This research examined longitudinal associations between caregiving stressors, caregiver depression, and quality of care. Informal caregivers of elderly care recipients were interviewed at baseline (N = 310) and again one year later (N = 213). Hierarchical regression analyses indicated that increases in caregiving stressors (i.e., caregiver physical health symptoms, caregiver activity restriction, and care recipient controlling and manipulative behavior) were related to increased caregiver depression. In turn, increased caregiver depression and decreased caregiver respectful behavior predicted increases in potentially harmful behavior. These results extend previous cross-sectional findings and indicate that changes in caregiving stressors, caregiver depression, and caregiver respect over time may signal that intervention is warranted in order to forestall or prevent poor quality of care.

Purpose-To demonstrate that assessing quality of informal care involves more than merely determining whether care recipient needs for assistance with activities of daily living (ADLs) are satisfied on a routine basis. Potentially harmful behavior (PHB), adequate care, and exemplary care (EC) are conceptually distinct dimensions of quality of care. We investigated the extent to which these three dimensions also are empirically distinguishable.Design-237 care recipients completed the quality of care measures, and their caregivers completed psychosocial measures of depressed affect, life events, cognitive status, and perceived pre-illness relationship quality.Results-Confirmatory factor analyses indicated that PHB, adequate care, and EC are empirically distinct factors. Although PHB was moderately related to EC, adequate care was not associated with PHB and was only slightly related to EC. Psychosocial variables were not related to adequate care but were differentially associated with PHB and EC, providing further evidence for the distinction between the measures of quality of care used in this study.Conclusions-Assessing quality of informal care is a complex endeavor. ADL assistance can be adequate in the presence of PHB and/or the absence of EC. Declines in EC may signal increases in PHB, independent of adequacy of care. These findings produce a brief, portable, and more comprehensive instrument for assessing quality of informal care. Keywordscaregiving; elder abuse and neglect; quality of informal careCorrespondence concerning this article should be addressed to Gail M. Williamson, Department of Psychology, University of Georgia, Athens, GA 30602. LGMW@uga.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/rep. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptQuality of informal care traditionally has been conceptualized as the extent to which care recipient needs for assistance are routinely satisfied in terms of basic (e.g., bathing, dressing) and instrumental (e.g., handling personal finances) activities of daily living (e.g., MorrowHowell, Proctor & Dore, 1998;Morrow-Howell, Proctor, & Rozario, 2001;Skinner et al., 1999). When viewed this way, care ranges from inadequate (care recipient never receives help) to adequate (care recipient always receives help). Adequacy of care assessments are useful for identifying specific areas of deficiency where additional help might be provided. However, we believe that these measures ignore dimensions of quality of care ...

Racial and ethnic minorities and injection drug users (IDUs) are at increased risk of HIV infection. To date, the associations between these caseload characteristics and availability of onsite HIV testing in substance use disorder treatment programs are unknown. This uses data collected in 2008–2009 from 198 program administrators of treatment programs participating in the National Institute on Drug Abuse’s Clinical Trials Network to address this gap in the literature. Results show positive associations between the percentages of African American, Hispanic, and IDU patients and the odds of non-rapid onsite HIV testing versus no onsite testing. The associations between racial/ethnic composition and the availability of rapid HIV testing were more complicated. These findings suggest that many programs are responding to the needs of at-risk populations. However, programs and their patients may benefit from greater adoption of rapid testing which is less costly and better ensures that patients receive their results.