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PubMed2004

An intergenerational group benefits both emotionally disturbed youth and older adults.

This qualitative descriptive study examined the perceived benefits of an intergenerational program for low-income older adults residing in subsidized housing and youth who were part of a support group for emotionally disturbed youth. The intergenerational group met bimonthly for 11 months at the independent living facility for the elderly. Activities consisted of group discussions, games, talent expressions, trips, picnics, and crafts. Frequently a teen was paired with an older adult to complete a craft project. Bonding between each pair occurred over time, as the older adults became role models for the youth. The perceived benefits of including emotionally disturbed youth and vulnerable but well older adults in an intergenerational program were determined by a structured interview and then through categorization of the participants' responses to a series of emotional, attitudinal, and behavioral questions using Yalom's (1985)Therapeutic Factors. The results indicated that both of the age groups' attitudes toward each other and relationships with each other changed positively. Behavioral changes among the youth included improved social skills observed by the co-facilitators of the group.

Adolescent↗
PubMedDate not supplied

The historical trauma response among natives and its relationship with substance abuse: a Lakota illustration.

Historical trauma (HT) is cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences; the historical trauma response (HTR) is the constellation of features in reaction to this trauma. The HTR often includes depression, self-destructive behavior, suicidal thoughts and gestures, anxiety, low self-esteem, anger, and difficulty recognizing and expressing emotions. It may include substance abuse, often an attempt to avoid painful feelings through self-medication. Historical unresolved grief is the associated affect that accompanies HTR; this grief may be considered fixated, impaired, delayed, and/or disenfranchised. This article will explain HT theory and the HTR, delineate the features of the HTR and its grounding in the literature, offer specific Native examples of HT and HTR, and will suggest ways to incorporate HT theory in treatment, research and evaluation. The article will conclude with implications for all massively traumatized populations.

Adolescent↗
PubMedDate not supplied

Incorporating Yup'ik and Cup'ik Eskimo traditions into behavioral health treatment.

The Yup'ik and Cup'ik Eskimo of Southwest Alaska have developed programs to provide healing from historical trauma. The Village Sobriety Project, a Center for Substance Abuse Treatment-funded project administered by the Yukon-Kuskokwim Health Corporation from 1999 to 2002, is an effort to incorporate the local Yup'ik and Cup'ik peoples' ways into treatment services for mental health and substance abuse. Activities such as tundra walks and time with elders are supported in treatment, and Medicaid reimbursement was successfully obtained for such activities. Documentation of treatment showed that it incorporated cultural elements of the Yup'ik and Cup'ik people.

Alaska↗
PubMedDate not supplied

Paying respect: care of elderly parents by Chinese and Filipino American women.

Chinese and Filipino American women's caregiving for their elderly parents was explored. Patterns of care, sources of stress, and resources and strategies used in coping with the stress and providing care were investigated using a grounded-theory methodology. Patterns of care included "paying respect" by "caring for" and "providing for" elderly parents. Sources of stress were caregiving demands, interpersonal relationships, conflict between traditional cultural expectations and what the caregivers could provide, and issues of control. Resources identified were primarily personal, familial, and cultural. Strategies used to cope with the stress included optimism, trust in religion, setting limits, and taking charge. The phenomenon of respect for elders described in this study is consistent with that described by Stern et al. (1980, 1985). The satisfaction gained from paying respect contributed to the women's ability to integrate the caregiving role with other roles, congruent with Meleis's theory of role integration.

Adaptation, Psychological↗
PubMedDate not supplied

Health, stress, coping, and social support in grandmother caregivers.

The purposes of this study were to examine health, stress, coping, and supports of grandmothers who live with one or more grandchildren and participate in their care, and to examine whether differences exist between grandmothers with primary and partial responsibility for their grandchildren's care. A convenience sample of 90 women was recruited from various sites, and participants completed a self-administered questionnaire. There were no differences between grandmothers who had primary responsibility for raising their grandchildren (n = 58) and those who did not (n = 32) in self-assessed health, anxiety, or depression; in coping; or in typical grandparenting stresses. Grandmothers with primary responsibility reported significantly greater parenting stresses and less instrumental and subjective social support. Grandmothers in both groups reported high depression and anxiety scores and favorable scores on grandparenting stresses. Implications for grandmother caregivers are discussed.

Adaptation, Psychological↗
PubMed1993

Genograms: a psychosocial assessment tool for hospice.

Genograms are a valuable and non-threatening evaluation tool for hospice patients and families. The genogram provides basic information about the family including the role of each member and the family dynamics. As the diagram is drawn, family life cycle issues and relationships between family members become evident. The genogram may go beyond the household to include supportive neighbors, friends, and community resources. Religious and spiritual support is also noted. The information is used to assess family needs and to provide interventions both before the death and during bereavement.

Caregivers↗
PubMedDate not supplied

Improving intergenerational health care communication.

The relationship between health care providers and their older adult patients may suffer from miscommunication problems stemming from agist stereotyping. Stereotypes of older adults by younger adults may be revealed through patronizing speech--or elder-speak, which is the overaccommodation of speech interaction. Over- and underaccommodation strategies based on these stereotypes are often used by young health care providers when communicating with older adults. As the population ages and the demand for health care services increases, health care providers must improve their communicative effectiveness with their older patients. Attention to the individual needs of health care consumers, cognizance of age or role stereotyping, and proper training of health care providers would increase communicative effectiveness and enhance the patient-provider relationship.

Adult↗
PubMedDate not supplied

Role of gender, insurance status and culture in attitudes and health behavior in a US Chinese student population.

INTRODUCTION: Asians are an understudied population in health research. Often their lower utilization of health care services and low participation in clinical trials has been attributed to socioeconomic factors and cultural beliefs. However, the role of gender and perceptions of health beliefs across generations in determining access have not been studied in this population. OBJECTIVE: This study seeks to examine the relationship of gender to the health beliefs and health utilization patterns of a group of undergraduate Chinese students in regard to their own use and what they perceived as their parents' use. DESIGN: Seventy-eight Chinese students responded to a health belief and utilization survey. They were asked to provide information on their perceptions and attitudes of health as well as what they perceived to be their parents' health attitudes and behavior. RESULTS: Findings indicated that female students were more proactive in their health beliefs towards preventive care and getting regular check-ups than male students. This difference between genders remained true in the students' perceptions of their mothers being more likely to seek preventive care and to get regular check-ups than their fathers. Cultural factors including privacy and modesty were important factors in determining use of health care by Chinese women. Insurance status played an important role in determining health behavior among Chinese men. Uninsured fathers were perceived as more likely to use complementary and alternative therapies (CAM) than mothers. Male students and fathers who had private insurance were perceived to access and utilize health services equally as the women. Gender differences are seemingly less apparent among parents who are using CAM. Language difficulty was identified most frequently as the major barrier to accessing care among this population. CONCLUSIONS: Considerations of socioeconomic factors, cultural and language barriers need to be made with particular focus on gender differences in attitudes and health behavior when making policy decisions for the Asian American population. Further studies are also needed on intergenerational attitudes and health behavior of older Asian Americans.

Adolescent↗
PubMed2003

Coping strategies and its effects on depression among caregivers of impaired elders in Japan.

The purpose of this study was to explore the coping strategies of Japanese family caregivers and to investigate relationships between coping strategies, caregiving stressors,and family caregivers' mental health. We conducted a survey by mail among family members who provided care for physically or mentally impaired elderly. In this study, we used 166 responses from family caregivers for analysis. Results of exploratory and confirmatory factor analysis indicated three factors,categorized 'Resignation,' 'Consulting and complaining' and 'Distancing'. In addition, results of structure equation modelling suggested a significant effect of 'Resignation' on the mental health of caregivers. Although the factor structure of coping strategies was similar to other studies conducted in Western countries, the effects of coping strategies were quite different. In conclusion, the effects of coping strategies on caregivers' mental health were confirmed in this study, but different types of coping strategies from those of Western countries were found to be associated with mental health of Japanese family caregivers.

Activities of Daily Living↗
PubMedDate not supplied

Intergenerational communication: fundamental but under-exploited theory for speech and language therapy with older people.

There is a body of research literature already applied in speech and language therapy practice that is concerned with communication between children and adults and the adaptations adults make to facilitate the development of language in children. There is much less and more recent literature concerned with intergenerational communication involving older people and older people in institutional care. This has not yet impacted on speech and language therapy practice, especially in the area of training others. The aims of this paper are (1) to describe some of the main theoretical concepts associated with intergenerational communication, (2) to present the results from a study of the opinions about and experiences of intergenerational communication in which children, community- based older women and professional carers of older people were included and (3) to discuss the implications for speech and language therapy practice. A hypothesis for the study was that views on and attitudes towards communication and ageing would vary among the age groups. Some of the main concepts and models associated with intergenerational communication with older people are reviewed, including the communication predicament and enhancement models and the concept of patronizing communication. A qualitative study of three different age groups of (mainly) women was undertaken using a variety of methods of data elicitation (including written questionnaire and focus group discussion). Themes arising from the data were illuminated using content analysis. Participants' responses demonstrate some current generally positive views across the life-span on what it means to be old and the value of communication with older people. The implications for speech and language therapy practice are outlined, with the main emphasis on the potential use of intergenerational communication theory in developing a new focus for training other staff groups who care for older people and for measures of effectiveness of such in-service training.

Adult↗
PubMed2005

Locating control: psychology and the cultural production of 'healthy subject positions'.

This paper addresses some of the ways in which psychological constructs, which have been traditionally positioned as intra-psychic phenomena, may be more productively understood as local performances of intelligible 'healthy subject positions'. More specifically, it focuses on the cultural location of psychological epistemologies, and the assumptions of universality (based upon the normative subject position 'white middle-class heterosexual male') that shape them. Through an analysis of traditional locus of control research, it explores the ways in which individualistic notions of 'personality traits' enact a form of governmentality over subjects who are expected to inhabit specific, fixed subject positions. Thus, traditional research on locus of control can be seen as instantiating the very subject positions that it seeks to measure. To counter this, the paper draws upon experience as a methodological tool in order to examine some of the ways in which neo-liberal discourses of control work to homogenize the broad range of experiences that construct intelligible subject positions. In particular, the focus is on the potentialities and limitations of drawing on such discourses of control to understand non-heterosexual experiences, and it is suggested that we need to examine how such experiences may render individuals complicit with heterosexist 'practices of self'.

Communication Barriers↗
PubMed2004

Menopause: why does fertility end before life?

Menopause is associated with an ultimate cessation of child-bearing potential. Medical research on menopause focuses mostly on the underlying physiological changes associated with menopause. By contrast, evolutionary biologists are interested in understanding why women lose their potential to reproduce before the end of their lives. Evolution by natural selection predicts that the behaviors that we observe today are products of generations of selection on the genes that govern those behaviors. Since one would expect an individual reproducing throughout its life to produce more offspring than an individual stopping early, one would seldom expect genes for menopause to be selected for during our evolutionary past. This article discusses how menopause and prolonged lifespan might be explained by evolutionary theory, and highlights some angles for future research.

Aging↗
PubMed2001

A vicious circle: transgenerational attachment representations in a case of factitious illness by proxy.

Attachment theory offers a robust way to investigate transgenerational child maltreatment; first because there is a coherent theoretical hypothesis of how this might be mediated by the development of insecure working models of relationships, and second, because there is existing evidence from prospective studies that transgenerational attachment patterns can be predicted. Specifically, attachment theory may be particularly useful in cases of Fictitious Illness by Proxy (FIP), where the maltreating behavior is characterized bv disordered illness behavior and care-eliciting. We present a case history, using the Adult Attachment Interview (AAI), which examines attachment and child maltreatment in three generations. A single case history allows for hypothesis generation about the genesis of FIP behavior.

Child Abuse↗
PubMed2003

Measuring sensitivity moment-by-moment: microanalytic look at the transmission of attachment.

Meta-analyses have indicated that the mediating power of sensitivity in the transmission of attachment across generations is not nearly as great as would be predicted by attachment theory (van IJzendoorn, 1995; De Wolff & van IJzendoorn, 1997). To make sense of these findings, the author suggests that current measures of sensitivity should be expanded to include the assessment of mother-infant behavior on a micro-behavioral level. This paper reviews evidence for two central propositions: (1) The internal working model of mothers is expressed in subtle, fine-grained interactive behaviors with their infants, and (2) infants perceive and remember these behaviors in the form of interactional expectancies. Following these propositions, hypothesized representational micromodels for each major attachment organization are then offered, based on the Parallel Distributed Processing (PDP) approach to information processing. In closing, this paper presents some of the most pressing unresolved issues for attachment researchers as they seek to empirically identify the mechanisms by which attachment is transmitted across generations.

Child↗
PubMed1999

Ghosts in the consulting room. An attachment perspective on intergenerational transmission.

Intergenerational transmission of attachment patterns--Selma Fraiberg's classic account of 'ghosts in the nursery'--is one of the basic assumptions of attachment theory, amply confirmed by empirical studies which link narrative style in parents (as measured by the Adult Attachment Interview) with security or insecurity of attachment in infants, as measured by the Strange Situation test. This paper argues that a 'sense of self' and Fonagy's 'reflective function', vital to healthy psychic functioning, arise out of early parental handling, and particularly out of the kind of mirroring experiences hypothesized by Winnicott and elaborated by Gergely and Watson, in which the parent defines her or himself as a 'mirror', by 'marking' (exaggeration of response) and 'contingency' (scrupulously following the child's lead in interactive play). The paper argues that in psychotherapy a similar responsiveness on the part of the therapist is called for. Dealing with 'ghosts in the consulting room' (i.e. transference) is a three phase project comprising (a) calling up the ghosts, through the development of narrative function (b) attempts to expel the ghosts through anger at environmental failure and differentiation of the self from its past (c) coming to terms with ghosts, thus seeing that one's parents were themselves products of intergenerational transmission. An illustrative case is presented.

Adult↗
PubMed2004

Parent/child transactional processes predictive of resilience or vulnerability to "substance abuse disorders".

This article discusses implications of a theoretical model of resilience--the Resilience Framework, including the impact of parent/child transactional processes in moderating or mediating a child's biological or environmental risks and later substance misuse. Research is presented on behavioral and emotional precursors of substance abuse disorders in children of substance users. Detrimental processes within dysfunctional family environments are presented followed by a listing of strategies for increasing resilience in youth by improving family dynamics. The value in elucidating these interactive processes is to increase our understanding of ways to reduce the impact of risk factors. Prevention providers should use these strategies as benchmarks for selecting or developing effective family-focused prevention programs. Resources are presented for finding effective family interventions as well as an example of a family intervention based on resilience principles, namely the Strengthening Families Program. Recommendations are made for future research and better dissemination of evidence-based family interventions.

Adaptation, Psychological↗
PubMed2004

Attachment representations of deaf adults.

The primary goal of this study was to examine the feasibility of using the Adult Attachment Interview (AAI) with 50 culturally Deaf adults. Modifications to the standard protocol included using a visual-spatial language (American Sign Language) rather than a spoken language (English), as well as coding and procedural variations from the standardized protocol. Results suggested that the adapted AAI interview and coding processes provided an effective assessment of the state of mind regarding the attachment of Deaf individuals. The expectation that Deaf participants would be less coherent in their AAI transcripts and therefore less likely than hearing individuals to be classified as Autonomous was not supported. The distribution of the classifications of this Deaf sample was not different from existing normative distributions. Moreover, there was no evidence that early separation from parents associated with attendance at a residential school for the Deaf resulted in attachment formations with residential counselors or teachers at the school.

Adult↗