Faculty Bibliography

While HIV-patient education has emphasized the importance of adherence to antiviral combination therapies, the complexity of current multi-drug regimens, coupled with aversive sideeffects pose significant threats to adherence. Given that greater non-adherence among older adults is well documented in the general medication adherence literature, older HIV-infected adults may be at elevated risk for non-adherence. Patient accounts for non-adherence were explored as part of a psychosocial investigation of the experiences of HIV-infected late middle-age and older adults on protease inhibitors. Thematic classification of the 'accounts' offered for non-adherence according to Scott and Lyman's (1968) typology of justifications and excuses allowed for the identification of the perceived motives for intentional versus unintentional non-adherence. Excuses offered for non-adherence included: (1) intolerable side-effects, (2) unusually busy lives, (3) unavailability of food when needed, (4) tiredness, and (5) the need to conceal medications to avoid stigma/exposure of HIV status. Common justifications for non-adherence were: (1) some flexibility won't hurt me, (2) no one really knows the real impact of non-adherence, (3) if my viral load is 'undetectable' then strict adherence is not necessary, and (4) strict adherence is an unattainable standard. In contrast to expectations, few age-related reasons for non-adherence were identified. These understandings for their non-adherence provide a crucial basis for understanding new paths for promoting adherence to combination antiviral therapies

The death of a parent in childhood represents a profound psychological insult. Although a number of studies have examined rates of depression and anxiety in bereaved children, less attention has been given to understanding predictors of children's adjustment to the loss. Data are presented from 83 families with schoolage children in which a parent had died of cancer in the preceding 18 months. The surviving parent and one randomly selected child completed individual interviews conducted by a clinician in the families' homes. Using multiple regression, potential predictors of children's psychosocial adjustment to parental death are examined and their relative importance is discussed. Among the predictors considered were child's age, child's gender deceased parent's gender; time since death, length of illness, presence of siblings, and parental communication patterns. The child's perception of the surviving parent's level of openness in parental communication was found to be significantly correlated with lower levels of depressive symptoms and state anxiety in bereaved children. Boys reported lower levels of depressive symptoms than did girls, and older children reported lower levels of state anxiety than did younger children.

As more elderly people experience a cancer diagnosis and live longer, the psychological sequelae of the disease and its treatment increasingly becomes a central concern. Cancer and its treatment are likely to present significant adaptive challenges to the elderly. Knowledge of the correlates of depressive symptoms in older patients may help to identify patients who are at increased risk for co-morbid depression and to inform the development of programs and services that can help reduce depressive symptoms. Data from 169 outpatients with cancer (aged 60 to 86 years) were included in-an analysis to estimate a model of patients' depressive symptoms using the Center for Epidemiologic Studies Depression Scale. The results of regression analyses indicated that a college degree and a lesser impact of the disease on patients' social functioning correlated with lower depression and that feeling separated or set apart from others and a wider range of negative interactions with one's support network correlated with greater depression.

Understanding the factors that increase adult caregiving daughters vulnerability to poor psychological functioning and thereby threaten their ability to provide adequate informal support and assistance is important to maintaining the chronically ill elderly in the community. On the basis of data obtained from 164 elderly outpatients (aged 60 to 90) and their adult caregiving daughters, the effect of potential predictors on the caregiving daughter's state anxiety (STAI-S) scores was estimated using hierarchical regression. The total model suggests that scores of a daughter having a health-limiting condition, a greater sense of filial obligation, and a greater caregiver burden were correlated with higher anxiety scores, whereas having a favorable attitude regarding her caregiving experience, providing care in a greater number of domains of care, and having a higher level of overall satisfaction with the help received in providing care were correlated with lower scores. These findings demonstrate the value of considering the situational factors that may constrain or facilitate caregiving when investigating emotional distress among familial caregivers.

The features of a preventive mental health intervention developed to assist late middle-aged and older spouses' psychosocial adjustment to spousal death from cancer and facilitate their transition to widowhood are described. Beginning during the last few months of the patient's illness and continuing into the initial months of the post-death period, the program is designed to provide the well/surviving spouse with emotional support, facilitate grief work and enable open discussion. Program format and delivery are discussed and the pre- and post-death components are presented. High risk criteria are used to target spouses at risk for mor bid bereavement outcomes. The rationale for the risk profile is discussed. Implications of the program for social work practice are provided.