Gender differentials on the health consequences of care-giving to people with AIDS-related illness among older informal carers in two slums in Nairobi, Kenya

Informal caregivers, most often older people, provide valuable care and support for people ill due to AIDS, especially in poor-resource settings with inadequate health care systems and limited access to antiretroviral therapy. The negative health consequences associated with care-giving may vary depending on various factors that act to mediate the extent of the effects on the caregiver. This paper investigates the association between care-giving and poor health among older carers to people living with AIDS, and examines potential within-gender differences in reporting poor health. Data from 1429 men and women aged 50 years or older living in two slum areas of Nairobi are used to compare AIDS-caregivers with other caregivers and non-caregivers based on self-reported health using the World Health Organization disability assessment (WHODAS) score and the presence of a severe health problem. Women AIDS-caregivers reported higher disability scores for mobility and the lowest scores in self-care and life activities domains while men AIDS-caregivers reported higher scores in all domains (except interpersonal interaction) compared with other caregivers and non-caregivers. Multiple regression analysis is used to examine the association of providing care with health outcomes while controlling for other confounders. Consistently across all the health measures, no significant differences were observed between female AIDS-caregivers and female non-caregivers. Male AIDS-caregivers were however significantly more likely to report disability and having a severe health problem compared with male non-caregivers. This finding highlights a gendered variation in outcome and is possibly an indication of the differences in care-giving gender-role expectations and coping strategies. This study highlights the relatively neglected role of older men as caregivers and recommends comprehensive interventions to mitigate the impact of HIV and AIDS on caregivers that embrace men as well as wom

Changes in network composition among the very old living in inner London

This article examines changes over time in social network composition among a sample of people aged 85 and over at baseline interview in 1987, who were followed-up two and a half to three years later. Almost half of respondents at follow-up had smaller networks than in 1987, with 19% having fewer relatives in their networks, 30% having fewer friends, and 26% also having fewer confidants. However, for most (84%) there was no change in whether they could name a main helper. Network density (integration) had declined for 30%, a substantial minority. For the remainder there were either increases or no changes. Most of those who needed help with tasks of daily living were given help, and while much of the help was given by relatives, by 1990 professionals were also providing a major part of the help. There were no associations with network change and health or functional ability, or with use of services. Those whose network size had increased were more likely to report at follow-up interview (in 1990) a need for (more) help. Multivariate analysis confirmed that while the greater part of the change in network size was accounted for by changes in numbers of relatives, it was closely followed as an explanatory variable by changes in numbers of friends, indicating that both variables (relatives and friends) account almost equally for changes in network size over time among very elderly people. The research presented here reports a considerable amount of change in network size and structure

The Provision of Social Support to Injured Athletes: A Qualitative Analysis

Twelve seriously injured athletes were asked to describe the provision of eight functional types of support during their rehabilitation. NUD*IST (Nonnumerical Unstructured Data Indexing Searching and Theorizing) was used to organize the data. Overall, the provision of social support largely matched demand. Emotional and practical forms of support decreased with time, while varieties of informational support were increasingly received and preferred over time. The provision of informational and emotional support appeared to be dictated by four temporally sequential appraisals: injury severity, rehabilitation progress, recovery/readiness to return, and sports performance. Practical support in the form of personal assistance greatly depended upon the visibility of the injury and the mobility of the injured athlete. Physiotherapists, doctors, and other currently or previously injured athletes were most likely to provide informational support requiring expert medical knowledge, whereas coaches provided informational support requiring sport-specific expertise. Friends and family were the main source of emotional and practical support. The situational and temporal context of the provision of support is represented diagrammatically