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March 10, 1993, Vol 269, No. 10 >
ARTICLE | March 10, 1993

Physicians and Family Caregivers: Title and subTitle BreakA Model for Partnership FREE

[+] Author Affiliations

The recommendations of this report were adopted by the House of Delegates of the American Medical Association at the Interim Meeting, December 1991.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the scientific literature as of December 1991.

Members of the Council on Scientific Affairs include the following: Yank D. Coble, Jr, MD, Jacksonville, Fla, Vice-Chair; A. Bradley Eisenbrey, MD, PhD, Grosse Pointe Woods, Mich, Resident Representative; E. Harvey Estes, Jr, MD, Durham, NC, Chair; Mitchell S. Karlan, MD, Beverly Hills, Calif; William R. Kennedy, MD, Minneapolis, Minn; Patricia Joy Numann, MD, Syracuse, NY; William C. Scott, MD, Tucson, Ariz; W. Douglas Skelton, MD, Macon, Ga; Richard M. Steinhilber, MD, Cleveland, Ohio; Jack P. Strong, MD, New Orleans, La; Christine C. Toevs, Greenville, NC, Medical Student Representative; Henry N. Wagner, Jr, MD, Baltimore, Md; Jerod M. Loeb, PhD, Chicago, Ill, Secretary; and Robert C. Rinaldi, PhD, Chicago, Ill, Assistant Secretary. Invited authors were Joseph M. Keenan, MD, and Kenneth W. Hepburn, PhD, both from Minneapolis, Minn.

Reprint requests to the Group on Science, Technology, and Public Health, American Medical Association, 515 N State St, Chicago, IL 60610 (Jerod M. Loeb, PhD).


JAMA. 1993;269(10):1282-1284. doi:10.1001/jama.1993.03500100080032
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Article
References

Primary care physicians need a strong and effective model to guide their relationships with family caregivers, key resources for the frail elderly. Caregivers provide a significant proportion of the home care needed by the rapidly growing number of frail elderly living in the community. Caregiving exacts a physical, psychological, social, and emotional toll that no intervention strategies have proven powerful enough to offset. An effective relationship model would acknowledge the key linkage role of the primary care physician, recognize that caregivers and patients form interdependent units, and affirm a care partnership between the physician and caregiver. In this model, the physician conducts periodic assessments of the caregiver as well as the patient; uses a comprehensive home-based approach to care and services; provides training to caregivers, particularly in managing difficult behavior; validates the role of caregiver; and acts as case manager. Educational opportunities and reimbursement structures should be modified to encourage physicians to use the partnership model.

(JAMA. 1993;269:1282-1284)

REFERENCES

1 +
Brody SJ, Poulshock SW, Masciocchi CF.  The family caring unit: a major consideration in the long-term support system. Gerontologist . 1978;;18: 556-561.
2 +
Doty P.  Family care of the elderly: the role of public policy. Milbank Q . 1986;;64:34-75.
3 +
Shanas E.  Social myth as hypothesis: the case of the family relations of old people. Gerontologist . 1979;;19:3-9.
4 +
Coe RM, Wolinsky FD, Miller DK, Prendergast JM.  Elderly persons without family support networks and use of health services. Res Aging . 1985;; 7:617-622.
5 +
Newman SJ, Struyk R, Wright P, Rice M.  Overwhelming odds: caregiving and the risk of institutionalization. J Gerontol Soc Sci . 1990;;45:S173-S183.
6 +
Brody EM, Lawton MP, Liebowitz B.  Senile dementia: public policy and adequate institutional care. Am J Public Health . 1984;;74:1381-1383.
7 +
Shaughnessy PW, Kramer AM.  The increased needs of patients in nursing homes and patients receiving home health care. N Engl J Med . 1990;; 322:21-27.
8 +
Fischer LR, Eustis NN.  DRGs and family care for the elderly: a case study. Gerontologist . 1988;; 28:383-389.
9 +
Long-term Care for the Elderly: Issues of Need, Access, and Cost . Washington, DC: United States General Accounting Office; 1988;. Publication GAO/ HRD-89-4.
10 +
Office of the Actuary, Health Care Financing Administration.  National health expenditures, 1986-2000. Health Care Financ Rev . (Summer) 1987;;8:1-36.
11 +
Stone R, Cafferata GL, Sangl J.  Caregivers of the frail elderly: a national profile. Gerontologist . 1987;;27:616-626.
12 +
Cafferata GL, Stone R.  The caregiving role: dimensions of burden and benefits. Compr Gerontol . 1989;;3:57-64.
13 +
American Association of Retired Persons/Travelers Companies. National Survey of Caregivers: Summary of Findings . Washington, DC: American Association of Retired Persons; 1988;.
14 +
Scharlach AE, Boyd, S.  Caregiving and employment: results of an employee survey. Gerontologist . 1989;;29:382-387.
15 +
Keenan J, Ostwald S, Choi T, Aroskar M.  Factors that contribute to a caregiver's positive identification with caring for a frail elderly person. Gerontologist . 1989;;2( (suppl) ):83A. Abstract.
16 +
Zarit SH, Reever KE, Bach-Peterson J.  Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist . 1980;;20:649-655.
17 +
Gallagher D, Rose J, Rivera P, Lovett S, Thompson LW.  Prevalence of depression in family caregivers. Gerontologist . 1989;;29:449-456.
18 +
George LK, Gwyther LP.  Caregiver well-being: a multidimensional examination of family caregivers of demented adults. Gerontologist . 1986;;26: 253-259.
19 +
Clipp EC, George LK.  Psychotropic drug use among caregivers of patients with dementia. J Am Geriatr Soc . 1990;;38:227-235.
20 +
Kiecolt-Glaser J, Glaser R, Shuttleworth E, Dyer C, Ogrocki P, Speicher C.  Chronic stress and immunity in family caregivers of Alzheimer's disease victims. Psychosom Med . 1987;;49:523-535.
21 +
Pruchno RA, Kleban MH, Michaels JE, Dempsey NP.  Mental and physical health of caregiving spouses: development of a causal model. J Gerontol Psychol Sci . 1990;;45:192-199.
22 +
Schulz R, Visinainer P, Williamson GM.  Psychiatric and physical morbidity effects of caregiving. J Gerontol Psychol Sci . 1990;;45:181-191.
23 +
Fitting M, Rabins P, Lucas MJ, et al.  Caregivers for dementia patients: a comparison of husbands and wives. Gerontologist . 1986;;26:248-252.
24 +
Pruchno RA, Potashnik SL.  Caregiving spouses: physical and mental health in perspective. J Am Geriatr Soc . 1989;;37:697-705.
25 +
Pruchno RA, Resch NL.  Husbands and wives as caregivers: antecedents of depression and burden. Gerontologist . 1989;;29:159-165.
26 +
Bass DM, Bowman K.  The transition from caregiving to bereavement: the relationship of care-related strain and adjustment to death. Gerontologist . 1990;;30:35-42.
27 +
Noelker LS.  Incontinence in elderly cared for by family. Gerontologist . 1987;;27:194-200.
28 +
Colerick EJ, George LK.  Predictors of institutionalization among caregivers of patients with Alzheimer's disease. J Am Geriatr Soc . 1986;;34: 493-498.
29 +
Morycz RK.  Caregiving strain and the desire to institutionalize family members with Alzheimer's disease. Res Aging . 1985;;7:329-361.
30 +
Deimling GT, Bass DM.  Symptoms of mental impairment among elderly adults and their effects on family caregivers. J Gerontol . 1986;;41:778-784.
31 +
Haley WE.  Group intervention for dementia family caregivers: a longitudinal perspective. Gerontologist . 1989;;29:481-483.
32 +
Toseland RW, Rossiter CM.  Group interventions to support family caregivers: a review and analysis. Gerontologist . 1989;;29:438-448.
33 +
Zarit SH. Interventions with caregivers: do they help and why? Presented at the 36th Annual Meeting of the Gerontological Society of America; November 20, 1983; San Francisco, Calif.
34 +
Chiverton P, Caine ED.  Education to assist spouses in coping with Alzheimer's disease: a controlled trial. J Am Geriatr Soc . 1989;;37:593-598.
35 +
Montgomery RJV, Borgatta EF.  The effects of alternative support strategies on family caregiving. Gerontologist . 1989;;29:457-464.
36 +
Lovett S, Gallagher D.  Psychoeducational interventions for family caregivers: preliminary efficacy data. Behav Ther . 1988;;19:321-330.
37 +
Hogarty GE, Anderson CM, Reiss DJ, et al.  Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. Arch Gen Psychiatry . 1986;; 43:633-642.
38 +
Lawton MP, Brody EM, Saperstein AR.  A controlled study of respite service for caregivers of Alzheimer's patients. Gerontologist . 1989;;29:8-16.
39 +
Montgomery RJV.  Barriers to the design and delivery of family support services.  In: Kethey AJ, Pacben MK, eds. Conference Proceedings: Family Support and Long Term Care . Excelsior, Minn: Interstudy; 1984;:113-130.
40 +
Mossey JM, Mutran E, Knott K, Craik R.  Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health . 1989;;79:279-286.
41 +
Tessler R, Mechanic D, Dimond M.  The effect of psychological distress on physician utilization: a prospective study. J Health Soc Behav . 1976;;17: 353-364.
42 +
Cassileth BR, Lusk EJ, Strouse TB, et al.  Psychosocial status in chronic illness. N Engl J Med . 1984;;311:506-511.
43 +
Holvey SM.  Psychosocial aspects in the care of elderly diabetic patients. Am J Med . 1986;;80:61-63.
44 +
Ford DE, Kamerow DB, Thompson JW.  Who talks to physicians about mental health and substance abuse problems? J Gen Intern Med . 1988;;
45 +
German PS, Shapiro S, Skinner EA.  Mental health of the elderly: use of health and mental health services. J Am Geriatr Soc . 1985;;33:246-252.
46 +
Winogrond IR, Fisk AA, Kirsling RA, Keyes, B.  The relationship of caregiver burden and morale to Alzheimer's disease patient function in a therapeutic setting. Gerontologist . 1987;;7:336-339.
47 +
Williams ME, Williams TF, Zimmer JG, et al.  How does the team approach to outpatient geriatric evaluation compare with traditional care: a report of a randomized controlled trial. J Am Geriatr Soc . 1987;;35:1071-1078.
48 +
Ramsdell JW, Swart JA, Jackson JE, Renvall M.  The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc . 1989;;37:17-24.
49 +
Brown JL, Potter JF, Foster BG.  Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc . 1990;;38:455-460.
50 +
Silliman RA, McGarvey ST, Raymond PM, Fretwell MD.  The senior care study: does inpatient interdisciplinary geriatric assessment help the family caregivers of acutely ill older patients? J Am Geriatr Soc . 1990;;38:461-466.
51 +
Hase HD, Luger JA.  Screening for psychosocial problems in primary care. J Fam Pract . 1988;; 26:297-302.
52 +
Shapiro S, German PS, Skinner EA, et al.  An experiment to change detection and management of mental morbidity in primary care. Med Care . 1987;;25:327-339.
53 +
Fischer L, Visintainer PF, Schulz R.  Reliable assessment of cognitive impairment in dementia patients by family caregivers. Gerontologist . 1989;; 29:333-335.
54 +
Pinkston EM, Linsk NL, Young RN.  Homebased behavioral family treatment of the impaired elderly. Behav Ther . 1988;;19:331-344.
55 +
Seltzer MM, Ivry J, Litchfield LC.  Family members as case managers: partnership between the formal and informal support networks. Gerontologist . 1987;;27:722-728.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Brody SJ, Poulshock SW, Masciocchi CF.  The family caring unit: a major consideration in the long-term support system. Gerontologist . 1978;;18: 556-561.
2 +
Doty P.  Family care of the elderly: the role of public policy. Milbank Q . 1986;;64:34-75.
3 +
Shanas E.  Social myth as hypothesis: the case of the family relations of old people. Gerontologist . 1979;;19:3-9.
4 +
Coe RM, Wolinsky FD, Miller DK, Prendergast JM.  Elderly persons without family support networks and use of health services. Res Aging . 1985;; 7:617-622.
5 +
Newman SJ, Struyk R, Wright P, Rice M.  Overwhelming odds: caregiving and the risk of institutionalization. J Gerontol Soc Sci . 1990;;45:S173-S183.
6 +
Brody EM, Lawton MP, Liebowitz B.  Senile dementia: public policy and adequate institutional care. Am J Public Health . 1984;;74:1381-1383.
7 +
Shaughnessy PW, Kramer AM.  The increased needs of patients in nursing homes and patients receiving home health care. N Engl J Med . 1990;; 322:21-27.
8 +
Fischer LR, Eustis NN.  DRGs and family care for the elderly: a case study. Gerontologist . 1988;; 28:383-389.
9 +
Long-term Care for the Elderly: Issues of Need, Access, and Cost . Washington, DC: United States General Accounting Office; 1988;. Publication GAO/ HRD-89-4.
10 +
Office of the Actuary, Health Care Financing Administration.  National health expenditures, 1986-2000. Health Care Financ Rev . (Summer) 1987;;8:1-36.
11 +
Stone R, Cafferata GL, Sangl J.  Caregivers of the frail elderly: a national profile. Gerontologist . 1987;;27:616-626.
12 +
Cafferata GL, Stone R.  The caregiving role: dimensions of burden and benefits. Compr Gerontol . 1989;;3:57-64.
13 +
American Association of Retired Persons/Travelers Companies. National Survey of Caregivers: Summary of Findings . Washington, DC: American Association of Retired Persons; 1988;.
14 +
Scharlach AE, Boyd, S.  Caregiving and employment: results of an employee survey. Gerontologist . 1989;;29:382-387.
15 +
Keenan J, Ostwald S, Choi T, Aroskar M.  Factors that contribute to a caregiver's positive identification with caring for a frail elderly person. Gerontologist . 1989;;2( (suppl) ):83A. Abstract.
16 +
Zarit SH, Reever KE, Bach-Peterson J.  Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist . 1980;;20:649-655.
17 +
Gallagher D, Rose J, Rivera P, Lovett S, Thompson LW.  Prevalence of depression in family caregivers. Gerontologist . 1989;;29:449-456.
18 +
George LK, Gwyther LP.  Caregiver well-being: a multidimensional examination of family caregivers of demented adults. Gerontologist . 1986;;26: 253-259.
19 +
Clipp EC, George LK.  Psychotropic drug use among caregivers of patients with dementia. J Am Geriatr Soc . 1990;;38:227-235.
20 +
Kiecolt-Glaser J, Glaser R, Shuttleworth E, Dyer C, Ogrocki P, Speicher C.  Chronic stress and immunity in family caregivers of Alzheimer's disease victims. Psychosom Med . 1987;;49:523-535.
21 +
Pruchno RA, Kleban MH, Michaels JE, Dempsey NP.  Mental and physical health of caregiving spouses: development of a causal model. J Gerontol Psychol Sci . 1990;;45:192-199.
22 +
Schulz R, Visinainer P, Williamson GM.  Psychiatric and physical morbidity effects of caregiving. J Gerontol Psychol Sci . 1990;;45:181-191.
23 +
Fitting M, Rabins P, Lucas MJ, et al.  Caregivers for dementia patients: a comparison of husbands and wives. Gerontologist . 1986;;26:248-252.
24 +
Pruchno RA, Potashnik SL.  Caregiving spouses: physical and mental health in perspective. J Am Geriatr Soc . 1989;;37:697-705.
25 +
Pruchno RA, Resch NL.  Husbands and wives as caregivers: antecedents of depression and burden. Gerontologist . 1989;;29:159-165.
26 +
Bass DM, Bowman K.  The transition from caregiving to bereavement: the relationship of care-related strain and adjustment to death. Gerontologist . 1990;;30:35-42.
27 +
Noelker LS.  Incontinence in elderly cared for by family. Gerontologist . 1987;;27:194-200.
28 +
Colerick EJ, George LK.  Predictors of institutionalization among caregivers of patients with Alzheimer's disease. J Am Geriatr Soc . 1986;;34: 493-498.
29 +
Morycz RK.  Caregiving strain and the desire to institutionalize family members with Alzheimer's disease. Res Aging . 1985;;7:329-361.
30 +
Deimling GT, Bass DM.  Symptoms of mental impairment among elderly adults and their effects on family caregivers. J Gerontol . 1986;;41:778-784.
31 +
Haley WE.  Group intervention for dementia family caregivers: a longitudinal perspective. Gerontologist . 1989;;29:481-483.
32 +
Toseland RW, Rossiter CM.  Group interventions to support family caregivers: a review and analysis. Gerontologist . 1989;;29:438-448.
33 +
Zarit SH. Interventions with caregivers: do they help and why? Presented at the 36th Annual Meeting of the Gerontological Society of America; November 20, 1983; San Francisco, Calif.
34 +
Chiverton P, Caine ED.  Education to assist spouses in coping with Alzheimer's disease: a controlled trial. J Am Geriatr Soc . 1989;;37:593-598.
35 +
Montgomery RJV, Borgatta EF.  The effects of alternative support strategies on family caregiving. Gerontologist . 1989;;29:457-464.
36 +
Lovett S, Gallagher D.  Psychoeducational interventions for family caregivers: preliminary efficacy data. Behav Ther . 1988;;19:321-330.
37 +
Hogarty GE, Anderson CM, Reiss DJ, et al.  Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. Arch Gen Psychiatry . 1986;; 43:633-642.
38 +
Lawton MP, Brody EM, Saperstein AR.  A controlled study of respite service for caregivers of Alzheimer's patients. Gerontologist . 1989;;29:8-16.
39 +
Montgomery RJV.  Barriers to the design and delivery of family support services.  In: Kethey AJ, Pacben MK, eds. Conference Proceedings: Family Support and Long Term Care . Excelsior, Minn: Interstudy; 1984;:113-130.
40 +
Mossey JM, Mutran E, Knott K, Craik R.  Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health . 1989;;79:279-286.
41 +
Tessler R, Mechanic D, Dimond M.  The effect of psychological distress on physician utilization: a prospective study. J Health Soc Behav . 1976;;17: 353-364.
42 +
Cassileth BR, Lusk EJ, Strouse TB, et al.  Psychosocial status in chronic illness. N Engl J Med . 1984;;311:506-511.
43 +
Holvey SM.  Psychosocial aspects in the care of elderly diabetic patients. Am J Med . 1986;;80:61-63.
44 +
Ford DE, Kamerow DB, Thompson JW.  Who talks to physicians about mental health and substance abuse problems? J Gen Intern Med . 1988;;
45 +
German PS, Shapiro S, Skinner EA.  Mental health of the elderly: use of health and mental health services. J Am Geriatr Soc . 1985;;33:246-252.
46 +
Winogrond IR, Fisk AA, Kirsling RA, Keyes, B.  The relationship of caregiver burden and morale to Alzheimer's disease patient function in a therapeutic setting. Gerontologist . 1987;;7:336-339.
47 +
Williams ME, Williams TF, Zimmer JG, et al.  How does the team approach to outpatient geriatric evaluation compare with traditional care: a report of a randomized controlled trial. J Am Geriatr Soc . 1987;;35:1071-1078.
48 +
Ramsdell JW, Swart JA, Jackson JE, Renvall M.  The yield of a home visit in the assessment of geriatric patients. J Am Geriatr Soc . 1989;;37:17-24.
49 +
Brown JL, Potter JF, Foster BG.  Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc . 1990;;38:455-460.
50 +
Silliman RA, McGarvey ST, Raymond PM, Fretwell MD.  The senior care study: does inpatient interdisciplinary geriatric assessment help the family caregivers of acutely ill older patients? J Am Geriatr Soc . 1990;;38:461-466.
51 +
Hase HD, Luger JA.  Screening for psychosocial problems in primary care. J Fam Pract . 1988;; 26:297-302.
52 +
Shapiro S, German PS, Skinner EA, et al.  An experiment to change detection and management of mental morbidity in primary care. Med Care . 1987;;25:327-339.
53 +
Fischer L, Visintainer PF, Schulz R.  Reliable assessment of cognitive impairment in dementia patients by family caregivers. Gerontologist . 1989;; 29:333-335.
54 +
Pinkston EM, Linsk NL, Young RN.  Homebased behavioral family treatment of the impaired elderly. Behav Ther . 1988;;19:331-344.
55 +
Seltzer MM, Ivry J, Litchfield LC.  Family members as case managers: partnership between the formal and informal support networks. Gerontologist . 1987;;27:722-728.

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