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Journal of Women & Aging, 22:61–75, 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer
Copyright © Taylor & Francis Group, LLC
ISSN: 0895-2841 print/1540-7322 online
DOI: 10.1080/08952840903489094
WJWA 0895-2841 1540-7322 Journal of Women & Aging, Vol. 22, No. 1, Dec 2009: pp. 0–0 Journal of Women & Aging Effects of Three Caregiver Interventions:
Support, Educational Literature, and Creative
Movement
Effects of Three Caregiver Interventions L. 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 creativemovement 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 providing informal care to frail mothers. 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. 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 intervention 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: laura.donorfio@uconn.edu
62 L. K. M. Donorfio et al.
INTRODUCTION/BACKGROUND
The United States is in the midst of a significant and growing caregiving crisis, with approximately 5.6 million Americans aged 65 plus receiving unpaid
or informal care at home from family members or friends (ILC-SCSHE Taskforce, 2006 – Write a paper; Professional research paper writing service – Best essay writers). According to the Older Women’s League (2006 – Write a paper; Professional research paper writing service – Best essay writers), 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 caregiving. 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 – Write a paper; Professional research paper writing service – Best essay writers; Wolff & Kasper, 2006 – Write a paper; Professional research paper writing service – Best essay writers). One way to help support
the well-being of caregivers is to provide intervention techniques specifically 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 experienced 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 – Write a paper; Professional research paper writing service – Best essay writers). 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 situations; (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 caregivers 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 creativemovement interventions. Also, these two types of interventions have not
been compared to any other intervention format(s). Many other interventions have been utilized in the literature and evaluated for their
effectiveness.
Intervention Techniques Employed
The most commonly employed intervention techniques have been support groups and educational training programs (e.g., Callahan et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers;
Claxton-Oldfield, Crain, & Claxton-Oldfield, 2007; Drentea, Clay, Roth, &
Mittelman, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Gitlin, Hauck, Dennis, & Winter, 2005; Marziali &
Donahue, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Smith & Toseland, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Stewart, Barnfather, Neufeld,
Warren, Letourneau, & Liu, 2006 – Write a paper; Professional research paper writing service – Best essay writers). Positive outcomes achieved in utilizing
support groups as an intervention technique primarily involve lowering caregiver depression and stress. Similarly, educational training programs have
achieved effective outcomes including teaching caregivers to cope with distress, 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 counseling therapy (Drentea et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers; Kissane, McKenzie, Block, Moskowitz,
McKenzie, & O’Neill, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Whitlatch, Judge, Zarit, & Femia, 2006 – Write a paper; Professional research paper writing service – Best essay writers). A consistent 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 impairments 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 relatively new and scant. Only a handful of studies have used CDMT as a caregiving 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 educational 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 daughters providing informal care to frail mothers. The support-group intervention 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 intervention 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 onequarter 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 immediately 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 yourself, 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 different 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 intervention wave and to recruit another wave. The second MG began 1
month after the first group ended and initially consisted of three participants. 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 assessment. 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 variables. 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. Common 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 information was helpful because it reinforced what I already know.” No one particular weekly tip was found most useful by the majority of the
participants. While one participant found one or two tips extremely helpful, others commented that it did not apply to their specific situation or
“been there and done that.” Even though the participants gave very positive 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 “Relaxing.” 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 intervention 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 individualized. 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 intervention group.
QUESTION #3: WOULD YOU PARTICIPATE IN YOUR INTERVENTION GROUP AGAIN
AND WHY?
All three groups indicated that they would enroll in their respective intervention 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 frustrated, they would think about what the other caregivers would do or recommend. 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 caring 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 interventions (Cohler, 1997). Future research should approach this area from a family 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 sample. 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 caregiver intervention field. On the other hand, the support group format is the
most commonly employed intervention targeting individual family caregivers (Callahan et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers; Claxton-Oldfield et al., 2007; Drentea et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers;
Gitlin et al., 2005; Marziali & Donahue, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Smith & Toseland, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Stewart
et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers). Only one study by Eisdorfer et al. (2003) used education materials in conjunction with a support group as part of the intervention. Previous 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 management 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 increasing 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 mentioned 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 situation. 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 – Affordable Custom Essay Writing Service | Write My Essay from Pro Writers). 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 natural 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 recollections 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 populations. 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 engaging 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 carereceivers 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 caregiving 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 interventions, 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 institutions 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 – Write a paper; Professional research paper writing service – Best essay writers;
Smith & Toseland, 2006 – Write a paper; Professional research paper writing service – Best essay writers; Stewart et al., 2006 – Write a paper; Professional research paper writing service – Best essay writers), other types of interventions
can also be useful. For example, some caregivers may prefer a type of intervention that is similar to the LG because of its convenience and flexibility,
while others may prefer an intervention that requires more physical involvement such as the MG intervention. Zwerling (1989) argues that because
creative-art therapies employ nonverbal techniques, they more directly connect 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.
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Perkins, A. J., et al. (2006 – Write a paper; Professional research paper writing service – Best essay writers). Effectiveness of collaborative care for older adults
with Alzheimer disease in primary care: A randomized controlled trial. Journal
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Claxton-Oldfield, S., Crain, M., & Claxton-Oldfield, J. (2007). Death anxiety and
death competency: The impact of a palliative care volunteer training program.
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