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WJWA0895-28411540-7322Journal of Women & Aging, Vol. 22, No. 1, Dec 2009: pp. 0–0Journal of Women & Aging

Effects of Three Caregiver Interventions: Support, Educational Literature, and Creative

Movement

Effects of Three Caregiver InterventionsL. K. M. Donorfio et al.

LAURA K. M. DONORFIO University of Connecticut, Department of Human Development & Family Studies,

Waterbury, CT

RHEBA VETTER Northwest Missouri State University, Health, Physical Education, Recreation and

Dance Department, Maryville, MO

MARINA VRACEVIC University of Connecticut, Department of Human Development & Family Studies, Storrs, CT

The primary focus of this study is to compare the effectiveness of three distinct intervention techniques in relieving some of the stress experienced by midlife daughters’ caregiving for their frail mothers. The three techniques are: (a) a home-based literature “tip of the week” group, (b) a caregiver’s support group, and (c) a creative- movement group. Based on a review of caregiving literature, no other studies have utilized a home-based literature intervention or a creative-movement intervention with midlife daughters provid- ing informal care to frail mothers. As part of the weekly assessment evaluation, participants were asked to rate how helpful the previ- ous week’s session was with respect to five mental health variables: irritability, depression, anxiety, stress, and concentration. Overall, the support-based group had higher average scores for each of the five mental health variables and the highest overall mental health score. Future research and promising applications of future inter- vention programs are discussed.

KEYWORDS informal caregiving, caregiving interventions, mothers and daughters

Address correspondence to Laura K. M. Donorfio, PhD, University of Connecticut, Department of Human Development & Family Studies, 99 East Main Street, Waterbury, CT 06702. E-mail: [email protected]

62 L. K. M. Donorfio et al.

INTRODUCTION/BACKGROUND

The United States is in the midst of a significant and growing caregiving cri- sis, with approximately 5.6 million Americans aged 65 plus receiving unpaid or informal care at home from family members or friends (ILC-SCSHE Task- force, 2006). According to the Older Women’s League (2006), if informal caregiving had to be replaced with paid services, it would cost upwards of $257 billion annually, more than twice what is spent nationwide on nursing homes and paid home care combined. Projections of the growing aging population resulting from increasing longevity and medical advancement, contribute to increased sensitivity to the immense value of informal caregiv- ing. Consequently, it is increasingly important to preserve the well-being and provide support for family caregivers in their efforts to provide care (Hebert & Schulz, 2006; Wolff & Kasper, 2006). One way to help support the well-being of caregivers is to provide intervention techniques specifi- cally created to help alleviate some of the perceived stress associated with caregiving. The purpose of this study is to compare the effectiveness of three distinct intervention techniques in relieving some of the stress experi- enced by midlife daughters caring for their frail mothers: (a) a home-based educational “tip of the week” group, (b) a caregivers’ support group, and (c) a creative-movement group.

While there is no universally agreed-upon definition of caregiving in the literature, a caregiver generally refers to someone who provides some type of service to people who are unable to care for themselves due to a disability or functional limitation (ILC-SCSHE Taskforce, 2006). According to a national survey distributed by the Opinion Research Corporation (2005), central aspects of U.S. caregiving include the following: (a) it is prevalent across all economic levels and ethnic groups; (b) the majority of caregivers are women over the age of 45; (c) most care-receivers are aging mothers; (d) one person tends to provide the majority of informal care in family situ- ations; (e) on average, caregivers spend 21 hours per week on caregiving responsibilities; and (f) the majority of caregivers work full- or part-time while providing care.

While caregiving is recognized as an activity with perceived benefits, caregiving often carries emotional, physical, and financial burdens, and is recognized as a risk factor for illness (Vitaliano, Young, & Zhang, 2004). Caregivers are more prone to depression, grief, fatigue, physical health problems, and changes in social relationships, many of which have roots in stress, exhaustion, and self-neglect (Sullivan, 2004). Fifty percent of caregiv- ers make some sort of work-related adjustment such as taking time off, dropping back to part-time, or even taking a leave of absence (National Alliance for Caregiving, 2004). In a study done by MetLife and Brandeis University (1999), the cost to caregivers over a caregiving and working career can be nearly $600,000 in lost pensions, wages, and Social Security benefits.

Effects of Three Caregiver Interventions 63

In reviewing the current literature on interventions for family caregivers, there is a paucity of research involving educational literature or creative- movement interventions. Also, these two types of interventions have not been compared to any other intervention format(s). Many other inter- ventions have been utilized in the literature and evaluated for their effectiveness.

Intervention Techniques Employed

The most commonly employed intervention techniques have been sup- port groups and educational training programs (e.g., Callahan et al., 2006; Claxton-Oldfield, Crain, & Claxton-Oldfield, 2007; Drentea, Clay, Roth, & Mittelman, 2006; Gitlin, Hauck, Dennis, & Winter, 2005; Marziali & Donahue, 2006; Smith & Toseland, 2006; Stewart, Barnfather, Neufeld, Warren, Letourneau, & Liu, 2006). Positive outcomes achieved in utilizing support groups as an intervention technique primarily involve lowering car- egiver depression and stress. Similarly, educational training programs have achieved effective outcomes including teaching caregivers to cope with dis- tress, depression, and grief in the case of the death or impending death of the care-receiver. Eisdorfer et al. (2003) combined several strategies into a single intervention. The results did not indicate that any one-intervention hybrid was significantly better than any other.

The second most popular intervention for family caregivers is counsel- ing therapy (Drentea et al., 2006; Kissane, McKenzie, Block, Moskowitz, McKenzie, & O’Neill, 2006; Whitlatch, Judge, Zarit, & Femia, 2006). A con- sistent counseling-based therapy program has been found to contribute to relieving caregivers’ anxiety, depression, and distress.

Creative-Movement Improvisation

Creative-movement literature leads to a range of positive effects when used with healthy individuals and those suffering from different types of impair- ments and diseases (Brooks & Stark, 1989; Jeong, Hong, Lee, & Park, 2005; Osgood, Smith, Meyers, & Orchowsky, 1990; Picard, 2000). Previous studies found creative movement to be effective in lowering depression, stress, anxiety, and improving psychological distress (Brooks & Stark, 1989; Jeong et al., 2005; Walsh, Culpepper Martin, & Schmidt, 2004).

Applications of creative dance movement therapy (CDMT) are rela- tively new and scant. Only a handful of studies have used CDMT as a care- giving intervention strategy. CDMT was shown to be effective in increasing sensitivity and awareness of self and others in interpersonal relationships. For example, Picard (2000) found creative movement to be helpful in “expanding consciousness at midlife, with patterns of meaning identified in relationships with others, self, and spirit, as well as challenges, loss, illness,

64 L. K. M. Donorfio et al.

and threats to relationships” (p. 150). Wilson (1985) also found changes in participants’ self-awareness as a result of participating in CDMT. The goal of the current study is to assist midlife daughters in better understanding and coping more successfully with their feelings associated with providing care to their older frail mothers. According to creative-movement theory, the improvisational forms of movement are means of communicating emotions and feelings and can contribute to increasing one’s sensitivity toward others, their self-awareness, and their environment (Wilson, 1985).

PURPOSE

The primary purpose of this study is to investigate the effectiveness of three intervention techniques in lowering caregiving daughters’ perceived amounts of irritability, depression, anxiety, stress, and overall strain. The three techniques administered weekly include: (a) a home-based educa- tional literature “tip of the week” group (LG), (b) a caregiver’s support group (SG), and (c) a creative-movement group (MG). Based on a review of caregiving literature, no previous studies have utilized an LG intervention technique. Also, while creative movement is a newer intervention technique for family caregivers, it has not been specifically used with midlife daugh- ters providing informal care to frail mothers. The support-group interven- tion is the most commonly used, proving to be effective in relieving caregiver’s stress. The main goal of this research is to explore the benefits of each of these interventions, as well as to compare the effectiveness of each in relieving stress for midlife daughters providing care for their mothers.

The three specific research questions are:

1. Are LG, SG, and MG strategies effective in reducing caregiver irritability, depression, anxiety, stress, and increasing concentration levels?

2. If so, which of the three intervention strategies is most effective in reducing irritability, depression, anxiety, stress, and increasing concentration levels?

3. How is each intervention helpful and/or not helpful for midlife daughters providing informal care to their frail mothers?

METHODS

Recruitment

Participants were recruited through flyers, e-mail, radio and newspaper advertisements, telephone calls, and in-person visits to caregiver agencies, hospitals, the Osher Lifelong Learning Institute (University of Connecticut Waterbury Campus), and the University of Connecticut regional campuses. Participants were selected based on the following qualifications: (a) individuals

Effects of Three Caregiver Interventions 65

were primary caregivers, (b) the caregivers were female and had to be at least 40 years of age, and (c) the care-receivers were the mothers of the caregiver. The caregivers were not randomly assigned to each of the inter- vention groups; rather, they volunteered to participate in the intervention group of their choice. All participants signed a consent form and received instructions concerning their particular intervention group as well as the questionnaires used to collect information each week.

Participants

The final sample (N = 16) consisted of middle-aged women, aged 42–72, who were the primary caregivers for their frail mothers. The number of daughters in each intervention group was: SG = 6, LG = 6, MG = 4. The length of caregiving ranged between 3 to 18 years. The daughters assisted their mothers in at least three of the following eight activities: personal care (62.5%), emotional support (87.5%), housekeeping (75%), transportation (87.5%), meal preparation (62.5%), laundry (66.3%), financial support (43.8%), and helping with bills and paperwork (87.5%). The majority were unable to carry out all tasks of daily living on their own (56.3%), and one- quarter had some cognitive impairment (25%). The care-receivers ranged in age between 63 and 95. See Table 1 for additional demographic information.

The study focused on midlife daughters as caregivers because research shows that females make up 80% of all family caregivers, with daughters most likely being the primary caregivers to their mothers (Cohler, 1997).

Measurement Instruments

In addition to a demographic questionnaire and a caregiver qualification screener, two data-collection instruments were constructed by the research

TABLE 1 Participant Demographics

White 87.5% Catholic 65.3% Married 62.5% Employed

Full-time 31.3% Part-time 31.3% Retired 37.5%

Household income of $50,000 63.0% Graduate level education 43.8% Mother’s living arrangement

Own home 37.5% Living with daughter 31.3% Living with other relatives 6.3% Senior housing 6.3%

Mother’s widowed 75.0%

66 L. K. M. Donorfio et al.

team. The first was a weekly assessment consisting of five Likert-scale questions and two open-ended questions asking participants to rate their current levels of irritability, depression, anxiety, stress, and concentration. The second was an end-of-program evaluation form consisting of three open-ended questions aimed at evaluating participants’ perceptions of the interventions.

Procedures

The participants in the LG were sent a weekly caregiving tip for 8 weeks, compiled by the researchers and based on the popular literature targeted for caregivers. They were asked to answer their questionnaires immedi- ately when they arrived the next week with the next week’s “tip,” and to mail their responses back in the enclosed self-addressed envelope. Some of the caregiving tips concerned why it is important to take care of your- self, defining the help you need, and techniques for relaxation and stress relief.

The SG met once a week, 1.5 hours per week, for 9 consecutive weeks. The sessions were led by a trained facilitator. The format consisted of one topic being presented each week (based on the same caregiving tips used for the LG), short exercises, group discussions, and weekly readings assigned for the next week. Participants were also offered an opportunity each week to discuss any topics they deemed relevant. The questionnaires were administered at the beginning and end of each session to assess the effectiveness of the intervention group.

Due to conflicts beyond the control of the researchers, two differ- ent groups of women were involved in the MG intervention group. The first MG met once a week for 1 hour for 9 weeks (n = 3). Toward the end of the 3-month period, the research team decided to end this inter- vention wave and to recruit another wave. The second MG began 1 month after the first group ended and initially consisted of three partic- ipants. Within the first 3 weeks of the study, two of the participants dropped out (n = 1).

Both MGs were led by a novice improvisational-movement facilitator and guided through various movement exercises to help participants work through the stressors and emotions associated with caregiving over time. A function of creative movement is to provide an opening for expression by transferring thoughts, feelings, and stressors, from memory to physical action. The facilitator sought to guide the participants through movement improvisations designed to tap into their memories and feelings associated with events related to their caregiving experiences. The nature of the MG intervention was to replace verbal discussions with movement experiences to express thoughts. Weekly topics and tips, consistent with the previous two groups, were also provided and discussed at the end of each session

Effects of Three Caregiver Interventions 67

before they went home. The questionnaires were administered at the beginning and end of each session to assess the effectiveness of the creative-movement intervention.

FINDINGS

The findings are divided into three sections. The first section presents the findings from the weekly assessment Likert-scale questions for both the LG and SG; because the MG was conducted with two waves over two periods of time, these findings were not seen as being comparable for this assess- ment. The second and third sections present for all groups the findings from the weekly assessment open-ended responses and the end-of-program evaluation assessment.

Weekly Assessment Likert-Scale Questions: Comparing Educational and Support Groups

As part of the weekly assessment evaluation, participants were asked to rate how helpful the previous week’s session was with respect to five mental health variables: irritability, depression, anxiety, stress, and concentration. Helpfulness was rated on a Likert-scale from 1 to 5 (1 = minimally helpful to 5 = extremely helpful). Overall, the SG had higher average scores for each of the five mental health variables than the LG.

Looking at each of the variables individually, the LG (see Table 2) found their intervention most helpful with anxiety, while the SG found their intervention most helpful with stress, depression, and anxiety (see Table 3). An overall mental health score was compiled using all five vari- ables. Results indicate that the SG (mean = 3.41) found their intervention to be more helpful than the LG (mean = 1.72). Based on the results of the data analysis, it can be concluded that the SG intervention was the more

TABLE 2 Literature Group Weekly Assessment Scores

Variables

Participants Irritability Depression Anxiety Stress Concentration Overall Mental

Health

LG1 1.33 2.83 2.50 2.50 2.00 2.23 LG5 1.57 1.00 1.14 1.29 0.43 1.09 LG6 0.00 1.00 1.14 1.29 0.43 0.27 LG7 2.00 2.00 2.80 2.00 2.00 2.16 LG8 2.71 2.86 2.71 2.86 2.71 2.77 LG10 2.20 1.20 3.40 2.20 0.00 1.80 Average 1.64 1.73 2.15 1.81 1.27 1.72

68 L. K. M. Donorfio et al.

effective in reducing irritability, depression, anxiety, stress, and improving concentration than the LG.

Weekly Assessment Open-Ended Responses: Comparing All Three Interventions

Based on the majority of open-ended weekly responses gathered from participants in the LG, the following two general themes emerged: (a) New Information, and (b) Reinforcement of Existing Information. Com- mon participant responses included: “Interesting information shared about caregiving for it brought my attention to many new ideas and strategies”; “It [the weekly tip] gave many different suggestions”; and “The informa- tion was helpful because it reinforced what I already know.” No one par- ticular weekly tip was found most useful by the majority of the participants. While one participant found one or two tips extremely help- ful, others commented that it did not apply to their specific situation or “been there and done that.” Even though the participants gave very posi- tive feedback concerning the usefulness of receiving the caregiving tips, many wished the tips were more specifically applied to them and their unique situation.

As compared to the LG, the SG had only one strong overarching theme, labeled “Validation.” The majority of participants in this group found this intervention rewarding because it was an opportunity to “talk, listen, and share,” to be able to “vent in a safe environment,” and to “realize I am not alone.”

Like the SG, the MG had only one overarching theme, labeled “Relax- ing.” This actual word appeared most often in the participant’s weekly responses. Some participants commented that this intervention “helped my depression,” was “time to myself,” and “loosened me up and warmed my stiff muscles.” Another shared, “I was able to express myself in different way, and it helped me relax in a different way.”

TABLE 3 Support Group Weekly Assessment Scores

Variables

Participants Irritability Depression Anxiety Stress Concentration Overall Mental

Health

SG1 2.17 1.67 2.17 2.50 2.17 2.14 SG5 4.88 4.88 4.88 4.88 4.88 4.88 SG6 5.00 5.00 5.00 5.00 5.00 5.00 SG7 3.40 4.00 3.40 4.00 3.50 3.66 SG8 3.25 3.50 3.50 3.25 3.25 3.35 SG10 1.50 1.75 1.50 2.25 0.00 1.40 Average 3.37 3.47 3.41 3.65 3.13 3.41

Effects of Three Caregiver Interventions 69

2End-of-Program Evaluation: Comparing All Three Interventions

QUESTION #1: WHAT DID YOU LIKE MOST ABOUT PARTICIPATING IN YOUR SPECIFIC INTERVENTION GROUP?

The LG indicated that they liked the reinforcement, knowing they were not alone, and the helpful tips. They liked to learn new information that could help them in their caregiving situation. They also were glad to see that some of what they were doing was considered the “right thing” and that others were going through similar problems while caregiving. The SG indicated that both interaction and comradery were provided and that the sharing of positive and negative caregiving experiences with each other was their favorite aspect of this particular intervention. As one participant shared, “It was very meaningful for me to share with the others, especially because they knew what I was going through because their situations were similar. We had this unspoken connection.” The MG indicated that their interven- tion served as an “expressive outlet.” Participants felt the creative movement sessions helped them relax and feel energized.

QUESTION #2: WHAT DID YOU LIKE LEAST ABOUT PARTICIPATING IN YOUR SPECIFIC INTERVENTION GROUP?

The LG indicated that many of the caregiver tips were not “specific enough” or “did not apply enough” to their caregiving situation to be useful. They suggested that future LG participants receive tips that are more individual- ized. The SG felt that the intervention was too short, in terms of the number of meeting sessions, and that future groups should last longer. Because of this request, it was suggested that the women form relationships outside of the weekly support group meeting. A phone and e-mail tree was created that they began to utilize after intervention ended. The MG did not list any responses for what they liked least about participating in their specific inter- vention group.

QUESTION #3: WOULD YOU PARTICIPATE IN YOUR INTERVENTION GROUP AGAIN AND WHY?

All three groups indicated that they would enroll in their respective inter- vention group again. The LG expressed that they would participate again because the intervention was “informative” and “reflective.” The SG expressed that they would participate again because of the “support” they received while in the group, both inside and outside of the meeting. It seemed that the meetings created a reservoir from which they could draw until the next meeting. Some even indicated that when they became frus- trated, they would think about what the other caregivers would do or rec- ommend. Some would think ahead to the next meeting, “counting the days

70 L. K. M. Donorfio et al.

down,” to help them get through the week. The MG indicated that they would participate in their intervention group again because they found the sessions to be a “relaxing,” “energizing,” and an “expressive outlet.”

LIMITATIONS

A major limitation of the current study was the overall small sample size, especially for the creative-movement intervention group (MG: n = 4). Such a small sample size did not allow for comparisons to be made among the three intervention strategies. In addition, the small sample did not allow the findings to be generalized to the larger population of midlife daughters car- ing for their elderly mothers.

A second limitation of this study was that it concentrated only on mother and daughter caregiving pairs. Although the caregiving literature at large also concentrates on daughters and mothers, with very little on other caregiving pairs, future research will benefit by examining the dynamics between other caregiving pairs and identifying the most beneficial interven- tions (Cohler, 1997). Future research should approach this area from a fam- ily perspective, rather than just the caregiving dyad, since informal caregiving often involves many family members and secondary caregivers.

A third limitation is that there was no way of knowing how thoroughly the LG read and understood the caregiving tips and how this affected the weekly assessment survey. A fourth limitation was the homogeneous sam- ple. The majority of the sample was White, highly educated, and had an income of $50,000 per year or more. Consequently, the findings cannot be generalized to other populations of caregiving daughters and care-receiving mothers of other ethnic and socioeconomic backgrounds.

DISCUSSION

The review of the caregiving intervention literature shows that the home literature and the creative-movement formats are new to the family care- giver intervention field. On the other hand, the support group format is the most commonly employed intervention targeting individual family caregiv- ers (Callahan et al., 2006; Claxton-Oldfield et al., 2007; Drentea et al., 2006; Gitlin et al., 2005; Marziali & Donahue, 2006; Smith & Toseland, 2006; Stewart et al., 2006). Only one study by Eisdorfer et al. (2003) used education mate- rials in conjunction with a support group as part of the intervention. Previ- ous studies have found positive outcomes for support groups lowering depression and stress among family caregivers. The weekly Likert-scale awareness surveys showed that the women benefited from being in their respective intervention groups.

Effects of Three Caregiver Interventions 71

The review of the literature also showed that the most common goal of the previously used interventions was teaching caregivers stress manage- ment and problem-behavior management skills. The main goal of this research was to evaluate which of the three interventions was most effective in reducing caregiver irritability, depression, anxiety, stress, and in increas- ing concentration levels among midlife daughters. Results of the weekly assessment instrument indicated that the SG had higher average scores for each of the five mental health variables. Participants in the LG found their intervention most helpful with depression and anxiety, while the SG found their intervention most helpful with stress, depression, and anxiety. The five mental health variables were combined to produce an overall mental health score. The overall mental health scores were 1.72 for LG and 3.41 for SG, indicating that the support-group intervention had a more positive effect on the caregivers’ mental health than the home-based intervention. As men- tioned previously, the MG was not compared to the other two groups due to recruitment difficulties.

When asked what they liked most about participating in their specific intervention group, the LG participants indicated that they liked learning new information, knowing they were not alone, and glad to see that what they were doing was considered the “right thing” by other caregivers participating in their group. The intervention seemed to provide reinforcement for their existing knowledge about caregiving practices and to provide new caregiving information. It is important to point out that while the participants gave very positive feedback concerning the usefulness of receiving the caregiving tips, many wished the tips more specifically applied to them and their unique situ- ation. The SG participants specifically liked the interaction and comradery and the sharing of positive and negative caregiving experiences.

The MG participants indicated that the most important outcome for them was that their intervention served as an “expressive outlet” and helped them feel relaxed and energized. These responses were similar to responses made by caregivers in the most recent dance improvisation research of Vetter and Myllykangas (2008). Caregiving participants called it “the hour of freedom.” They indicated that it helped with relaxation and better sleep. It was difficult to determine if the end results of the MG in the present study were due to the creative-movement exercises alone. Frequently, participants began with movement and then added verbal expression, which was a nat- ural response for individuals unfamiliar with movement improvisation. This is not atypical in the dance-movement literature. In one of Sandel’s (1994) dance-movement therapy groups, a participant began singing while moving and the others in the group joined and formed a chorus. Similarly, Truitt (1996) found dance combined with verbal expression completed the recol- lections of the actors and actresses used in the script for the audience.

Overall, each of the intervention groups was considered successful to some degree, with all participants indicating that they would enroll in their

72 L. K. M. Donorfio et al.

respective intervention group again in the future. The LG enjoyed gaining new knowledge related to caregiving but wished it were more specific to their particular situation. The SG enjoyed each other’s company, the open and nonthreatening atmosphere, and the knowledge that others were going through the same thing they were. They felt the length of the intervention was too short and hoped it was longer or could be started up again after a short break. The MG thought their intervention was relaxing and enjoyed the time to themselves, but because it was the first time they participated in such an intervention, they were unclear about where the sessions were going or what they were expected to achieve by the end.

FUTURE RESEARCH

Future research needs to recruit larger and more representative groups of participants in all of the intervention conditions. A larger sample would allow comparisons among groups as well as increase the generalizeability of results to more caregivers. In addition, because the creative-movement and home-based interventions are relatively new in the field, future research should modify these programs to best fit the specific needs of diverse popu- lations. In an effort to create a more individualized intervention, future research could recruit more diverse types of caregivers, such as caregivers for individuals with Alzheimer’s or Parkinson’s disease.

Also of particular interest is the use of creative-movement improvisation with caregiving dyads. Only one previous study implemented a creative-arts intervention with family caregivers of patients with cancer (Walsh et al., 2004). This intervention consisted of caregiver and care-receiver pairs engag- ing in drawing, painting, and making collages. The study showed a significant reduction in stress and anxiety and an increase in positive emotions of the dyads following their participation in the study. Also, caregivers and care- receivers expressed an increase in positive communication as a result of the creative-art processes. Future research is needed to explore the potential that creative movement can have the same impact as other art therapy.

Future research should consider combining strategies into different hybrid interventions in order to target more specific populations of caregiv- ing dyads. Combining this approach with targeting different caregiving populations will increase effectiveness for the greatest number.

APPLICATION OF THE STUDY

The current study does have promising application for the development of future intervention programs for family caregivers. The weekly assessment instrument evinces that the SG intervention is effective in reducing irritability,

Effects of Three Caregiver Interventions 73

depression, anxiety, and stress. Also, all participants indicated that they found their intervention helpful in coping with caregiving. Consequently, because participants generally had positive feedback regarding their inter- ventions, it is believed that similar types of intervention programs can be beneficial to caregivers. These interventions, or a hybrid form combining more than one intervention, could be easily implemented in different insti- tutions found in communities, such as senior centers, recreational facilities, work environments, and assisted living facilities.

Although support groups are the most common intervention method used for caregivers (Claxton-Oldfield et al., 2007; Marziali & Donahue, 2006; Smith & Toseland, 2006; Stewart et al., 2006), other types of interventions can also be useful. For example, some caregivers may prefer a type of inter- vention that is similar to the LG because of its convenience and flexibility, while others may prefer an intervention that requires more physical involve- ment such as the MG intervention. Zwerling (1989) argues that because creative-art therapies employ nonverbal techniques, they more directly con- nect to emotional processes than more traditional verbal therapies. He argues that creative-art therapies directly evoke responses at a level that psychotherapists may not reach.

REFERENCES

Brooks, D., & Stark, A. (1989). The effect of dance/movement therapy on affect: A pilot study. American Journal of Dance Therapy, 11, 101–112.

Callahan, C. M., Boustani, M. A., Unverzagt, F. W., Autsrom, M. G., Damush, T. M., Perkins, A. J., et al. (2006). Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: A randomized controlled trial. Journal of the American Medical Association, 295, 2148–2157.

Claxton-Oldfield, S., Crain, M., & Claxton-Oldfield, J. (2007). Death anxiety and death competency: The impact of a palliative care volunteer training program. American Journal of Hospice & Palliative Medicine, 23, 464–468.

Cohler, B. (1997). Fathers, daughters, and caregiving: Perspectives from psycho- analysis and life course social science (pp. 443–464). In J. Coyle (Ed.), Hand- book on women and aging. Westport, CT: Greenwood Press.

Drentea, P., Clay, O., Roth, D., & Mittelman, M. (2006). Predictors of improvement in social support: Five-year effects of a structured intervention for caregivers of spouses with Alzheimer’s disease. Social Science & Medicine, 63, 957–967.

Eisdorfer, C., Czaja, S. J., Loewenstein, D. A., Rubert, M. P., Arguelles, S., Mitrani, V. B., et al. (2003). The effects of family therapy and technology-based intervention on caregiver depression. The Gerontologist, 43, 521–531.

Gitlin, L., Hauck, W., Dennis, M., & Winter, L. (2005). Maintenance of effects of the home environmental skill-building program for family caregivers and individu- als with Alzheimer’s disease and related disorders. Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 60, 368–374.

74 L. K. M. Donorfio et al.

Hebert, R., & Schulz, R. (2006). Caregiving at the end of life. Journal of Palliative Medicine, 9, 1174–1187.

ILC-SCSHE Taskforce. (2006). Caregiving in America: The Caregiving Project for Older Americans. Retrieved November 18, 2007, from http://www.ilcusa.org/ media/pdfs/Caregiving%20Advisory%20Committee.pdf.

Jeong, Y., Hong, S., Lee, M. S., & Park, M. (2005). Dance movement therapy improves emotional responses and modulates neurohormones in adolescents with mild depression. International Journal of Neuroscience, 115, 1711–1720.

Kissane, D., McKenzie, M., Block, S., Moskowitz, C., McKenzie, D., & O’Neill, I. (2006). Family focused grief therapy: A randomized, controlled trial in pallia- tive care and bereavement. American Journal of Psychiatry, 163, 1208–1218.

Marziali, E., & Donahue, P. (2006). Caring for others: Internet video-conferencing group intervention for family caregivers of older adults with neurodegenerative disease. Gerontologist, 46, 398–403.

MetLife and Brandeis University. (1999). 1999 MetLife Juggling Act Study. Retrieved July 1, 2005, from http://iasp.brandeis.edu/womenandaging/metpress.htm

National Alliance for Caregiving. (2004). Caregiving in the U.S.: Findings from the national survey. Retrieved July 1, 2005, from http://www.caregiving.org/data/ 04finalreport.pdf

Older Women’s League. (2006). Women and long term care: Where will I live and who will take care of me? Retrieved July 1, 2005, from http://www.owl- national.org/Mothers_Day_Reports_Files/2006MothersDayReport.pdf

Opinion Research Corporation. (2005). Attitudes and beliefs about caregiving in the U.S.: Findings of a national opinion survey. Retrieved October 3, 2006, from http://www.strengthforcaring.com/util/press/research/index.html

Osgood, N. J., Smith Mayers, B., & Orchowsky, S. (1990). The impact of creative dance and movement training on the life satisfaction of older adults: An exploratory study. The Journal of Applied Gerontology, 9, 255–265.

Picard, C. (2000). Pattern of expanding consciousness in midlife women: Creative movement and the narrative as modes of expression. Nursing Science Quar- terly, 13, 150–157.

Sandel, S. (1994). Dance/movement therapy with the frail elderly. Journal of Long Term Home Health Care: The PRIDE Institute Journal, 13(3), 38–42.

Smith, T., & Toseland, R. (2006). The effectiveness of a telephone support program for caregivers of frail older adults. The Gerontologist, 46, 620–629.

Stewart, M., Barnfather, A., Neufeld, A., Warren, S., Letourneau, N., & Liu, L. (2006). Accessible support for family caregivers of seniors with chronic conditions: From isolation to inclusion. Canadian Journal on Aging, 25, 179–192.

Sullivan, T. M. (2004). Caregiver Strain Index (CSI). Dermatology Nursing, 16(4). Truitt, E. R. (1996). Sarah’s dance: An original performance piece integrating dra-

matic dance and text. Unpublished master’s thesis, University of Oregon, Eugene.

Vetter, R., & Myllykangas, S. (2008). The hour of freedom: A pilot study using cre- ative movement with caregivers. Missouri Journal of Health, Physical Educa- tion, Recreation and Dance, 18, 24–33.

Vitaliano, P. P., Young, H. M., & Zhang, J. (2004). Is caregiving a risk factor for illness? Current Directions in Psychological Science, 13, 13–16.

Effects of Three Caregiver Interventions 75

Walsh, S. M., Culpepper Martin, S., & Schmidt, L. A. (2004). Testing the efficacy of a creative-arts intervention with family caregivers of patients with cancer. Journal of Nursing Scholarship, 36, 214–219.

Whitlatch, C. J., Judge, K., Zarit, S. H., & Femia, E. (2006). Dyadic intervention for family caregivers and care receivers in early-stage dementia. The Gerontologist, 46, 688–694.

Wilson, T. (1985). The effect of creative movement and contact improvisation experiences on self-awareness. Unpublished doctoral dissertation, University of Houston.

Wolff, J., & Kasper, J. D. (2006). Caregivers of frail elders: Updating a national profile. The Gerontologist, 46, 344–356.

Zwerling, I. (1989). The creative arts therapies as “real therapies.” American Journal of Dance Therapy, 11, 19–26.

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