[雙語(yǔ)翻譯]--外文翻譯--殘疾老人及其主要護(hù)理者的一致性（原文）

1、The Gerontologist Copyright 2004 by The Gerontological Society of America Vol. 44, No. 4, 532–542Congruence Between Disabled Elders and Their Primary CaregiversAmy Horowitz, DSW,1 Caryn R. Goodman, PhD,2 and Joann P. Rei

2、nhardt, PhD1Purpose: This study examines the extent and indepen- dent correlates of congruence between disabled elders and their caregivers on several aspects of the caregiving experience. Design and Methods: Partic- ipa

3、nts were 117 visually impaired elders and their caregivers. Correlational analyses, kappa statistics, and paired t tests were used to examine the extent of congruence. Hierarchical multiple regression analyses identified

4、 significant correlates of congruence on four target issues: elder’s functional disability, elder’s adaptation to vision impairment, caregiver’s over- protectiveness, and caregiver’s understanding of the vision problem.

5、Results: Caregivers assessed elders as more disabled and rated themselves as more overprotective than did the elders. Although indepen- dent correlates varied by target issue, two domains most consistently influenced con

6、gruence across mea- sures: the caregiver’s assessment of the elder’s status and quality of the relationship. Implications: Find- ings underscore the importance of addressing con- gruence by target issue, rather than as a

7、 global characteristic of the caregiving relationship.Key Words: Family caregiving, Vision impairment, Caregiving relationships, Disability, ProxyCongruence may be defined as the level of agreement between two or more in

8、dividuals in their perceptions, assessments, or beliefs. Many investiga- tors have suggested that congruence (also referred to as consensus, shared relational reality, or sharedmeaning), within marital and other close re

9、lation- ships, is critically important in maintaining relational quality (Acitelli, 1996; Deal, Wampler, Duck, 1994). For older, disabled adults, one of their most important relationships, if not the most important, is

10、that with the family member or friend who serves as their primary caregiver. However, because of the many emotional and physical demands associated with caregiving, for both the caregiver and the care recipient, it is al

11、so a relationship that is often fraught with stress and susceptible to conflict. A lack of congruence on fundamental components of the caregiving experience may be a major contributor to this stress. Thus, knowledge abou

12、t the extent of discrepant perspectives can provide important in- formation to better understand variability in the caregiving experience for both the caregiver and care receiver. Given the assumption that no absolute tr

13、uth exists, it then becomes important to understand such differences by identifying factors that increase or decrease the potential for congruence (Burke et al., 1998). Furthermore, knowledge about the source of incongru

14、ence is important in order to understand its psychological and social meaning in the relationship (Acitelli, 1996). Although congruence is a concept relevant to a variety of issues in caregiving, there has been surprisin

15、gly little research that examines questions about the extent and correlates of congruence between older people and their primary caregivers. Furthermore, in addition to helping one to better understand the caregiving rel

16、ationship, congruence, or the lack thereof, can also have important implications for the quality of the caregiving re- lationship, and ultimate well-being of both dyad members. For example, it has been found that congrue

17、nce between caregivers and elders on the latter’s functional and health status is associated with better relationship quality (Fingerman, 1996); other researchers found family congruence on the elder’s functioning to be

18、related to lower care- giver stress (Pruchno, Burant, Carabellese et al., 1993; Crews HorowitzReuben, Silbey, Damesyn, Salive et al., 1994; Wahl, Oswald, West et al., 2002). There is also ample evidence that families

19、 exhibit signifi- cant distress when an older relative becomes visually disabled (Crews Dumas Goodman Horowitz et al., 1998; Reinhardt Null, 1988). Further- more, perspectives on overprotection, disease knowl- edge,

20、and adaptation are also relevant to a diverse range of caregiving situations in which elders ex- perience other common age-related conditions such as arthritis, hip fractures, and stroke. Fourth, we extend the methodolog

21、ical scope of most prior research on congruence. Specifically, as recommended by Long and colleagues (1998), we examine both caregiver and care-receiver character- istics associated with congruence and use a multivar- ia

22、te approach to identify the most salient variables. Further, on the basis of past congruence research, as well as models used in the study of caregiving outcomes, we conceptualize potential predictors of congruence as fa

23、lling into five major domains: sociodemographic factors; physical and mental health status of both elder and caregiver; assessment of the elder’s functional and adaptive status; the caregiving context (e.g., help given,

24、appraisals); and the quality of the relationship. We addressed two primary research questions in this study:1. To what extent is there congruence between elders and their primary caregivers on theelder’s functional disab

25、ility, family overprotec- tiveness, family understanding of the vision condition, and elder’s adaptation to the vision impairment? 2. What caregiver and care-receiver character- istics represent independent risk factors

26、for greater incongruence on each of these issues?MethodsSampleWe drew the sample from vision rehabilitation service applicants participating in a larger research– demonstration project, the objectives of which were to de

27、sign, implement, and evaluate a family-based model of vision rehabilitation. The criteria for participation were age 60 and older, onset of a vision problem at age 55 or older, English speaking, anticipated to be involve

28、d in a multiservice re- habilitation program, could identify a primary caregiver, and was sufficiently hearing and cogni- tively intact to participate in the study. Interviewers conducted preservice interviews with elder

29、s, lasting an average of 1 hr, over the telephone. At the conclusion, the interviewers asked elders to identify the ‘‘person who helps you the most with the things you need to do.’’ This person could be a close friend as

30、 well as family member, but not a formal helper. Telephone interviews averaging 50 min were con- ducted with the caregiver. The research reported in this article draws from these preservice baseline data. In total, we re

31、cruited 221 older adults for the evaluation study, representing a response rate of 78%. Because of design elements in the larger study, only 178 of the 221 respondents were asked to give permission to contact a caregiver

32、, of whom 151, or 85%, did so. Seventy-seven percent (n = 117) of the contacted caregivers agreed to participate in an interview. Thus, 117 dyads comprise the sample for this study of congruence. Approximately two thirds

33、 of the visually impaired elders were female (68.4%) and White (66.1%). Only one third (33.3%) were currently married, but 50.4% lived with others rather than alone. Age ranged from 60 to 94 years, with an average of 76.

34、2 years (SD = 8.0). Fifteen percent of the elders were over the age of 85 years. Thirty-seven percent rated their health as either excellent or good, 41.0% rated it as fair, and 22.2% as poor or very poor. Spouses compri

35、sed 29.1% of the caregivers (18.8% wives, 10.3% husbands); one third of the caregivers were adult children (27.4% daughters, 6.8% sons), 20.8% were other relatives (e.g., siblings, cousins, nieces, daughters-in-law), and

36、 16.3% were friends. Age ranged from 40 to 88 years, with an average of 59.7 (SD = 15.8) years. The majority of caregivers were female (78.6%) and two thirds were White (65.0%). Caregivers were generally healthy, with534