms to manage their stress at different times in the care process that included psychological reframing (e.g., acceptance), self-care (e.g., exercise), external engagement (e.g., seeking support) and avoidance (e.g., distancing), and (2) often struggled with their care partner role and the additional and sometimes unexpected responsibilities such as managing money, providing transportation, and assisting with household tasks. Many adult care partners responded to their changing roles by expressing frustration or disappointment, although some still viewed their care partner experiences as generally positive. Consistent with the Caregiver Identity Theory, study participants discussed the stress generated by a perceived incongruity between their expected roles as adult children and the reality of their roles as care partners. Findings suggest that social workers and other mental health professionals who work with adult children of parents with MCI can better assist their clients by educating families about MCI and exploring effective coping mechanisms for dealing with stress.

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