We examined the association between employment-related characteristics and the quality-of-care mi... more We examined the association between employment-related characteristics and the quality-of-care migrant live-in caregivers provide to older care-recipients. Structured interviews were conducted with 115 migrant live-in caregivers, 72 older care-recipients, and 117 relatives of care-recipients. We conducted correlations among dependent (quality-of-care), independent (quality of relationship between caregiver and informant, caregiver perception of work, and problematic employment conditions), and demographic variables, and performed a path analysis by conducting a series of multiple regressions. Quality-of-care was most highly correlated with quality of relationship between informant and caregiver. Quality of relationship was predicted by caregiver perceptions of work, which was negatively predicted by problematic employment conditions. In the relatives-based model, quality of relationship was significantly better when the care-receiver was female and the care-recipient needed more assistance with activities of daily living. The study clarifies the role of caregiver work characteristics for quality-of-care and highlights the crucial role of the relationship with the care-recipient.
Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic ... more Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic pain is also associated with premature aging, manifested in shortened telomere length (TL). However, evidence for this hypothesis is scarce and inconsistent. The aim was twofold: 1) Investigate whether chronic pain is associated with premature aging, and 2) Determine whether physical exercise (PE) moderates this association if it exists. Participants were 116 male subjects, with (n=67) and without chronic pain (n=49). Blood samples for TL analysis were collected and participants were interviewed and completed questionnaires. As a part of the cohort, we included people with physical disability; this variable was controlled in the analysis. The TL of individuals with chronic pain was significantly shorter than that of pain-free individuals. Regression analysis revealed a significant moderating effect of PE on chronic pain and TL, above and beyond the effects of disability, age, and weight. Whereas chronic pain was associated with shorter telomeres in participants who did not exercise, this association was non-significant among participants who did exercise. The results suggest that chronic pain is associated with premature ageing; however, PE may mitigate this association and may protect individuals against the harmful effects of chronic pain. PERSPECTIVE: The study suggest that it is important to monitor signs of premature ageing among chronic pain patients as they are at risk. However, chronic pain patients may benefit from regular physical exercise in this respect as it may moderate premature ageing.
Migrant care-workers (MCWs) are often the main caregivers for frail older persons. We examined th... more Migrant care-workers (MCWs) are often the main caregivers for frail older persons. We examined the complex relationship between MCWs and primary family caregivers (PFCs) in Israel to better understand how MCWs and PFCs perceive the formal and informal nature of their relationship. Given the high prevalence of two-income families who are unavailable for caregiving, the relationships among MCWs, PFCs, and care-recipients warrants examination, particularly when PFCs serve as managers of care and the care-recipient has dementia. The sample of 116 MCWs and 117 PFCs included 92 MCW–PFC pairs who were part of a larger study on home care for frail older persons. A mixed-methods approach was used involving quantitative (correlations/paired t-tests) and qualitative (grounded theory framework) analyses conducted on data obtained from structured interviews. A significant correlation was found between ratings of the quality of the relationship by MCWs and PFCs, although PFCs rated it significantly more positively than MCWs. MCWs’ ratings of their relationship with the PFCs were significantly correlated with their ratings of the quality of their relationship with the care-recipient. Four main thematic categories emerged from the qualitative analysis: (1) communication, (2) dependence, (3) relationship quality, and (4) triad: MCW–PFC–care-recipient. For each theme, we present perspectives of MCWs and PFCs, reflecting either “closeness” or “distance” in their relationship. The findings highlight the complexity of such relationships, with the potential for a meaningful positive bond or mistrust or abuse. The study provides a basis for testing methods for ameliorating the negative experiences described by some participants.
Background: Prodromes are signs and symptoms preceding attacks. Many Hereditary Angioedema patien... more Background: Prodromes are signs and symptoms preceding attacks. Many Hereditary Angioedema patients are able to foretell the onset of attacks by having a prodrome. However, the clinical significance and practical value of prodromes as predictors of attacks needs to be assessed by objective measures. Objective: To prospectively evaluate associations between prodromes and attacks. Methods: 48 patients reported four occasions of prodromes, attacks or both. Pre-defined domains and scalable dimensions were assessed in each episode by a disease-specific instrument. Results: Participants reported 192 different events. Significant differences were found across all dimensions, indicating that prodromes are distinct from attacks. Positive correlations were found between the same attributes of prodromes and attacks. Specifically, pain was correlated in the extremities (r = .291, p < .05) and oropharyngeal clusters (r = .936, p < .01). Impairment was correlated across all clusters, most n...
ABSTRACTBackground:As more older persons opt to age in place, there is a growing trend to hire mi... more ABSTRACTBackground:As more older persons opt to age in place, there is a growing trend to hire migrant workers as live-in caregivers to care for them. This raises the need to examine the quality of care they receive within this unique care setting. The objective of this pilot study was to establish the components of quality of care as provided by migrant live-in caregivers.Methods:We interviewed a convenience sample of older persons cared for by migrant live-in caregivers and their relatives. When relatives reported that older persons could not be interviewed due to advanced dementia, only relatives were interviewed. Overall, 72 older persons and 117 relatives were interviewed. We used the Quality of Care Questionnaire (QuCQ) developed for this study to examine the main components of quality of care in this population.Results:Factor analysis using older persons’ data revealed two factors. In the first factor, “caretaking,” items concerning provision of prompt care exhibited the high...
In this study, the impact of past experiences, present stressors, and expectations of future stre... more In this study, the impact of past experiences, present stressors, and expectations of future stress on psychological distress were explored. Participants were 38 male and 41 female spouses of patients hospitalized with non-life-threatening diseases. Participants completed questionnaires on which they appraised past, present, and future stressors and described their levels of psychological distress. Five models of the relationships between appraisals of past, present, and future stressors with psychological distress were examined. Only one model was confirmed by the data. It suggests that an appraisal of past stressors affects the appraisal of present stressors only indirectly, through its effect on the appraisal of future stressors. This model also maintains that only the appraisal of present stressors affects psychological distress directly. The implications of these findings for stress research are discussed.
The Israel Medical Association journal : IMAJ, 2018
BACKGROUND Aging has been associated with perceived lowering of health, especially in post-trauma... more BACKGROUND Aging has been associated with perceived lowering of health, especially in post-traumatic individuals. The effects may be more complex or even different for Holocaust survivors as they age due to their inherited resilience and life perspective. A cross-sectional study was conducted of Holocaust survivors and a matched comparison group recruited from the general Israeli population. All participants underwent a personal interview and completed the Cumulative Illness Rating Scale and a survey of subjective Likert-scale questions about perceived health. The study comprised 214 older adults: 107 Holocaust survivors and 107 comparison participants; 101 women and 113 men. The mean age for the participants was 80.7 ± 4.7 years (range 68-93). Holocaust survivors did not differ from comparison subjects in general health measures (mean 51.50 ± 3.06 vs. 52.27 ± 3.24, respectively). However, the Holocaust survivors' subjective health was significantly lower, F (2,211) = 4.18, P &l...
The journals of gerontology. Series B, Psychological sciences and social sciences, 2020
OBJECTIVES To clarify predictors of migrant live-in care workers' burden/burnout as well as t... more OBJECTIVES To clarify predictors of migrant live-in care workers' burden/burnout as well as their job satisfaction. METHODS Data from 116 migrant live-in care workers were collected from 2013-2014 in Tel Aviv and Jerusalem through structured interviews about their job satisfaction and their degree of burden/burnout. These outcome measures were examined in connection with the older person's level of disability, care workers' relationship with the older person, and their employment conditions. RESULTS Work characteristics (care-recipients' functional status and care workers' relationship with the care-recipient) had a direct impact on burden/burnout; employment-related variables (employment conditions and satisfaction with those conditions) had an indirect effect. A combination of work characteristics (relationship with the older person) together with the care worker's response to employment conditions (satisfaction with employment conditions) emerged as direct...
A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and ... more A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and attacks of hereditary angioedema (HAE) is a clinical unmet need. We constructed such instrument and examined its validity, acceptability, and discriminative ability. Sixty-six patients participated in a survey addressing their demographics, social, and medical status. Discriminant content validity involved: (1) construct definition by in-depth cognitive debriefing interviews, (2) item selection identifying relevant categories, and (3) judgment of the format whereby questionnaires were tested on experienced patients and its content/reliability was validated. Prodromes and attacks affecting certain body systems (domains) were organized in “clusters”. Internal consistency, content, and convergent validities were analyzed. Analyses of variance and regression models were used to evaluate the discriminative ability of the instrument to differentiate between attacks and prodromes. The study dem...
Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Objectives Evidence suggests that individuals with physical disability may suffer from psychologi... more Objectives Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown. Methods The participants consisted of 119 male subjects (mean age 54.36 years, range 35−70). Of them, 30 were able-bodied and 86 had a physical disability: 34 were due to Poliomyelitis (polio) and 55 were due to spinal cord injury (SCI). Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation. Results Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression ...
ABSTRACTFrail older people worldwide are increasingly being cared for in their own homes by migra... more ABSTRACTFrail older people worldwide are increasingly being cared for in their own homes by migrant live-in care workers; however, extant literature on care relationships in this care context is sparse. The purpose of this mixed-methods study was to explore the quality and the nature of care relationships between full-time, live-in migrant care workers and older people in Israel. Quantitative and qualitative data were drawn from a 2014 survey of 116 migrant care workers and 73 older care recipients. Mean scores for four quantitative items relating to care relationships were examined and independent samples t-tests and Pearson correlations were performed, whereas qualitative data were examined using thematic analysis. Credibility of qualitative findings was checked by peer review. Most older people and migrant care workers gave high ratings to the four items. Significant correlations between the two groups were found for their responses on all four relationship items assessed, with o...
Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2017
Objectives To describe social engagement care (SEC) provided by live-in migrant caregivers for fr... more Objectives To describe social engagement care (SEC) provided by live-in migrant caregivers for frail older adults compared with care recipients’ and families’ wishes for such care. Method Interviews with care recipients, family members, and migrant caregivers assessed preferences for and provision of five types of SEC activities: knowing the older person as a person, knowing their main concerns, having personal conversations, going for walks, and sharing social or leisure activities. Results Care recipients and family proxies reported a moderate desire for SEC from migrant caregivers, except for sharing leisure activities, for which there was only a slight preference. Migrant caregivers reported these practices at somewhat higher levels compared with the other respondents. Migrant caregivers’ reports of practice show little relationship with care-recipients’ preferences, but care recipients tended to perceive practice as agreeing with their own wishes. Discussion It is important to ...
We examined the association between employment-related characteristics and the quality-of-care mi... more We examined the association between employment-related characteristics and the quality-of-care migrant live-in caregivers provide to older care-recipients. Structured interviews were conducted with 115 migrant live-in caregivers, 72 older care-recipients, and 117 relatives of care-recipients. We conducted correlations among dependent (quality-of-care), independent (quality of relationship between caregiver and informant, caregiver perception of work, and problematic employment conditions), and demographic variables, and performed a path analysis by conducting a series of multiple regressions. Quality-of-care was most highly correlated with quality of relationship between informant and caregiver. Quality of relationship was predicted by caregiver perceptions of work, which was negatively predicted by problematic employment conditions. In the relatives-based model, quality of relationship was significantly better when the care-receiver was female and the care-recipient needed more assistance with activities of daily living. The study clarifies the role of caregiver work characteristics for quality-of-care and highlights the crucial role of the relationship with the care-recipient.
Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic ... more Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic pain is also associated with premature aging, manifested in shortened telomere length (TL). However, evidence for this hypothesis is scarce and inconsistent. The aim was twofold: 1) Investigate whether chronic pain is associated with premature aging, and 2) Determine whether physical exercise (PE) moderates this association if it exists. Participants were 116 male subjects, with (n=67) and without chronic pain (n=49). Blood samples for TL analysis were collected and participants were interviewed and completed questionnaires. As a part of the cohort, we included people with physical disability; this variable was controlled in the analysis. The TL of individuals with chronic pain was significantly shorter than that of pain-free individuals. Regression analysis revealed a significant moderating effect of PE on chronic pain and TL, above and beyond the effects of disability, age, and weight. Whereas chronic pain was associated with shorter telomeres in participants who did not exercise, this association was non-significant among participants who did exercise. The results suggest that chronic pain is associated with premature ageing; however, PE may mitigate this association and may protect individuals against the harmful effects of chronic pain. PERSPECTIVE: The study suggest that it is important to monitor signs of premature ageing among chronic pain patients as they are at risk. However, chronic pain patients may benefit from regular physical exercise in this respect as it may moderate premature ageing.
Migrant care-workers (MCWs) are often the main caregivers for frail older persons. We examined th... more Migrant care-workers (MCWs) are often the main caregivers for frail older persons. We examined the complex relationship between MCWs and primary family caregivers (PFCs) in Israel to better understand how MCWs and PFCs perceive the formal and informal nature of their relationship. Given the high prevalence of two-income families who are unavailable for caregiving, the relationships among MCWs, PFCs, and care-recipients warrants examination, particularly when PFCs serve as managers of care and the care-recipient has dementia. The sample of 116 MCWs and 117 PFCs included 92 MCW–PFC pairs who were part of a larger study on home care for frail older persons. A mixed-methods approach was used involving quantitative (correlations/paired t-tests) and qualitative (grounded theory framework) analyses conducted on data obtained from structured interviews. A significant correlation was found between ratings of the quality of the relationship by MCWs and PFCs, although PFCs rated it significantly more positively than MCWs. MCWs’ ratings of their relationship with the PFCs were significantly correlated with their ratings of the quality of their relationship with the care-recipient. Four main thematic categories emerged from the qualitative analysis: (1) communication, (2) dependence, (3) relationship quality, and (4) triad: MCW–PFC–care-recipient. For each theme, we present perspectives of MCWs and PFCs, reflecting either “closeness” or “distance” in their relationship. The findings highlight the complexity of such relationships, with the potential for a meaningful positive bond or mistrust or abuse. The study provides a basis for testing methods for ameliorating the negative experiences described by some participants.
Background: Prodromes are signs and symptoms preceding attacks. Many Hereditary Angioedema patien... more Background: Prodromes are signs and symptoms preceding attacks. Many Hereditary Angioedema patients are able to foretell the onset of attacks by having a prodrome. However, the clinical significance and practical value of prodromes as predictors of attacks needs to be assessed by objective measures. Objective: To prospectively evaluate associations between prodromes and attacks. Methods: 48 patients reported four occasions of prodromes, attacks or both. Pre-defined domains and scalable dimensions were assessed in each episode by a disease-specific instrument. Results: Participants reported 192 different events. Significant differences were found across all dimensions, indicating that prodromes are distinct from attacks. Positive correlations were found between the same attributes of prodromes and attacks. Specifically, pain was correlated in the extremities (r = .291, p < .05) and oropharyngeal clusters (r = .936, p < .01). Impairment was correlated across all clusters, most n...
ABSTRACTBackground:As more older persons opt to age in place, there is a growing trend to hire mi... more ABSTRACTBackground:As more older persons opt to age in place, there is a growing trend to hire migrant workers as live-in caregivers to care for them. This raises the need to examine the quality of care they receive within this unique care setting. The objective of this pilot study was to establish the components of quality of care as provided by migrant live-in caregivers.Methods:We interviewed a convenience sample of older persons cared for by migrant live-in caregivers and their relatives. When relatives reported that older persons could not be interviewed due to advanced dementia, only relatives were interviewed. Overall, 72 older persons and 117 relatives were interviewed. We used the Quality of Care Questionnaire (QuCQ) developed for this study to examine the main components of quality of care in this population.Results:Factor analysis using older persons’ data revealed two factors. In the first factor, “caretaking,” items concerning provision of prompt care exhibited the high...
In this study, the impact of past experiences, present stressors, and expectations of future stre... more In this study, the impact of past experiences, present stressors, and expectations of future stress on psychological distress were explored. Participants were 38 male and 41 female spouses of patients hospitalized with non-life-threatening diseases. Participants completed questionnaires on which they appraised past, present, and future stressors and described their levels of psychological distress. Five models of the relationships between appraisals of past, present, and future stressors with psychological distress were examined. Only one model was confirmed by the data. It suggests that an appraisal of past stressors affects the appraisal of present stressors only indirectly, through its effect on the appraisal of future stressors. This model also maintains that only the appraisal of present stressors affects psychological distress directly. The implications of these findings for stress research are discussed.
The Israel Medical Association journal : IMAJ, 2018
BACKGROUND Aging has been associated with perceived lowering of health, especially in post-trauma... more BACKGROUND Aging has been associated with perceived lowering of health, especially in post-traumatic individuals. The effects may be more complex or even different for Holocaust survivors as they age due to their inherited resilience and life perspective. A cross-sectional study was conducted of Holocaust survivors and a matched comparison group recruited from the general Israeli population. All participants underwent a personal interview and completed the Cumulative Illness Rating Scale and a survey of subjective Likert-scale questions about perceived health. The study comprised 214 older adults: 107 Holocaust survivors and 107 comparison participants; 101 women and 113 men. The mean age for the participants was 80.7 ± 4.7 years (range 68-93). Holocaust survivors did not differ from comparison subjects in general health measures (mean 51.50 ± 3.06 vs. 52.27 ± 3.24, respectively). However, the Holocaust survivors' subjective health was significantly lower, F (2,211) = 4.18, P &l...
The journals of gerontology. Series B, Psychological sciences and social sciences, 2020
OBJECTIVES To clarify predictors of migrant live-in care workers' burden/burnout as well as t... more OBJECTIVES To clarify predictors of migrant live-in care workers' burden/burnout as well as their job satisfaction. METHODS Data from 116 migrant live-in care workers were collected from 2013-2014 in Tel Aviv and Jerusalem through structured interviews about their job satisfaction and their degree of burden/burnout. These outcome measures were examined in connection with the older person's level of disability, care workers' relationship with the older person, and their employment conditions. RESULTS Work characteristics (care-recipients' functional status and care workers' relationship with the care-recipient) had a direct impact on burden/burnout; employment-related variables (employment conditions and satisfaction with those conditions) had an indirect effect. A combination of work characteristics (relationship with the older person) together with the care worker's response to employment conditions (satisfaction with employment conditions) emerged as direct...
A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and ... more A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and attacks of hereditary angioedema (HAE) is a clinical unmet need. We constructed such instrument and examined its validity, acceptability, and discriminative ability. Sixty-six patients participated in a survey addressing their demographics, social, and medical status. Discriminant content validity involved: (1) construct definition by in-depth cognitive debriefing interviews, (2) item selection identifying relevant categories, and (3) judgment of the format whereby questionnaires were tested on experienced patients and its content/reliability was validated. Prodromes and attacks affecting certain body systems (domains) were organized in “clusters”. Internal consistency, content, and convergent validities were analyzed. Analyses of variance and regression models were used to evaluate the discriminative ability of the instrument to differentiate between attacks and prodromes. The study dem...
Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Objectives Evidence suggests that individuals with physical disability may suffer from psychologi... more Objectives Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown. Methods The participants consisted of 119 male subjects (mean age 54.36 years, range 35−70). Of them, 30 were able-bodied and 86 had a physical disability: 34 were due to Poliomyelitis (polio) and 55 were due to spinal cord injury (SCI). Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation. Results Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression ...
ABSTRACTFrail older people worldwide are increasingly being cared for in their own homes by migra... more ABSTRACTFrail older people worldwide are increasingly being cared for in their own homes by migrant live-in care workers; however, extant literature on care relationships in this care context is sparse. The purpose of this mixed-methods study was to explore the quality and the nature of care relationships between full-time, live-in migrant care workers and older people in Israel. Quantitative and qualitative data were drawn from a 2014 survey of 116 migrant care workers and 73 older care recipients. Mean scores for four quantitative items relating to care relationships were examined and independent samples t-tests and Pearson correlations were performed, whereas qualitative data were examined using thematic analysis. Credibility of qualitative findings was checked by peer review. Most older people and migrant care workers gave high ratings to the four items. Significant correlations between the two groups were found for their responses on all four relationship items assessed, with o...
Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2017
Objectives To describe social engagement care (SEC) provided by live-in migrant caregivers for fr... more Objectives To describe social engagement care (SEC) provided by live-in migrant caregivers for frail older adults compared with care recipients’ and families’ wishes for such care. Method Interviews with care recipients, family members, and migrant caregivers assessed preferences for and provision of five types of SEC activities: knowing the older person as a person, knowing their main concerns, having personal conversations, going for walks, and sharing social or leisure activities. Results Care recipients and family proxies reported a moderate desire for SEC from migrant caregivers, except for sharing leisure activities, for which there was only a slight preference. Migrant caregivers reported these practices at somewhat higher levels compared with the other respondents. Migrant caregivers’ reports of practice show little relationship with care-recipients’ preferences, but care recipients tended to perceive practice as agreeing with their own wishes. Discussion It is important to ...
Uploads
Papers by Hava Golander