@article {7570, title = {Caring for individuals with dementia and cognitive impairment, not dementia: findings from the aging, demographics, and memory study.}, journal = {J Am Geriatr Soc}, volume = {59}, year = {2011}, month = {2011 Mar}, pages = {488-94}, publisher = {59}, abstract = {

OBJECTIVES: To compare the characteristics and outcomes of caregivers of adults with dementia with those of caregivers of adults with cognitive impairment, not dementia (CIND).

DESIGN: Cross-sectional.

SETTING: In-home assessment for cognitive impairment and self-administered caregiving questionnaire.

PARTICIPANTS: One hundred sixty-nine primary family caregivers of participants in the Aging, Demographics, and Memory Study (ADAMS). ADAMS participants were aged 71 and older drawn from the nationally representative Health and Retirement Study.

MEASUREMENTS: Neuropsychological testing, neurological examination, clinical assessment, and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics.

RESULTS: Dementia caregivers spent approximately 9 hours per day providing care, compared with 4 hours per day for CIND caregivers (P=.001). Forty-four percent of dementia caregivers exhibited depressive symptoms, compared with 26.5\% of CIND caregivers (P=.03). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Behavioral problems (P=.01) and difficulty with instrumental activities of daily living (P=.01) in persons with CIND partially explained emotional strain experienced by CIND caregivers. For those with dementia, behavioral problems predicted caregiver emotional strain (P<.001) and depressive symptoms (P=.01).

CONCLUSION: Although support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the U.S. population may therefore be greatly underestimated if people who have reached the diagnostic threshold for dementia are focused on exclusively.

}, keywords = {Activities of Daily Living, Aged, Analysis of Variance, Caregivers, Cognition Disorders, Cross-Sectional Studies, Dementia, Female, Humans, Linear Models, Male, Neuropsychological tests, Time Factors, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2010.03304.x}, url = {http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.03304.x/full}, author = {Gwenith G Fisher and Melissa M Franks and Brenda L Plassman and Stephanie Brown and Guy G Potter and David J Llewellyn and Mary A M Rogers and Kenneth M. Langa} } @article {7039, title = {What is perfect health to an 85-year-old?: evidence for scale recalibration in subjective health ratings.}, journal = {Med Care}, volume = {43}, year = {2005}, month = {2005 Oct}, pages = {1054-7}, publisher = {43}, abstract = {

BACKGROUND: If an 85-year-old man rates his health as 90 on a scale in which 100 represents "perfect health," would his rating mean the same thing as a 90 rating from a 25-year-old? We conducted a randomized trial of 3 different ways of eliciting subjective health ratings from participants in the Health and Retirement Study to test whether the meaning of perfect health changes as people age, causing people to recalibrate their self-reported health ratings to account for their age.

METHODS: The Health and Retirement Study (HRS) is a nationally representative, prospective study of 22,000 persons born in 1947 or earlier. The data analyzed in this study come from the self-assessed health utilities module administered in 2002 to 1031 randomly selected HRS respondents. Respondents were randomized to receive one of 3 versions of a subjective health rating task. In the perfect health version, they were asked how they would rate their "current health on a scale from 0 to 100, in which 0 represents death and 100 represents perfect health." In the your-age version, the phrase "for someone your age" was added to the end of the question to encourage people to recalibrate their responses based on age, and in the 20-year-old version, the phrase "for a 20-year-old" was added to minimize recalibration.

RESULTS: A total of 1015 subjects responded to the rating task (98\% response rate). Health ratings varied significantly across versions, with subjects responding to the 20-year-old version reporting lower health (mean rating 66 of 100) than those responding to the your-age version (mean rating of 73, P<0.001) or the perfect health version (mean rating of 73, P<0.001). This result suggests that subjects interpret perfect health to mean "perfect health for someone your age." However, additional analysis showed that the interpretation of the phrase perfect health lies somewhere between the other 2 versions. For example, responses to the perfect health and 20-year-old versions varied significantly by respondent age (both P{\textquoteright}s<0.075), whereas responses to the your-age scale did not (P=0.8).

CONCLUSION: The phrase "perfect health" is ambiguous, causing some people to recalibrate their responses based on their age. Such ambiguity threatens the validity of common subjective health ratings, thereby reducing the comparability of responses across people of different ages or different circumstances.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Analysis of Variance, Attitude to Health, Calibration, Female, Geriatric Assessment, Health Status, Humans, Interviews as Topic, Male, Prospective Studies, Psychometrics, Self Concept}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000178193.38413.70}, author = {Peter A. Ubel and Jankovic, Aleksandra and Dylan M Smith and Kenneth M. Langa and Angela Fagerlin} }