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Biomedical subjects

M Stommel

Publications and source records attributed to M Stommel.

At least 37 records · Page 2Linked to original sources
PubMed1994

Predictors of use of secondary carers used by the elderly following hospital discharge.

This research examines how caregiver-patient relationship (female spouses, and adult daughters and daughters-in-law) when cross classified with patient coresidence patterns explains the level of secondary carers' involvement among patients with newly added needs for assistance at home following hospital discharge. Among 196 primary caregivers (104 spouses, 92 daughters and daughters-in-law), patient needs were divided into ADL and mobility limitations, and medical tasks. Secondary carer involvement was categorized into levels differing at two observations: one following discharge and a second 3 months later. Analyses focused on explaining the levels of involvement of secondary carers following hospital discharge and the changes in secondary carers' involvement between the two observations. The baseline and change analyses revealed that caregiver-patient relationship was more important than coresidence patterns or patients' demands in explaining assistance from secondary carers. The implications of these findings on caregivers' reactions and policies regarding home care are explored.

Aged↗
PubMed1993

The cost of cancer home care to families.

BACKGROUND: For the most part, previous research on costs of cancer care has focused on the formal medical care costs. Research on home care for patients with cancer has emphasized direct care costs (expenditures). Among indirect costs, only loss of income to family members has been studied. However, a major component of indirect costs, the family labor expended to care for the patient with cancer, needs to be included for a more realistic appreciation of home care costs. METHODS: The costs of family labor are estimated by imputing monetary values for the time spent caring for the patient with cancer. The assigned monetary cost either is equated with income losses of the helper in question or is based on a putative market value of the expended labor time. In addition, out-of-pocket expenditures examined in this study cover all cancer care-related expenses for which the patient was not reimbursed by third parties. Data were obtained from a convenience sample of 192 patients with cancer and their families in lower Michigan. RESULTS: When family labor is included in the cost calculations, average cancer home care costs for a 3-month period ($4563) are not much lower than the costs of nursing home care. The substantial variation in home care costs (standard deviation [SD] = $4313) appears to be unrelated to the type of cancer diagnosis, type of treatment, or time since diagnosis but seems to be driven by the functional status of the patient and the family living arrangements. CONCLUSIONS: Outpatient care for patients with cancer coupled with greater reliance on home care appear to be economically attractive because costs to families usually are underestimated.

Adult↗
PubMed1993

Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D).

Confirmatory factor-analytic models are used to examine gender biases of individual items of the Center for Epidemiologic Studies Depression (CES-D) Scale. In samples containing 708 cancer patients and 504 caregivers of the chronically ill elderly, two CES-D items are identified as producing biased responses in comparisons of male and female respondents. Three additional CES-D items are excluded on the basis of other psychometric problems, yielding a subset of 15 CES-D items that capture almost all the information of the original 20-item CES-D scale but are free of any gender bias. Gender differences in mean levels of depressive symptomatology are significantly reduced, but not eliminated, when the 15-item scale is used.

Activities of Daily Living↗
PubMed1993

The influence of cancer patients' symptoms and functional states on patients' depression and family caregivers' reaction and depression.

In this article the paths among cancer patients' physical and mental health and the reactions and mental health of their family caregivers were examined. Data for these analyses came from a cross-sectional sample of cancer patients who were recruited through ambulatory outpatient chemotherapy units, and their family caregivers. Patients' depression was explained largely by their symptomatology and, to a lesser extent, by loss of mobility. Patients' physical limitations impacted caregivers' daily schedules but not their physical health. Patients' levels of depression were related to those of their caregivers. However, caregivers' optimism proved to be a significant predictor of their mental health and reactions to caregiving.

Activities of Daily Living↗
PubMed1992

The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments.

The development and testing of a multidimensional instrument to assess the reactions of family members caring for elderly persons with physical impairments, Alzheimer's disease, and cancer is reported. Forty items were administered to a sample of 377 caregivers of persons with physical impairments and Alzheimer's disease. Five dimensions of caregivers' reactions were identified through exploratory factor analysis. Using confirmatory factor analysis on an independent sample (N = 377), these dimensions were tested for factorial invariance across spouse and nonspouse caregivers and between caregivers of persons with cancer and those caring for persons with Alzheimer's disease. The subscales also had a high level of factorial invariance across a three-wave panel study (N = 185). The subscales appeared consistent with first order tests of construct validity.

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PubMed1992

Confirmatory factor analysis (CFA) as a method to assess measurement equivalence.

Employing the example of a multidimensional caregiver reaction scale, the use of confirmatory factor analysis techniques to establish measurement equivalence across comparison groups is discussed. The discussion is organized around the key concept of factorial invariance which provides the yardstick for assessing measurement equivalence.

Alzheimer Disease↗
PubMed1992

Patient attitudes concerning health behaviors during pregnancy: initial development of a questionnaire.

The major determinant of infant mortality in the United States is low birthweight (LBW). Health behaviors related to LBW are inadequate prenatal care, poor nutrition, smoking, and moderate to heavy alcohol use. Before interventions can be designed to assist women in modifying these health behaviors, more must be understood about their causes. The Health Belief Model (HBM) is a framework for analyzing beliefs that motivate health behaviors and is well established as a model for understanding health behavior decisions. The chief aim of this study was to develop an instrument to assess women's health beliefs during pregnancy. Questions for the instrument were generated around the four major constructs of the HBM: perceived susceptibility, seriousness, benefits, and barriers. Four focus group interviews, a literature review, and consultation with an HBM expert provided content for questions. The questionnaire was administered to a convenience sample of 127 women. The measurement models were tested using confirmatory factor analysis. Parsimony was achieved by reducing the original 106-item scale to 64 items. The final instrument provides support for the HBM but not for all of its discrete constructs.

Adolescent↗
PubMed1991

Knowledge and use of community services among family caregivers of Alzheimer's disease patients.

The number of people with dementia residing within the community is steadily increasing. Community services can alleviate the burdens experienced by families, but are used infrequently by families of dementia patients. Caregivers (N = 93) of dementia patients were surveyed regarding their knowledge and use of community services. The most frequently used services were family support groups and home health aides. Overall, service use was low despite high levels of perceived availability of services. Older and less educated caregivers had higher levels of uncertainty about service availability. Depressed caregivers were less likely to know about service availability. Implications for practice and research are presented.

Age Factors↗
PubMed1991

Assessment of the attitudes of family caregivers toward community services.

Previous research has not taken into account the influence of attitudinal variables on the use of community services by dementia caregivers. The Community Service Attitude Inventory (CSAI) was developed to provide a measurement tool to further understanding of community service use by family caregivers. Testing of the CSAI revealed five distinct components of family attitudes toward use of community services.

Alzheimer Disease↗
PubMed1991

Support patterns for spouse-caregivers of cancer patients. The effect of the presence of minor children.

This study examines the support received by spouse-caregivers of cancer patients with minor children. The pattern of help encountered by these caregivers is compared to that of other caregivers, either living alone with the cancer patient or together with their adult children. This comparison leads to an exploration of compensatory support patterns depending on the source of help and the living arrangements. The study is based on a convenience sample of 232 spouse-caregivers of cancer patients in the Midwest. The findings suggest that other family members are willing to provide additional support when minor children are present in the household of the caregiver-patient dyad. However, this compensatory pattern does not extend to the situation of caregiver and patient living alone, nor do friends and neighbors engage in compensatory support behavior.

Adult↗
PubMed1990

Responses of elderly spouse caregivers.

In this paper three categories of variables were identified to predict spouses' reactions to caregiving roles: patient characteristics, the caregiving environment, and characteristics of the caregiver. Measures of these variables were administered to 159 spouse caregivers. Four domains of caregivers' responses were identified: negative emotional reactions, feelings of responsibility for the patient, feelings of abandonment by family, and impact of caregiving on daily schedules. These domains were influenced most by patient negative behaviors, physical health, and age, and by caregiver age, employment, and emotional status. Amount of assistance, affective support, and hours of care also were predictive of spouse responses.

Activities of Daily Living↗
PubMedDate not supplied

Predictors of depressive symptomatology of geriatric patients with lung cancer-a longitudinal analysis.

BACKGROUND: Lung cancer is a major health problem throughout the world. It is the leading cause of cancer-related death in men and women in the USA, with a 5-year survival rate of only 14%. It has been hypothesized that variables such as physical and social functioning, cancer-related symptomatology, comorbid conditions, cell type, and treatment are valid predictors of the psychological response to a diagnosis of lung cancer. METHODS: As part of a larger longitudinal study, 211 patients, 65 years of age or older, with an incident diagnosis of lung cancer, were recruited from 23 sites within a midwestern state. Repeated measures analysis of variance techniques were used to analyse how age, gender, comorbid conditions, stage of disease, cell type, as well as the time-dependent variables symptoms, physical functioning, social functioning, and treatment predict depressive symptomatology at four assessments over the first year following diagnosis. RESULTS: Social functioning (p<0.0001), symptoms severity (p<0.0001) and radiation treatment (p=0.017) were significant predictors of depressive symptomatology, with more symptoms and more restricted social functioning generally corresponding to higher levels of depressive symptomatology. Patients who had not received radiation treatment were more depressed than those who had received treatment at least 40 days prior to the interview. CONCLUSIONS: At a clinical level of patient care, these findings mandate early identification of psychosocial difficulties experienced, an individualized symptom management plan and the application of other interventions, such as information giving, reassurance and referral to other resources.

Activities of Daily Living↗
PubMedDate not supplied

Physical functioning and depression among older persons with cancer.

PURPOSE: The purpose of this study was to help identify factors to assess which elderly patients are likely to experience problems with physical and psychological functioning in association with cancer or its treatment. DESCRIPTION OF STUDY: A study was undertaken with a sample of 420 patients with cancer who were between the ages of 65 and 98 years and had received an incident diagnosis of breast, colon, lung, or prostate cancer. An analysis of covariance technique was used to determine how cancer site, treatment type, stage of disease, gender, age, comorbidity, symptom severity, and pre-diagnosis levels of physical functioning were related to physical functioning deficit, and how all of these in turn influenced patient depressive symptomatology. RESULTS: Pre-diagnosis physical functioning, symptom severity, and days since surgery were significant predictors of physical functioning deficit. Patients who had been treated only with surgery experienced greater physical functioning deficits than did patients who had received both surgery and adjuvant therapy. This apparent anomaly was partly explained by the time interval from surgery to interview. Higher levels of symptom severity, lower levels of prior physical functioning, and greater physical functioning deficits all predicted higher levels of depressive symptomatology. CLINICAL IMPLICATIONS: In the care of elderly patients with cancer, it is important for healthcare providers to consider the pre-diagnosis levels of physical functioning of patients with cancer to understand and anticipate the physical and psychological consequences of cancer and its treatment. Equally important is the proper management of patient symptoms in maximizing both the physical and psychological quality of life.

Aged↗
PubMedDate not supplied

Promoting positive well-being in employed mothers: a pilot study.

In this quasi-experimental pilot study, women who were returning to work within 6 months after the birth of a first baby were assigned to participate in a control group (n = 13) or a six-session small group intervention (n = 18). The content of the group intervention was developed based on a stress and coping framework (Lazarus & Folkman, 1984). The experimental and control groups were surveyed at 2 months after their return to employment and on their baby's first birthday on measures of well-being in marriage, work, and parenting. Repeated measures analysis of covariance was used to examine differences over time between the experimental and control group with length of maternity leave and number of hours worked as covariates. Participants in the intervention reported increasing levels of marital satisfaction over time, whereas the control group experienced a decline in marital satisfaction over time (p = .04). Implications for practice and research are presented.

Adult↗
PubMedDate not supplied

Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment.

BACKGROUND AND OBJECTIVES: Using an instrument to measure physical functioning that was normed to the U.S. population, data were obtained from patients with a new diagnosis of breast, colon, lung, and prostate cancer. Two questions were addressed: (a) after controlling for age, and number of comorbid conditions, do site and stage of cancer predict functional limitations prior to diagnosis; (b) using age adjusted national norms on physical functioning, how well do age, number of comorbid conditions, stage, treatment and cluster of symptoms (pain, fatigue, and insomnia) explain changes in physical function between 3 months prior to and 8 weeks following diagnosis? METHODS: Patients 65 years of age and older were accrued from 24 community oncology settings. Consenting patients were interviewed within 8 weeks of initial treatment. The SF-36 was used to measure physical functioning. Comorbidity and symptom experience were assessed through patient report and site and stage of cancer from record audits. RESULTS: Prior to diagnosis of cancer, patients were comparable in physical functioning to the U.S. population aged 55-64, a full decade younger than the sample of cancer patients. Site and stage of disease did not account for variations in physical functioning prior to diagnosis. Compared against national norms, patients with more extensive treatments (surgery plus adjuvant therapy) reported greater loss in functioning. Pain, fatigue, and insomnia had a consistent and significant effect on losses in functioning unrelated to patients' treatments or their comorbid conditions. CONCLUSIONS: Site and stage of cancer prior to diagnosis do not affect functioning. Older cancer patients report higher functioning than their counterparts in the U.S. population. Changes in functioning following diagnosis varied by cancer site. Treatments were related to loss in functioning, but comorbidity was not. Pain, fatigue, and insomnia were significant and independent predictors of change in patient functioning. This underscores the importance of interventions to manage symptoms early in the course of treatment for individuals.

Activities of Daily Living↗
PubMedDate not supplied

Research design and subject characteristics predicting nonparticipation in a panel survey of older families with cancer.

BACKGROUND: While recognized that loss of subjects over time may introduce bias and complicate statistical analysis in panel studies, it is seldom acknowledged that sampling bias starts with subjects who are eligible but do not participate. OBJECTIVES: Community-based recruiters identified 1,948 subjects as eligible to participate in a descriptive panel survey of older families with cancer. Focusing on the time between identification of eligible subjects until contact for the first interview for consenting subjects, the purpose of this study was to determine if subject or research design factors predicted who was more prone to nonparticipation. METHOD: A multivariate model explored the simultaneous effects of subject and research design characteristics on nonparticipation. Demographic and cancer characteristics, as well as features of the study protocol, were used as predictors in a multinomial logit regression model to enable a three-way comparison between nonconsenters (n = 748), consenters who dropped out prior to data collection (n = 208), and consenters who participated in the intake interview (n = 992). RESULTS: Age and cancer diagnosis played roles in whether consent was obtained, whereas race did not affect consent but raised odds of drop out after consent. Powerful evidence emerged that design features, such as if a caregiver participated, recruitment staff roles, and payment to recruiters, affected the probability of subjects not participating or dropping out before being interviewed. CONCLUSIONS: Findings suggest that both subject and research design characteristics affect the likelihood of nonparticipation in a panel study of older cancer patients and family caregivers. Future research involving testing of strategies addressing access and accrual issues, research staff roles, reimbursements, and responsiveness to the needs of research personnel, ill participants, and family members is warranted.

Age Factors↗
PubMedDate not supplied

Caregiving transitions: changes in depression among family caregivers of relatives with dementia.

Depression among family caregivers of relatives with dementia was examined at three time intervals over a 4-year period. Comparisons were made between 46 residential caregivers, 49 caregivers of institutionalized elders, and 47 bereaved caregivers. No overall difference was found between the depression paths of the three groups. Female bereaved caregivers experienced a pattern of decreasing depression following their relative's death, while male bereaved caregivers experienced an increase in depression. Findings suggest the need for further investigation of the influences of gender on bereavement following the experience of providing family care for a relative with dementia.

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