Objectives Using data from a national sample of informal caregivers to older adults, we identify predictors of lack of choice and the consequences of lack of choice in taking on the caregiving role. Methods A national telephone survey with 1397 caregivers was carried out to assess whether respondents had a choice in taking on the caregiving role, their demographic characteristics, the nature and duration of their caregiving experience, and its impact on their physical and psychological well-being. We compare caregivers who felt they had no choice in taking on the caregiving role to those who did. Results Forty-four percent of caregivers reported a lack of choice in taking on the caregiving role. Highly educated, older caregivers caring for a younger care recipient with emotional or behavioral problems were most likely to report that they had no choice in taking on the caregiving role. Lack of choice is associated with higher levels of emotional stress, physical strain, and negative health impacts, after controlling for multiple confounds including level of care provided, relationship type, primary health condition of the care recipient, and demographic characteristics. Conclusion Lack of choice is an independent risk factor for the negative effects of caregiving, and clinicians should be vigilant to lack of choice as a marker of caregiver distress.

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suffering is an important but understudied domain. This article provides valuable tools for assessing the experience and perception of suffering in humans.

Objective Family caregivers generally underestimate the health and well-being of Alzheimer’s disease (AD) patients when compared to patient self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias. Methods 105 patients with AD and their family caregivers were assessed twice by trained interviewers one year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver-patient discrepancies. Results Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver-patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy. Conclusions Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers’ ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver’s own well-being is compromised.

This study examined the extent to which perceptions of partner suffering mediate the association between attachment insecurity (anxiety and avoidance) and personal distress among spouses of older adults with osteoarthritis. Fifty-three spouses watched two videos of targets (their partner and an opposite sex stranger) perform a pain-eliciting household task, and spouses were asked to rate their own distress and perceptions of the targets' pain. Spouses also completed self-report measures of trait attachment. Results revealed that attachment anxiety was associated with greater personal distress in reaction to the partner's suffering, and heightened perceptions of partner pain mediated this association. Avoidant attachment was associated with less distress in reaction to the partner's suffering, but not with less perceived pain. The results of this study identify an important mechanism linking attachment insecurity and heightened distress responses when observing the suffering of a significant other. Keywords attachment; caregiving; emotion; older adults; osteoarthritis In close relationships, there are times when people are faced with their partners' suffering. Being in a relationship often involves witnessing a loved one get sick, receive bad news, or fail to accomplish important goals. In these circumstances, most people feel some amount of personal distress along with compassion and typically offer support to their partners. Others are more likely to feel overwhelmed by their own distress, impeding their ability to provide support to their partners.Attachment theory provides a useful framework for identifying individuals who are at a greater risk for feeling personal distress in the face of their partners' suffering because it identifies Correspondence concerning this article should be addressed to Joan K. Monin, University Center for Social and Urban Research, University of Pittsburgh, PA 15260, jmonin@pitt.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript individual differences in peoples' ability to regulate emotions and to maintain felt security (e.g. Bretherton, 1985; Kobak & Sceery, 1988). Past studies have shown that attachment insecurity is predictive of personal distress in response to partners' vulnerability in experimental settings (Mikulincer, Gillath, Halevy, Avihou, Avidan, & Eshkoli, 2001; Westmaas & Silver, 2001) and in the context of caregiving (Braun, Mikulincer, Rydall, Walsh, & Rodin, 2007;Crispi, Schiaffino, & Berman, 1997;Daire, 2002; Markiewicz...