
373a772d27a9a976b87a7cd8b48cd66a.ppt
- Количество слайдов: 46
Emerging Trends in Family Caregiving Using the Life Course Perspective Elise K. Eifert, Ph. D(c), CHES Assistant Professor, Florida Atlantic University November 11, 2014
Introduction Our country is aging! Increase in chronic disease or disability and people who need intermittent or long-term care Providing this care is typically done by family Trends related to family caregiving will emerge
Demographics By 2030, there will be about 72. 1 million older persons, more than twice their number in 2000→ 19% of population Mostly because of baby boomers 85+ is fastest growing segment of older adults Often need the most personal care and support
Chronic Disease & Family Caregiving “Health care hasn’t slowed the aging process so much as it has slowed the dying process…“ – Dr. Ezekiel Emanuel (2014) Family provides an estimated 90% of longterm care Compare to paid, professional caregivers 48. 9 million caregiver or 1 in 5 households in 2009 Expected to increase by 85% from 2000 to 2050
Baby Boomers Individuals born between 1946 and 1964 76 million babies! 65. 2 million (2012) All be 65 in 2029 Influenced by distinct circumstances that affected how they think and behave as well as what they value How will they respond to caregiving situations?
Generational Markers TV Vietnam & Korean wars Scandals such as Watergate Availability of oral contraceptive & legal abortion Protests such as the women’s and civil rights movements College educated and held white collar jobs Lower rates of marriage, higher rates of divorces, and gave birth to fewer children More discretionary income but less savings
Younger vs Older OLDER (1945 -1954) YOUNGER (1955 -1964) Individualistic Focused on work Making a difference in society Graduated college during “free love” years Males experienced conscription (until 1973) Abnormally high expectations Seek balance between work & family Making a difference within himself Graduated college during conservative Reagan years Males have less military service
Purpose & Research Question
Life Course Perspective Interplay between man and history offers context for understanding common occurrences “…looks at how chronological age, relationships, common life transitions, and social change shape people’s lives form birth to death” (Hutchinson, 2007)
Life Course Perspective Cohort or Generation Group of persons who were born at the same historical time Transitions Changes in roles and statuses Trajectory Long-term patterns involving multiple transitions Life Event Abrupt occurrence that involves change Turning Point Life event that alters the life course trajectory
Methods Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al. , 2009)
Identification Records identified through database searching (n = 2, 034) Additional records resulting from online search (n = 12, 351) Records screened (n = 437) Included Eligibility Screening Records after duplicates removed (n = 1, 320) Records excluded (n =250) Literature fully assessed for eligibility (n = 187) Literature excluded, with reasons (n = 125) Studies included in synthesis (n = 62)
Results 1. 2. 3. 4. 5. 6. Increasing use of digital technology for information gathering and support Increasing diversity Strained finances and loss of entitlements More complex care and care management Demand for public policies related to caregiving Balancing work, family, and caregiving
Increasing use of digital technology for information gathering and support Availability of PC, tablets, cell & smart phones, MP 3 players, GPS, game consoles, digital cameras, web cameras, “apps”, etc. (Pew Research, 2010) Caregivers recognize the benefits of technology (FCA, 2012; United Healthcare & NCA 2011) Boomers are heavy internet users (Cline & Hayes, 2001; Neilson 2012;
Increasing use of digital technology for information gathering and support continued… Social network sites for support (Hamm et al, 2013) Caregiver “Apps” (Hasman 2011; US VA 2011) Online communities and support groups (Colvin et al 2003; Aging Care 2013; Glueckauf et al, 2003) Telemedicine (WHO 2010; Ludwig et al 2012)
Increasing use of digital technology for information gathering and support continued… From a Life Course Perspective… Boomers are situated in a specific time and place and experienced the emergence of the Internet as an everyday technology Timing of Internet’s arrival in life trajectory affect experiences (older vs younger) Use of technology may be dependent on life stage and events
Increasing diversity Traditional caregiver profile is changing Race & Ethnicity ↓ white, ↑ other racial or ethnic minorities (Vincent & Velkoff 2010; Administration on Aging 2012; NAC & AARP 2009) Caregiving experiences differ among racial & ethnic groups (Scharlach et al 2008; Pinquart & Sorenson 2003; National Academy on an Aging Society 2000; Dilworth-Anderson et al 2002; Toseland et al 2003)
Increasing diversity continued… Gender (NAC & AARP 2009) Caregiving has traditionally been a female role (Alzheimer’s Association 2012) Males respond to & handle caregiving differently (Pinquart & Sorenson 2006) Sexual Orientation (Grant & National Gay & Lesbian Task Force 2010) More likely to be single, childless, and estranged from biological family (MAP & SAGE 2010) Face stigma, discrimination, & legal issues surrounding caregiving (Metlife 2010)
Increasing diversity continued… From a Life Course Perspective… Human agency Cumulative advantage-disadvantage (CAD)
Strained finances and loss of entitlements Older adults are economically vulnerable (National Council on Aging 2012) Females & Minorities Costs of getting older are rising while resources are decreasing (Meschede, Sullivan, & Shapiro 2011)
Strained finances and loss of entitlements continued… Boomers less likely to have pensions and benefit plans (Meschede et al 2011) First generation to have government programs (“entitlements”) from birth until death (Roszak 2009) Dependency Ratio (Age Works 2004; SSA 2013) 16% of elderly fall under Federal Poverty Line→ higher risk if experience health crisis (O’Brien et al 2010; Short & Census Bureau 2011)
Strained finances and loss of entitlements continued… Caregiving is a threat to financial stability and retirement security (Wakabyashi & Bonato 2006) ~42% spend $5000 a year in out of pocket expenses (Feinberg et al 2011) 70% make work accommodations [reduce hours, forfeit promotions, less contributions to 401(k)] (NAC & AARP 2005) Some leave workforce all together (Metlife 2011)
Strained finances and loss of entitlements continued… From a Life Course Perspective… Assets and wealth accumulate over a lifetime Life events like a major illness or transitions like caregiving can be catastrophic to financial stability Younger baby boomers may have less entitlement benefits than older baby boomers
More complex care and care management Chronic disease management requires a comprehensive and integrated approach to care (Hwang et al 2011; Goldberg & Solloway 2011) Complex healthcare system with little communication between different sectors (Wagner 2013)
More complex care and care management continued… Caregivers perform medical/nursing tasks with little to no training (medication management, injections, wound care, physical therapy, etc) (Reinhard, Levine & Samis 2012) ↑ in caregiver burden (Given et al 2001; Papastavrou et al 2007)
More complex care and care management continued… From a Life Course Perspective… Few individuals look beyond themselves or close family members for help Human lives are interdependent and the family is the primary focus Caregiving is becoming a normative life event
Demand for public policies related to caregiving Lack of (funded) federal policy that supports family caregivers (Riggs 2008) Older adults have high voter turnout (Binstock 2000; Martinson & Minkler 2006) Need for a more policy that supports caregiver (Feinberg, Wolkwitz, & Goldstein 2006; FCA 2009)
Demand for public policies related to caregiving continued… From a Life Course Perspective…. Boomer history of political activism Belief that government has an obligation to support them considering the sacrifices they are making
Balancing work, family, and caregiving Will be caregivers while being employed and have dependent children Delaying retirement age (Kromer & Howard 2013) Caregiving negatively effects work performance (Wagner & Niles 2005; NAC & AARP 2005)
Balancing work, family, and caregiving continued… Caregiving cost employers (Metlife & NAC 2010) Boomers as “sandwich” generation (Grundy & Henretta 2006; Parker & Patten 2013; Riley & Bowen 2005)
Balancing work, family, and caregiving continued… From a Life Course Perspective…. Boomers had different opportunities for education, work, and family which altered their trajectories towards simultaneous, demanding roles
Discussion Knowledge of baby boomer caregivers is limited and fragmented First literature review to examine the generational impact of baby boomers on family caregiving using the life course perspective
Implications Boomer caregivers will have more options and choices because of technology Increased understanding of caregiving experiences, care-related values and beliefs, and care practices Boomers will be at risk for poverty and outliving resources especially if they are caregivers or face a health crisis
Implications Caregiving will be a more complicated and precarious experience than ever before which could cause an increase in caregiver stress & burden Increase in state and federal policies that support family caregivers More awareness of employed caregiver needs
Conclusion Highlight emerging trends related to family caregiving Address the needs of baby boomer family caregivers
Any Questions? ? ?
References Administration on Aging. Projected future growth of the older population- Older population as a percentage of the total population (Table 12). Retrieved from http: //www. aoa. gov/Aging_Statistics/future_growth. aspx#age. Published 2008. Accessed 2013. Vincent GK, Velkoff VA. The next four decades- the older population in the United States: 2010 to 2050. http: //www. census. gov/prod/2010 pubs/p 25 -1138. pdf. Published 2010. Accessed August 2013. Gondo Y, Hirose N, Arai Y. , et al. Functional status of centenarians in Tokyo, Japan: developing better phenotypes of exceptional longevity. J Gerontol A Biol Sci Med Sci. 2006; 61(3): 305 -310. Zikic L, Jankelic S, Milosevic D, Despotovic N, Erceg P, Davidovic M. Cross-sectional study on health and social status of the oldest old patients at home care in Belgrade. Adv Gerontol. 2008; 21(4): 614 -624. Crimmins EM, Beltrán-Sánchez H. Mortality and morbidity trends: is there compression of morbidity? J Gerontol B Psychol Sci Soc Sci. 2011; 66 B(1): 75 -86. King DE, Matheson E, Chirina S, Shankar A, Broman-Fulks J. The status of baby boomers' health in the United States- the healthiest generation? JAMA Intern Med. 2013; 173(5): 385 -6. doi: 10. 1001/jamainternmed. 2013. 2006. Vincent JA, Philipson CR, Downs M, eds. The Futures of Old Age. London, UK: Sage Publications; 2006. Institute of Medicine. Retooling for an aging America. http: //www. nap. edu/catalog/12089. html. Published 2008. Accessed August 2013. Arno PS, Levine C, Memmott M. The economic value of informal caregiving. Health Aff (Millwood). 1999; 18(2): 182 -188. Gibson Am Houser MJ. Valuing the invaluable: the economic value of family caregiving, 2008 update. http: //assets. aarp. org/rgcenter/il/i 13_caregiving. pdf. Published 2007. Updated 2008. Accessed August 2013. National Alliance for Caregiving and AARP. Caregiving in the U. S. http: //assets. aarp. org/rgcenter/il/caregiving_09_fr. pdf. Published 2009. Accessed August 2013.
References Department of Health and Human Services & Assistant Secretary for Planning and Evaluation. The future supply of long-term care workers in relation to the aging baby boom generation. Washington, DC: Author. http: //aspe. hhs. gov/daltcp/reports/ltcwork. pdf. Published 2003. Accessed August 2013. Feldman RS. An introduction to life span development. In: Feldman RS, eds. Development Across the Lifespan. Upper Saddle River, NJ: Prentice Hall, Inc; 2010: 2 -40. Howe N. What makes the boomers? Governing. http: //www. governing. com/generations/government-management/gov-what-makes-boomers. html. Published September 2012. Accessed August 2013. Freedman M. How Baby Boomers will Revolutionize Retirement and Transform America. New York, NY: Public. Affairs; 1999. Court D, Farrell D, Forsythe JE. Serving aging baby boomers. Mc. Kinsey Q. 2007; 4: 102 -113. Hughes ME, O’Rand AM. The Lives and Times of the Baby Boomers. Washington, DC: Population Reference Bureau; 2004. Morton LP. Segmenting publics: segmenting baby boomers. Public Relat Q. 2001; 46(3), 46 -47. Mannheim K. The problem of generations. In: K Manneheim, ed. Essays on the Sociology of Knowledge. NY: Oxford Univ. Press; 1952: 276 -320. Strauss, N. & Howe, N. (1991). Generations: The history of America’s future, 1584 -2069. New York City, NY: William Morrow Paperbacks. Mills CW. The sociological imagination. In: JJ Macionis, NV Benokraitis, eds. , Seeing Ourselves: Classic, Contemporary, and Cross-Cultural Readings in Sociology. 7 th ed. Upper Saddle River, NJ: Pearson Education Inc; 2007: 1 -5. Hutchison ED. A life course perspective. In E. D. Hutchison, ed. Dimensions of Human Behavior- The Changing Life Course. 4 th ed. Thousand Oaks, CA: SAGE Publications; 2007: 1 -38
References Green L. Undersanding the life course: sociological and psychological perspectives. Cambridge, UK: Polity Press; 2010. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLo. S Med. 2009; 6(6): e 1000097. Schlosser RW, Wendt O, Bhavnani S, Nail-Chiwetalu, B. Use of information-seeking strategies for developing systematic reviews and engaging in evidence-based practice: the application of traditional and comprehensive Pearl Growing. A review. Int J Lang Commun Disord. 2006; 41(5): 567 -582. Pew Research Center. Internet and American life project. http: //pewinternet. org/~/media//Files/Reports/2010/PIP_Generations_and_Tech 10. pdf. Published 2010. Accessed August 2013. Family Caregiver Alliance. Digital technology for the family caregiver. http: //www. caregiver. org/caregiver/jsp/content_node. jsp? nodeid=2587 Published 2012. Accessed August 2013. United Healthcare, National Alliance for Caregiving. e‑Connected family caregiver: bringing caregiving into the 21 st century. http: //www. unitedhealthgroup. com/news/rel 2011/e. Connected_Family_Caregiver_Study_Jan_2011. pdf. Published 2011. Accessed August 2013. Cline RJW, Haynes KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res. 2001; 16(6): 671 -692. Neilson, Boom. Agers. Introducing boomers: marketing's most valuable generation. http: //boomagers. com/sites/boomagers/files/Boomers__Marketing%27 s_Most_Valuable_Generation. pdf. Published 2012. Accessed August 2013. Hamm MP, Chisholm A, Shulman J, et al. Social media use among patients and caregivers: a scoping review. BMJ Open. 2013; 3(5): e 002819. doi: 10. 1136/bmjopen-2013 -002819.
References Hasman L. An introduction to consumer health apps for the i. Phone. J Consum Health Internet. 2011; 15(4): 322 -329. U. S. Department of Veteran Affairs. VA Mobile Health- About VA Mobile Health Family Caregiver Pilot. http: //mobilehealth. va. gov/caregivers Published 2011. Accessed August 2013. Colvin J, Chenoweth L, Bold M, Harding C. Caregivers of older adults: Advantages and disadvantages of internetbased social support. Fam Relat. 2003; 53(1): 49 -57. Aging Caregiver support forum. http: //www. agingcare. com/Caregiver-Forum Published 2013. Accessed August 2013. Glueckauf RL, Loomis JS. Alzheimer’s caregiver support online: lessons learned, initial findings, and future directions. Neuro. Rehabilitation. 2003; 18(2): 135 -46. World Health Organization. Telemedicine: opportunities and developments in member states. http: //www. who. int/goe/publications/goe_telemedicine_2010. pdf Published 2010. Accessed August 2013. Ludwig W, Klaus-Hendrik W, Duwenkamp C, et al. Health-enabling technologies for the elderly: an overview of services based on a literature review. Comput Methods Programs Biomed. 2012; 106(2): 70 -78. Glueckauf RL, Sharma D, Davis WS, et al. Telephone-based cognitive-behavioral intervention for distressed rural dementia caregivers: Initial findings. Clin Gerontologist. 2007; 31: 21 -41. Glueckauf RL, Noel LT. (Telehealth and family caregiving: developments in research, education, and health care policy. In: RW Toseland, DH Haigler, DJ Monahan, eds. Education and Support Programs for Caregivers: Research, Practice, Policy. New York, NY: Springer; 2011: 85 -105. Administration on Aging. A profile of older Americans: 2012. http: //www. aoa. gov/Ao. ARoot/Aging_Statistics/Profile/2012/2. aspx. Published 2012. Accessed August 2013.
References Scharlach AE, Kellam R. , Ong N, Baskin A, Goldstein C, Fox PJ. Cultural attitudes and caregiver service use: lessons from focus groups with racially and ethnically diverse family caregivers. J Gerontol Soc Work. 2008; 47(1/2): 133 -156. National Alliance for Caregiving and AARP. Caregiving in the U. S. http: //assets. aarp. org/rgcenter/il/us_caregiving_1. pdf Published 2005. Accessed August 2013. Pinquart M, Sorensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging. 2003; 18(2): 250 -267. National Academy on an Aging Society. Caregiving: Helping the elderly with activity limitations. http: //www. agingsociety. org/agingsociety/pdf/Caregiving. pdf. Published 2000. Accessed August 2013. Dilworth-Anderson P, Williams I, Gibson B. Issues of race, ethnicity, and culture in caregiving research: a 20 -year review (1980 -2000). The Gerontologist. 2002; 42(2): 237 -272. Toseland R, Mc. Callion P, Gerber T, Banks S. Predictors of health and human services use by persons with dementia and their family caregivers. Soc Sci Med. 2002; 55(7): 1255 -1266. Alzheimer’s Association. 2012 Alzheimer’s disease facts and figures. http: //www. alz. org/downloads/facts_figures_2012. pdf Published 2012. Accessed August 2013. Pinquart M, Sörensen S. Gender differences in caregiver stressors, social resources, and health: an updated metaanalysis. J Gerontol B Psychol Sci Soc Sci. 2006; 61(1): P 33 -45. Lin I, Fee HR, Wu H. Negative and positive caregiving experiences: a closer look at the intersection of gender and relationships. Fam Relat. 2012; 61(2): 343– 358. LGBT Movement Advancement Project (MAP), Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE). Improving the lives of LGBT older adults. http: //www. lgbtmap. org/file/improvingthe-lives-of-lgbt-older-adults. pdf Published 2010. Accessed August 2012.
References Grant, J. M. & National Gay and Lesbian Task Force. Outing age. http: //www. thetaskforce. org/downloads/reports/outingage_final. pdf Published 2010. Accessed August 2013. Met. Life Mature Market Institute. Still out, still aging. https: //www. metlife. com/assets/cao/mmi/publications/studies/2010/mmi-still-out-still-aging. pdf. Published 2010. Accessed August 2013. Dannefer D. Cumulative advantage/disadvantage and the life course: cross-fertilizing age and the social science theory. J Gerontol B Psychol Sci Soc Sci. 2003; 58(6): S 327 -337. Meschede T, Sullivan L, Shapiro T. From bad to worse: Senior economic insecurity on the rise (Institute on Assets & Social Policy Research and Policy Brief). http: //iasp. brandeis. edu/pdfs/2011/Bad_to_Worse. pdf. Published 2011. Accessed August 2013. National Council on Aging. Economic security for seniors. http: //www. ncoa. org/assets/files/pdf/Fact. Sheet_Economic. Security. pdf. Published 2012. Accessed August 2013. Roszak T. The Making of an Elder Culture. Gabriola Island, BC (Canada): New Society Publishers; 2009. Age Works. Demographics of an aging population. http: //www. ageworks. com/course_demo/200/module 2. htm Published 2004. Accessed August 2013. Social Security Administration. A summary of the 2013 annual report- Social Security and Medicare boards of trustees. http: //www. ssa. gov/oact/trsum/. Published 2013. Accessed August 2013. O’Brien E, Wu KB, Baer D. Older Americans in poverty: A snapshot (AARP Policy Brief). http: //assets. aarp. org/rgcenter/ppi/econ-sec/2010 -03 -poverty. pdf. Published 2010. Accessed August 2013. Short KS, U. S. Census Bureau. Who is poor? A New Look with the supplemental poverty measure. http: //www. census. gov/hhes/povmeas/methodology/supplemental/research/SGE_Short. pdf. Published 2011. Accessed August 2013.
References Wakabyashi C, Donato KM. Does caregiving increase poverty among women in later life? Evidence from the Health and Retirement Survey. J Health Social Behav. 2006; 247(3): 258 -274. Feinberg L, Reinhard SC, Houser A, Choula R. Valuing the invaluable: 2011 update. The growing contribution and costs of family caregiving (AARP Policy Brief). http: //assets. aarp. org/rgcenter/ppi/ltc/i 51 -caregiving. pdf. Published 2011. Accessed August 2013. Met. Life Mature Market Institute, National Alliance for Caregiving, Center for Long Term Care Research and Policy. Caregiving costs to working caregivers. http: //www. aarp. org/content/dam/aarp/livablecommunities/learn/health/metlife-study-of-caregiving-costs-to-working-caregivers-2011 -aarp. pdf. Published 2011. Accessed August 2013. Rank MR. Asset building over the life course. http: //aspe. hhs. gov/hsp/07/Poor. Finances/Life. Course/. Published 2008. Accessed August 2013. Hacker JS. Privatizing risk without privatizing the welfare state: the hidden politics of social policy retrenchment in the Unites States. Am Polit Sci Rev. 2004; 98(2): 243– 260. Hwang W, Weller W, Ireys H, Anderson G. Out-of-Pocket medical spending for care of chronic conditions. Health Affair. 2001; 20(6): 267– 278. Centers for Disease Control and Prevention. Percent of US adults 55 and over with chronic conditions. http: //www. cdc. gov/nchs/health_policy/adult_chronic_conditions. htm. Published 2009. Accessed August 2013. Goldberg A, Solloway Rickler K. The role of family caregivers for people with chronic illness. Rhode Island Med J. 2011; 94(2): 41 -42. Wagner EH. Chronic disease management: What will it take to improve care for chronic illness (American College of Physicians Brief). http: //www. acponline. org/clinical_information/journals_publications/ecp/augsep 98/cdm. htm Published 2013. Accessed August 2013.
References Reinhard SC, Levine C, Samis S. Home alone: Family caregivers providing complex chronic care. http: //www. aarp. org/content/dam/aarp/research/public_policy_institute/health/home-alone-family-caregiversproviding-complex-chronic-care-rev-AARP-ppi-health. pdf. Published 2012. Accessed August 2013. Callahan C, Boustani M, Unverzagt F, et al. Effectiveness of collaborative care for older adults with Alzheimer’s disease in primary care: a randomized controlled trial. JAMA. 2006; 295(18): 2148 -2157. Reinhard SC, Given B, Petlick NH, Bemis A. Supporting family caregivers in providing care. In: RG Hughes, ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008: 1 -64. Given B, Wyatt G, Given C. , et al. Burden and depression among caregivers of patients with cancer at the end-oflife. Oncol Nurs Forum. 2001; 31(6): 1105– 1117. Papastavrou E, Kalokerinou A, Papacostas SS, Tsangari H, Sourtzi P. Caring for a relative with dementia: family caregiver burden. J Adv Nurs. 2007; 58(5): 446– 4457. Bengston VL, Allen KR. The life course perspective applied to families over time. In: PG Boss, WJ Doherty, R La. Rossa, WR Schumm, SK Steinmetz, eds. Sourcebook of Family Theories and Methods: A Contextual Approach. New York, NY: Plenum Press; 1993: 469 -504. Roberto KA, Jarrott SE. Family caregivers of older adults: A lifespan perspective. Fam Relat. 2008; l 57(1): 100 -111. Binstock RH. Older people and voting participation: past and future. The Gerontologist. 2000; 40: 18 -31. Martinson M, Minkler M. Civic engagement and older adults: a critical perspective. The Gerontologist. 2006; 46(3): 318 -324. Riggs JA. A family caregiver policy agenda for the twenty-first century. Generations. 2008; 27(4): 68 -73. Feinberg LF, Wolkwitz K, Goldstein C. Ahead of the curve: Emerging trends and practices in family caregiver support (AARP Public Policy Institute Issue Paper). http: //assets. aarp. org/rgcenter/il/2006_09_caregiver. pdf. Published 2006. Accessed August 2013.
References Family Caregiver Alliance. National policy statement. https: //www. caregiver. org/national-policy-statement. Published 2009. Accessed August 2013. Owram D. Born at the Right Time: A History of the Baby Boom Generation. Toronto, Canada: University of Toronto Press; 1997. Smith JW, Clurman A. Generation Ageless. New York, NY: Harper. Collins Publishers; 2007. Steinhorn L. The Greater Generation: In Defense of the Baby Boom Legacy. London, UK: St. Marin’s Press; 2007. Kromer B, Howard D. Labor force participation and work status of people 65 years and older (United States Census Bureau Brief). http: //www. census. gov/prod/2013 pubs/acsbr 11 -09. pdf. Published 2013. Accessed August 2013. Wagner DL, Niles KJ. Looking into the future of family caregiving in the U. S (White House Conference on Aging Brief). http: //www. towson. edu/gerontology/documents/WHCo. A-Mini. Conf. pdf. Published 2005. Accessed August 2013. Met. Life Mature Market Institute, National Alliance for Caregiving. Workingcaregivers and employer health care costs. https: //www. metlife. com/assets/cao/mmi/publications/studies/2010/mmi-working-caregivers-employershealth-care-costs. pdf. Published 2010. Accessed August 2013. Grundy E, Henretta JC. Between elderly parents and adult children: a new look at the intergenerational care provided by the ‘sandwich generation’. Ageing Soc. 2006; 26(5): 707 -722. Parker K, Patten E. The sandwich generation: Rising financial burdens for middle-aged Americans. http: //www. pewsocialtrends. org/2013/01/30/the-sandwich-generation/. Published 2013. Accessed August 2013. Riley LD, Bowen C. The sandwich generation: challenges and coping strategies of multigenerational families. Fam J. 2005; 13(1): 52 -58. Guberman N, Lavoie J, Blein L, Olazabal I. Baby boomer caregivers: care in the age of individualization. The Gerontologist. 2012; 52(2): 210 -218.
References Chibucos TR. Life-span development theory. In: TR Chibucos, RW Leite, DL Weis, eds Readings in Family Theory. Thousand Oaks, CA: Sage; 2005: 39 -93. Toseland RW, Family Caregiver Alliance. Caregiver education and support programs: Best practice models. http: //www. caregiver. org/caregiver/jsp/content/pdfs/Education_Monograph_01 -20 -05. pdf. Published 2004. Accessed August 2013. National Commission for Health Education Credentialing, Inc (NCHEC), Society for Public Health Education (SOPHE), American Association for Health Education (AAHE). A Competency-Based Framework for Health Education Specialists- 2010. Whitehall, PA: National Commission for Health Education Credentialing, Inc; 2010. Hahn JS, Nicholson T. The role of computers in health education: some lessons from instructional technology. Fam Comm Health. 1986; 9(2): 64 -67. Hodge FS, Toms FD, Guillermo T. Achieving cultural competency and responsive health care delivery. Cancer. 1999; 83(Suppl 8): 1714– 1716, 15. Haber D. Cultural diversity among older adults: Addressing health education. Educ Gerontology. 2005; 31(9): 683697. Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact Questionnaire (hei. Q): an outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns. 2007; 66: 192– 201. Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (Part II). Health Promot Prac. 2005; 6(2): 148 -156. Steckler A, Dawson L. The role of health education in public policy development. Health Educ Q. 1982; 9(4): 275 -92. Dickersin K. Publication bias: recognizing the problem, understanding its origins and scope, and preventing harm. In: Rothstein HR, Sutton AJ, Borenstein M, eds. Publication Bias in Meta-Analysis-Prevention, Assessment and Adjustments. Chichester (UK): John Wiley & Sons; 2005: 11– 33.