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Positive Aspects of Caregiving: Contributions of the REACH Project to the
Development of New Measures for Alzheimer’s Caregiving
(Positive Aspects of Caregiving)
Tarlow, Barbara J. Ph.D.,1 Wisniewski, Stephen R. Ph.D.,2 Belle, Steven H. Ph.D. MScHyg.,3
Rubert, Mark Ph.D.,4 Ory, Marcia G. Ph.D.,5 and Gallagher-Thompson, Dolores Ph.D., ABPP. 6
1. Hebrew Rehabilitation Center for Aged, Research and Training Institute
2. Epidemiology Data Center, Department of Epidemiology
University of Pittsburgh
3. Epidemiology Data Center, Department of Epidemiology
University of Pittsburgh
4. National Institutes of Health, Center for Scientific Review
5. Texas A&M, University System School of Rural Public Health
6. Older Adult and Family Center, VA Medical Center and Stanford University School of
Medicine
Key words: Psychometric analysis, Alzheimer’s disease, Research measures,
Caregiving satisfaction
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Corresponding author:
Barbara Tarlow, Ph.D., Research Associate
Hebrew Rehabilitation Center for Aged, Research and Training Institute
1200 Centre Street,
Boston, MA 02131-1097
(617) 363-8548
tarlow@mail.hrca.harvard.edu
Funding Statement
The Resources for Enhancing Alzheimer’s Caregiver Health Project is supported by the
National Institute on Aging and the National Institute of Nursing Research (Grants:
Burgio, NR13269; Burns, AG13313; Eisdorfer, AG13297; Gallagher-Thompson,
AG13289; Gitlin, AG13265; Mahoney, AG13255; Schulz, AG13305)
(Word count:7,538)
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Positive Aspects of Caregiving: Contributions of the REACH Project to the
Development of New Measures for Alzheimer’s Caregiving
Abstract
Objectives: to assess a newly developed measure for the positive aspects of caregiving using a
sample of dementia caregivers.
Methods: the measure was developed and administered to1229 participants in a national
collaborative Alzheimer’s disease caregiver study and evaluated for validity and reliability using
standard psychometric analyses.
Results: factor analysis identified two components in this 9-item measure: Self-affirmation and
Outlook on life. Cronbach’s alphas for the components were .86 and .80, respectively. For the
entire scale, Cronbach’s alpha was .89.
Discussion: The Positive Aspects of Caregiving measure, tested with a large, diverse and wellcharacterized sample shows promise as a valid and reliable instrument. With additional
implementation and testing, the measure has the potential to substantially increase our
understanding of basic caregiving research and the outcomes of intervention efforts.
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Positive Aspects of Caregiving: Contributions of the REACH Project to the
Development of New Measures for Alzheimer’s Caregiving
Introduction
Extensive research in the area of family caregiving has produced a plethora of literature
describing the negative effects of the caregiving process (Anastas, Gibeau, and Larson 1990;
Aneshensel, Pearlin, and Schuler 1993; Brody 1985; Lawton et al. 1991; Seltzer et al.1997;
Stuckey, Neundorfer, and Smyth 1996). The majority of research regarding caregivers of
persons with cognitive impairment has been framed in the dominant theoretical model, the
stress-coping model (Donaldson, Tarrier, and Burns 1998; Gonzalez-Salvador et al.1999;
Lawton et al. 1991; Pearlin et al. 1990). Use of this model has been linked to an emphasis on
the negative aspects of caregiving (Lawton et al. 1991; Ory et al. 1999; Pearlin et al.1990;
Schulz 2000) and researchers have questioned the inattention to the positive aspects of
caregiving (Deimling 1994; Miller and Lawton 1997; Pearlin et al. 1990). The effort to
understand the complexity of the caregiving experience requires understanding variables that
may be associated with positive outcomes as well as negative outcomes. However, there are
few reliable, valid and brief measures for the positive aspects of caregiving, we therefore,
proposed to develop and test a psychometrically sound measure for assessing the positive
aspects of caregiving.
Review of existing literature
A review of the informal caregiving literature, limited to quantitative studies of caregivers
for persons with dementia that included a measure for positive aspects of caregiving, identified
fourteen studies which are presented in Table 1. This review focuses on sample size,
definitions used in the studies, and measurement approaches. Sample sizes ranged from 50 to
632 participants, with half of the studies enrolling less than 100 people. Caregiver and care
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recipient relationship varied, including studies limited to male spousal caregivers,
mother/daughter caregiving dyads and caregivers who self-reported being the primary
caregiver. Nine of the studies reported using some variation of the stress-coping model as the
theoretical framework for their research, one study was based on choice and social exchange
theory and four studies did not specify a theoretical framework.
All fourteen studies provided operational definitions of the positive aspects of caregiving.
“Satisfaction” was the most commonly used term, often set in the context of caregivers’
appraisal of their caregiving experiences. Other definitions included: “pleasures and rewards of
caregiving”, “enjoyment of caregiving”, “uplifts or daily events that evoke feelings of joy” and
“gladness or satisfaction”. Eight different measures for the construct were identified. Lawton’s
(1989) five-item caregiver satisfaction measure or a modification of same was most commonly
used. The number of items in the measures varied from 4 -110. The scaling techniques used in
the measures included dichotomous indicators, but were most often a 4 or 5-point ordinal scale
assessing degree of agreement with a phrase or frequency of an event. Alpha coefficients
ranging from .67-.90 were reported in seven of the fourteen studies, (See Table 1). The
literature review revealed a variety of research designs, a wide range of operational definitions,
use of a variety of instruments to measure the construct and a lack of psychometric analysis in
half of the studies, all of which served to impede comparisons among studies.
<Insert Table 1 here>
In general, the studies reported that caregivers did find the caregiving experience
satisfying along with identifying many stressful aspects of caregiving, highlighting the complex
nature of caregiving. The positive aspects of caregiving were frequently reported as positively
correlated with (1) prior relationship satisfaction (Braithwaite 1996; Cohen et al. 1994; Kramer
1993a; Lawton et al. 1989; Motenko 1989; Talkington-Boyer and Snyder 1994), (2) satisfaction
with social supports (Cohen et al. 1994; Kramer 1993a; Talkington-Boyer and Snyder 1994), (3)
increased functional impairment of the care recipient (Lawton et al. 1989; Lawton et al. 1991;
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Talkington-Boyer and Snyder 1994), (4) the use of problem solving coping strategies (Kramer
1993b; Talkington-Boyer and Snyder 1994), (5) older age of caregiver (Kramer 1993a; Kramer
1993b; Picot 1995a; Talkington-Boyer and Snyder 1994) and (6) better health of caregiver
(Cohen et al.1994; Motenko 1989). However, some studies reported non-significant or negative
correlations with older age and more education (Picot 1995a), institutionalization of the care
recipient (Pruchno, Michaels, and Potashnik 1990) and well being (Kinney and Stephens 1989).
This current mix of measures result in inconsistent and contradictory findings that
impede generalizations. Kramer’s (1997) detailed positive aspects of caregiving study review
identified four areas of methodological shortcomings in the research: 1) reliance on samples of
convenience, 2) inadequate subgroup analysis, 3) cross-sectional samples and 4) varying
measurement strategies. An improved positive aspects of caregiving measure would increase
our understanding of the complexity of caregiver appraisal thereby enhancing models of
caregiver adaptation and well-being.
Overview of REACH project:
The REACH project was funded through cooperative agreements with the National Institute
on Aging and the National Institute of Nursing Research in 1995 to carry out social and
behavioral research on interventions designed to enhance family caregiving for persons with
Alzheimer's disease and related dementias (ADRD). A description of the REACH study has
been published elsewhere (Coon, Schulz and Ory, 1999; Wisniewski et al. 2003). Nine active
interventions and six control conditions were implemented and evaluated across the six
collaborating research sites. (See Appendix A. for a list of research sites and principal
investigators.) The REACH project focused on characterizing and testing the most promising
home and community based interventions for enhancing family caregiving, particularly with
minority families. The interventions included psycho-educational support groups, behavioral
skills training programs, family-based systems interventions, environmental modifications, and
technological computer-based information and communication services. The coordinating
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center facilitated cooperation and standardization of the core protocol across all sites, and was
responsible for developing and maintaining a common database as well as carrying out all
cross-site analyses.
The unified model of the stress-health process applied to dementia caregiving was the
theoretical model used in the REACH study. This model was a variation of the stress-coping
model, a commonly used model for understanding the caregiving experience (see Schulz 2000
for a full description of the theoretical model). The positive aspects of caregiving were
understood to be part of the appraisal of the demands and adaptive capacities that mediate
between the stressors (Environmental demands) and caregiver well being (Increased risk of
physical and psychiatric disease). Caregiving appraisal refers to the subjective evaluation made
by the caregiver of his\her caregiving experience that weights both the demands and benefits of
caregiving, which may be either positive or negative. The literature suggested that positive
aspects of caregiving act as mediators to ameliorate the stresses of caregiving to help maintain
the quality of life for individuals. For example, the physically demanding work of assisting with
Activities of Daily Living (ADLs) by a spousal caregiver may be appraised to be an extension of
a long lasting mutually reciprocal relationship. Rather than being overwhelmed by the
demands, caregivers experience a sense of satisfaction and enhanced self-esteem because
they are able to help someone they love. Thus, the caregiver’s physical and mental well-being
is maintained. Positive aspects of caregiving as used in this study, refers to the caregiver’s
sense that their caregiving experience is generally satisfying and rewarding.
Methods
Sample
All participants in the present study were enrolled in the REACH project. The caregivers
were family members who lived with the care recipient, provided care for at least six months and
provided at least four hours of care each day. If multiple family members met these criteria, the
family was asked to identify the primary caregiver. Care-recipients were required to have at
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least two impairments of Independent Activities of Daily Living (IADL) or one ADL, and a
medical diagnosis of probable Alzheimer’s disease or cognitive impairment as defined by a MiniMental Status exam score of 23 or less. Caregivers were ineligible if they or their care-recipient
were terminally ill, participating in another clinical trial for caregivers, or were planning to
institutionalize the care-recipient within six months. Individual sites could employ additional
criteria as required to carry out their specific research design. All participants completed
informed consent before the core battery was administered.
The REACH core measures, including the Positive Aspects of Caregiving measure were
administered to all caregivers at the baseline assessment. Data was collected on 1229
caregiver/care-recipient dyads between September 1996 and March 2000, of which 1222 were
randomized into 15 groups of 9 active interventions and 6 control conditions. The sample of
1229 caregiver/care-recipient dyads was used for the psychometric analyses reported here (see
Table 2 for sample description).
<Insert Table 2 here.>
Measurement Battery and Instrument
The measurement battery was developed in both English and Spanish forms and tested
for clarity and comprehension (Coon et al. 1999). (The measurement battery is available on
CD-ROM upon request from the Coordinating Center, see Appendix A. list of collaborating
sites). The Positive Aspects of Caregiving instrument administered to REACH participants
initially consisted of 11 items, phrased as statements about the caregiver’s mental/affective
state in relation to the caregiving experience. Each item began with the stem “Providing help to
(name) has …”, followed with specific items such as “made me feel useful”, and “enabled me to
appreciate life more”. Each item was rated on a 5-point ordinal scale ranging from "Disagree a
lot” (1) through "Agree a lot” (5). This newly developed measure reflects the original work of
Lawton (Lawton 1989, 1991) and the modifications of a later measure administered to
caregivers of persons with a diagnosis of either physical or cognitive impairment as part of the
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Caregiver Health Effects Study (Beach et al. 2000; Schulz and Williamson 1997). The Positive
Aspects of Caregiving measure differed from the prior instrument in three ways: 1) response
options were changed from the yes/no format used on the original in order to increase variability
of responses and improve reliability; 2) questions were rephrased as statements to
accommodate the response options: 3) overall instructions were modified to facilitate ease of
administration.
Analytic Strategy
The first step in the analysis was to examine the distributions of the individual items to
reveal the extent of missing data and to determine whether lack of variability would preclude
including an item in further analyses. If data from any of the original11 items in the scale were
missing for a caregiver, then the data from that subject were excluded from the psychometric
analyses. The strength of the bivariate associations between all pairs of items was assessed
using the Gamma statistic, a measure appropriate for ordinal categorical data (Agresti 1984).
This statistic ranges from -1 to 1, with a positive value implying a positive relationship. When
the two variables are independent, Gamma is equal to 0. Exploratory factor analyses
(conducted using M-Plus Software, Version 1.0) utilizing principal components extraction,
oblique rotation, and weighted least squares estimation were performed on a randomly selected
sample of 75% of the data. Cronbach's alpha was used to assess internal consistency for
individual factors and for the entire instrument. Factors were confirmed (conducted using MPlus Software, Version 1.0) on the remaining 25% of the sample. Goodness of fit was assessed
using the Root Mean Square Error, Adjusted (RMSEA) (Browne and Cudeck 1993) and the ChiSquare statistics. A RMSEA of less than .05 is considered to be a good fit, values less than .08
are considered to be acceptable deviations and values greater than .1 are unacceptable.
Stability of the factor structure across numerous subgroups was also determined using
the RMSEA. The entire cohort (N=1229) was used in these analyses, except when considering
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site factors. When examining the stability across sites, only White/Caucasian women were
included because they were the only type of caregivers seen at all of the REACH sites.
Convergent validity was assessed using Spearman rank correlation coefficients between
the total score on the Positive Aspects of Caregiving instrument and a) the 4 item, Well-Being
ordinal subscale (Chronbach’s alpha=.72) of the Center for Epidemiologic Studies-D (CES-D),
(Radloff 1977); b) the amount of caregiver burden as measured by the 24 item, ordinal Revised
Memory and Behavior Problems Checklist (RMBPC) scale, (Teri et al. 1992) (Chronbach’s
alpha=.94); and c) two subscales from the Inventory of Socially Supportive Behaviors (ISSB)
Satisfaction with Received Support, 8 items, ordinal subscale (Chronbach’s alpha=.64) and
Negative Interactions, 4 items, ordinal subscale (Chronbach’s alpha=.82) (Krause 1995). These
relationships were assessed overall and for subgroups of participants. Subgroups were defined
by age quartiles, gender, ethnic identity, intervention site, and date of recruitment quartiles.
Discriminant validity was evaluated using the 7 item, ordinal Somatic subscale of the CES-D
(Chronbach’s alpha=.74), (Radloff 1977). Finally, distributions of the summary measure and the
subscales for the entire sample and the subgroups were described using percentiles and
ranges.
Missing data
There were few missing data; the most common missing item ("Providing help made me
feel appreciated") occurred only 4 times among the 1229 interviews. Over 99% of the
interviews were complete for all 11 items on the original instrument. If a caregiver had missing
data for less than 25% of the observations in the scale, then the total score was prorated on the
available data. If the caregiver had missing data for more than 25% of the observations in the
scale, then the score was considered to be missing.
RESULTS
Study Characteristics
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The sociodemographic characteristics of the population are presented in Table 2. The
caregivers were older adults, being on average 62.2 years of age (SE = .4). Five hundred and
ninety eight (48%) of the caregivers were the spousal caregivers 544 (44%) were adult children,
28 (2%) were siblings. Fifty-seven % of the sample was Caucasian, 22 % of the sample was
African-American, 20% was Hispanic and 1% self-identified as other diverse ethnic groups. The
care recipients were on average 79.1 (SE = .2) years of age, with an average MMSE score of
12.6 (SE = .2). Persons with MMSE scores between 10 and 19 are generally considered to be
moderately impaired (Kane and Kane 2000). Five hundred and eighty-eight (48%) of the care
recipients were reported to be in either fair or poor health.
Overall ratings and distribution of responses
The caregivers were generally positive about their caregiving experience with between
44% ("important") and 73% ("good about myself") responding that they agreed with each of the
statements (See Table 3). Each item showed sufficient spread to justify inclusion in the next
step of the analysis.
<Insert Table 3 here.>
Gamma statistics were all between .39 and .73 indicating strong relationships among the
items, but not indicative of redundancy (See table 4).
<Insert Table 4 here.>
Factor Analysis
Exploratory factor analysis was completed using a random selection of 75% of the total
sample. Two components were identified in the exploratory factor analysis, for which variable
loadings were at least .45. The two components correspond to Self affirmation and Outlook on
life. The item, "Enabled me to learn new skills (SKILLS)" loaded weakly on both components in
the early factor analytic procedures and was excluded from all further factor analyses. The
items “given more meaning to my life (MEANING)” and “made me feel strong and confident
(STRONG)” had loadings greater than .35 on both. To determine their overall contribution to
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the differentiation of the two components, a confirmatory factor analysis was conducted allowing
these items to load on both factors using the remaining 25% sample. The estimates of the
factor loadings were then tested to determine if they differed significantly from zero. The
estimated loadings were significantly different from zero on both factors for MEANING, so this
item was also dropped from the scale. STRONG had an estimated loading that was
significantly different from 0 on Self affirmation, but not Outlook on life and was kept in the
analysis. Hence, two items, SKILLS and MEANING, were dropped from the original 11 item
instrument, resulting in a 9-item instrument that was further analyzed (See Appendix B. Positive
Aspects of Caregiving Questionnaire).
The eigenvalues from the exploratory factor analysis of the nine-item scale are
presented in Table 5.
<Insert Table 5 here.>
The inter-item reliability was evaluated using Cronbach’s alpha. The alphas for the Self
affirmation items and the Outlook on life items were .86 and .80, respectively. The correlation
between the two components was .69, a strong correlation that supports creating a summary
score, and the overall reliability of the 9 items was high, Cronbach's alpha = .89 (See Table 6).
Confirmatory factor analyses, completed on the remaining 25% subsample (N=313), showed a
good fit of the two-component structure, with a Root Mean Square Error Adjusted (RMSEA)
statistic of .0592 (95% Confidence Interval: .0319, .0852), a Chi-square statistic of 54.477 with
26 degrees of freedom.
<Insert Table 6 here.>
The RMSEA statistics from confirmatory factor analyses indicated that the factor
structure fit in numerous subgroups of the REACH cohort implying invariance of the factor
structure. With the exception of the site subgrouping, all of the point estimates for the RMSEA
were below 0.10, and most were below .08, considered to be acceptable fit (Browne and
Cudeck 1993), pp.137-162).
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Scale Validity
The Positive Aspects of Caregiving questionnaire has demonstrated face validity. Items
were developed reflecting items in earlier instruments developed originally by Lawton (1989)
and modified by Beach (2000). Caregivers' positive feelings toward caregiving were expected
to be positively associated with their level of well-being, self reported health and satisfaction
with received social support, but negatively associated with the amount of burden they felt that
caregiving imparted and their dissatisfaction with negative social interactions. Hence, we
examined the convergent validity of the overall Positive Aspects of Caregiving measure with the
Well-Being subscale (CES-D), Self Reported Health and the Satisfaction with Received Social
Support subscale (ISSB) and the amount of burden reported by the caregivers on the RMBPC
and the Negative Interactions subscale (ISSB). The relationships were in the hypothesized
directions, though many of the correlations were smaller than anticipated. To evaluate the
discriminant validity of the measure, we examined the correlation between the overall score and
the Somatic subscale of the CES-D, expecting the Positive Aspects of Caregiving to be
negatively correlated with the Somatic subscale. A small negative correlation was found for the
overall sample and for racial, caregiver type and gender subgroupings (See Table 7).
<Insert Table 7 here.>
Subgroup Analyses
Finally, for selected subgroups of caregivers, we examined distributions of the overall
Positive Aspects of Caregiving summary score and those of the factors (See Table 8). The
overall average score of 34.0 on a scale that ranges from 9 to 45 represents an average that is
over 69% of the way from the minimum possible to maximum possible score (i.e., only 31% of
the range is above the mean on this sample). The average on both factors, as a percentage of
the range, is similar (69% for Self affirmation and 71% for Outlook on life). Scores tended to be
lower in whites than the other ethnic groups and higher in males than females. However, these
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univariate comparisons do not account for potential differences in the groups (e.g., carerecipient characteristics) and should be interpreted with caution.
<Insert Table 8 here.>
Results Summary
The results of the administration of the Positive Aspects of Caregiving reveal that at
baseline (pre-intervention) most caregivers of persons with dementia do perceive their
caregiving as providing them with a variety of positive and satisfying experiences. Caregivers
frequently reported that caregiving made them feel needed, useful and good about themselves.
Most caregivers also reported that caregiving enabled them to appreciate life more, develop a
more positive attitude toward life and strengthened their relationships with others. These
findings are generally consistent with what is reported in the caregiving literature (Farran et al.
1999; Lawton et al. 1989; (National Alliance for Caregiving and American Association of Retired
Persons 1997).
Discussion
An instrument comprised of 9 items has been developed to assess caregivers’
perceptions regarding the positive aspects of caregiving. The resulting instrument is a
combination of two components, 1) Self affirmation and 2) Outlook on life. The two component
model was shown to be consistent across subgroups in a large and diverse sample,
demonstrating its potential for future caregiving research. Although two components were
identified, the strength of the bivariate associations between all pairs of items and the strong
correlation between the two factors justified summing the items to generate a single score. In
addition, the overall measure demonstrated high internal reliability. Moderate convergent and
discriminant validity were demonstrated using other core battery measures. All correlations
were in the hypothesized directions though the sizes of almost all of the relationships were
smaller than anticipated. However, these results were modest and may be related to sample
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bias introduced with a self-selected population. Construct validity was supported in the results
of the distribution of the overall summary scores for selected subgroups of caregivers, by
demonstrating variability among subgroups that prior research indicates can be expected to
vary.
The nine items included in the Positive Aspects of Caregiving measure were compared
to the five items of the caregiving satisfaction scale, developed by Lawton et, al. (1989) as part
of a broader caregiver appraisal measure. Lawton’s caregiving satisfaction scale has been
subjected to psychometric analysis, shown to have good psychometric properties and has been
used directly or in a modified version by researchers in other studies (See Table 1). The 6
items included in the Self-affirmation factor of the Positive Aspects of Caregiving generally
reflect all five items in the caregiving satisfaction scale, except for ‘care recipient’s pleasure
gives caregiver pleasure’. The second factor, Outlook on life, expands the caregiving
satisfaction scale by identifying ways that the caregiving experience can strengthen the
caregivers’ connections to others and help sustain the caregiver in stressful circumstances.
This analysis, based on a large, diverse six site national sample confirms the usefulness of
items modified from Lawton’s original scale, while the additional items expand the concept that
caregiving entails positive as well as negative aspects and moves the scale from dichotomous
to ordinal.
The relative lack of research focused on positive aspects of caregiving has resulted in a
mix of unstandardized measures that have generated results that are difficult to interpret and
compare. Many investigators have been hampered in their efforts to develop a
psychometrically sound measure and complete a rigorous analysis due to small and
homogeneous samples, as reflected in several of the studies reviewed earlier (See Table 1).
In contrast to earlier studies, this multi-site, intervention study was able to recruit one of the
largest cohorts of caregivers and their ADRD care recipients (N = 1229), an ethnically diverse
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sample, with nearly half of the sample being ethnic minorities, 22.3% African Americans and
19.8% Hispanics. In the present study, African Americans and Hispanics scored higher than
Whites; males scored higher than females and variation occurred in scores across and within
sites. This is consistent with published studies reporting differences among Caucasian, African
American and Hispanic caregivers (Haley et al. 1996); Kemp and Adams 1996; Wykle 1991),
however a more detailed evaluation of the subgroups’ performance on the measure is beyond
the scope of the present paper.
There are limitations in this analysis. First, although the sample of caregivers is large
and drawn from multiple, national sites, the sample consists entirely of self-selecting caregivers.
Because it is known that AD caregivers experience greater stress in the role of caregiver than
other caregivers, it is likely that some of the severely distressed caregivers did not volunteer to
participate in the REACH, biasing the sample. In addition, the majority of caregivers were
husbands, wives or daughters of the person with dementia. The reliability and validity of the
Positive Aspects State measure for non-primary family caregivers not participating in an
intervention study is unknown. It was decided not to attempt to establish criterion validity with
an existing measure, because of investigator reluctance to increase respondent burden by
lengthening an already substantial measurement battery, a further limitation. Finally, there were
some important differences between the sites such as caregiver age and amount of formal
education. Evaluation of the impact of these differences would require more detailed analyses
that are beyond the scope of a present investigation.
Conclusion
The Positive Aspects of Caregiving measure has demonstrated promise as a valid and
reliable instrument when tested with a large, diverse and well-characterized sample.
Psychometric analysis identified two components: Self Affirmation and Outlook on Life. The
overall measure has demonstrated good factor structure and invariance among sample
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subgroups, as well as good internal reliability. This brief, easily administered and generic nineitem measure can be used in a range of caregiving research environments to evaluate the
positive dimensions of this important and complex human experience.
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Appendix A.
REACH Research Group-Participating Institutions and Principal Staff
University of Alabama (Birmingham and Tuscaloosa, Alabama): Louis Burgio, Ph.D.
(Principal Investigator - Tuscaloosa), Alan Stevens, Ph.D. (Principal Investigator - Birmingham),
Alfred Bartolucci, Ph.D., Delois Guy, Ph.D., William Haley, Ph.D., David Roth, Ph.D., Alan
Stevens, Ph.D., David Vance, M.A.
Hebrew Rehabilitation Center for Aged Research and Training Institute (Boston,
Massachusetts): Diane Mahoney, Ph.D. (Principal Investigator), Robert Friedman, M.D.,
Brooke Harrow, Ph.D., Timothy Heeren, Ph.D. (former participant), Richard Jones, Ph.D.,
Barbara Tarlow, Ph.D., Sharon Tennstedt, Ph.D., Ladislav Volicer, M.D., Ph.D.
Veterans Affairs Medical Center (Memphis, Tennessee): Robert Burns, M.D. (Principal
Investigator), Marshall Graney, Ph.D., Kenneth Lichstein, Ph.D., Jennifer Martindale-Adams,
Ed.D., Linda Nichols, Ph.D., Grant Somes, Ph.D.
University of Miami (Miami, Florida): Carl Eisdorfer, M.D., Ph.D. (Principal Investigator),
Soledad Arguelles, Ph.D., Trinidad Arguelles, M.S., Judy Bean, Ph.D. (former participant), Sara
Czaja, Ph.D., David Loewenstein, Ph.D., Mark Rubert, Ph.D., Jose Szapocznik, Ph.D.
Veterans Affairs Medical Center and Stanford University School of Medicine (Palo Alto,
California): Dolores Gallagher-Thompson, Ph.D., ABPP, (Principal Investigator), Patricia
Arean, Ph.D., David Coon, Ph.D., Helena Kraemer, Ph.D., Ana Menendez, Larry Thompson,
Ph.D.
Thomas Jefferson University (Philadelphia, Pennsylvania): Laura N. Gitlin, Ph.D. (Principal
Investigator), Mary Corcoran, Ph.D., Walter Hauck, Ph.D., Susan Klein, M.A., Sue Marcus,
Ph.D. (former participant), Laraine Winter, Ph.D.
Project Office, National Institutes of Health: Marcia Ory, Ph.D., M.P.H., Mary Leveck, Ph.D.,
Karin Helmer, Ph.D.
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Coordinating Center, University of Pittsburgh (Pittsburgh, Pennsylvania): Richard
Schulz, Ph.D. (Principal Investigator), Steven H. Belle, Ph.D., Joy Herrington, M.Ed., Stephen
R. Wisniewski, Ph.D., Jason Newsom, Ph.D. (former participant), Galen Switzer, Ph.D. (former
participant)
External Advisory Committee: Patricia Archbold, DNSc, Oregon Health Sciences University;
Larry Beutler, Ph.D. (former participant), University of California, Santa Barbara; Joel
Greenhouse, Ph.D., Carnegie Mellon University; J. Neil Henderson, Ph.D., University of South
Florida; Ira Katz, M.D., Ph.D., University of Pennsylvania; Powell Lawton, Ph.D., Philadelphia
Geriatric Center; Len Pearlin, Ph.D., University of Maryland; May Wykle, Ph.D., Case Western
Reserve University
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