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Training Grant-
Biology of Aging

Betty Kramer

Betty J. Kramer

Ph.D., University of Washington
Professor, School of Social Work

Family Caregiving: Understanding Variations in Adaptation

The main thrust of my earlier research agenda focused on understanding the experience and variation found among family members caring for older adults with cognitive and physical impairments. My research highlighted the positive dimensions that often accompany the more challenging or negative dimensions of the family caregiving experience, gender differences in caregiving, interpersonal predictors of caregiver well-being, and the experience of the male caregiver. My more recent caregiving research has addressed the distinctive experience of family members providing care at the end-of-life and the transition into "end-stage" caregiving.

Understanding and Improving Care at the End-of-Life

Another line of my work has focused on understanding and improving care at the end of life through attention to three lines of enquiry. First, I have sought to determine and enhance the role of social work in the provision of palliative and end-of-life care and related research. I have documented insufficiencies in end-of-life care content in leading social work textbooks, helped to develop competencies for social workers in palliative care and put forth the national research agenda for social work in palliative and end of life care.

Second, I have studied innovations in end-of-life care for low-income elders with advanced chronic disease to learn about the distinctive challenges experienced by interdisciplinary team members in a fully integrated managed care program, and implications for program development, practice, policy and future research. Building upon this work, I have assessed the feasibility of integrating hospice consultation to address some of these challenges and improve the provision of palliative care.

Third, my current research agenda focuses on understanding conflicts in families that may arise in the context of palliative and end-of-life care. Through a qualitative investigation of the phenomenon of family conflict, I have developed an explanatory matrix of family conflict at the end of life depicting the nature of end of life conflict, family context, conditions, contributing factors, intervening processes and consequences. I have several current projects underway that will allow me to better identify families who are at greatest risk of family conflict and begin to test this explanatory model. One study is looking at how the quality of care provided at the end of life to persons with lung cancer, precipitates the development of conflict and how both quality of care and family conflict affect survivor well-being. Another study is making use of the Wisconsin Longitudinal Study (WLS), a large sample survey of men and women who graduated from Wisconsin high schools in 1957 and were re-interviewed at three points in time. We are investigating the impact of WLS respondent's end-of-life planning on the psychological and financial well-being of bereaved family members. We are investigating three possible pathways linking end-of-life planning with survivor well-being: the quality of care received by the decedent, conflicts surrounding end-of-life care and the nature of the dying process. Finally, through surveys of primary family caregivers of hospice patients we will be documenting descriptive statistics on family conflict, and comparing families with and without conflict in terms of historical relationship patterns, patient and family caregiver characteristics, caregiving strain, family involvement in care, social support, advanced care planning, and psychological well-being. We will be using the explanatory matrix of family conflict to examine predictors and consequences of family conflict.

Representative Publications
Hovland-Scafe, C. A., & Kramer, B. J. (2017). Preparedness for death: How caregivers of elders with dementia define and perceive its value. Gerontologist, 57(6), 1093-1102.
View publication via DOI: DOI:10.1093/geront/gnw092

Kramer, B.J., & Boelk, A.Z. (2015). Managing Family Conflict: Providing Responsive Family Care at the End of Life. Handbook of Oncology Social Work. NY: Oxford University Press.

Kramer, B.J. & Boelk, A. (2015). Correlates and predictors of conflict at the end of life among families enrolled in hospice. Journal of Pain and Symptom Management, 50, 155-162.
View publication via DOI: DOI:10.1016/j.jpainsymman.2015.02.026

Kramer, B. J., Cleary, J., & Mahoney, J. (2014). Enhancing palliative care for low-income elders with chronic disease: Feasibility of a hospice consultation model. Journal of Social Work in End-of-life and Palliative Care, 10(4), 356-77.
View publication via DOI: DOI:10.1080/15524256.2014.975088

Hung, W.W., Rossi, M., Thielke, S., Caprio, T., Barczi, S., Kramer, B.J., Kochersberger, G., Boockvar, K.S., & Howe, J.L. (2014). A multisite geriatric education program for rural providers in the veteran health care system (GRECC-Connect). Gerontology & Geriatric Education, 35(1), 23-40.
View publication via DOI: DOI:10.1080/02701960.2013.870902

Kavanaugh, M., Kramer, B.J., Trentham-Dietz, A., & Walsh, M. (2014). Factors contributing to economic burden in lung cancer spousal caregivers. Journal of Palliative and Supportive Care, 1-10.
View publication via DOI: DOI:Journal of Palliative and Supportive Care, 1-10

Kwak, J., Ko, Eunjeong, & Kramer, B.J. (2013). Facilitating advance care planning with ethnically diverse groups of frail, low-income elders in the USA: Perspectives of care managers on challenges and recommendations. Health and Social Care in the Community. Advance online publication.
View publication via DOI: DOI:10.1111/hsc.12073

Kwak, J., Kramer, B. J., Lang, J., & Ledger, M. (2013). Challenges in end-of-life care management for low-income frail elders: A case Study of the Wisconsin family care program. Research on Aging, 35(4), 393-419.
View publication via DOI: DOI:10.1177/0164027512446939

Kramer, B. J. (2013). The role of social work in caring for elders with advanced chronic disease at the end-of-life. Journal of Social Work in Palliative and End-of-life Care, 9, 1-23.
View publication via DOI: DOI:10.1080/15524256.2013.846887

Boelk, A.Z. & Kramer, B.J. (2012). Advancing theory of family conflict at the end of life: A hospice case study. Journal of Pain and Symptom Management, 44(5), 655-70.
View publication via DOI: DOI:10.1016/j.jpainsymman.2011.11.004

Kwak, J., Kramer, B.J., Lang, J., & Ledger, M. (2012). Challenges in End-of-Life Care Management for Low-Income Frail Elders: A Case Study of the Wisconsin Family Care Program. Research on Aging, 35(4), 393-419.
View publication via DOI: DOI:10.1177/0164027512446939

Kramer, B.J. & Yonker, J.A. (2011). Perceived success in addressing end-of-life care needs of low-income elders and their families: What's family conflict got to do with it? Journal of Pain and Symptom Management, 41(1), 35-48.
View publication via DOI: DOI:10.1016/j.jpainsymman.2010.04.017

Kramer, B.J. (2011). Buddhist perspectives on end-of-life care. In K. Doka & A. S. Tucci (Eds.), Living with grief: Spirituality and end-of-life care (pp. 207-219). Washington, D.C.: Hospice Foundation of America.

Kramer, B. J., Kavanaugh, M., Trentham-Dietz, A., Walsh, M. & Yonker, J.A. (2010). Complicated grief symptoms in caregivers of persons with lung cancer: The role of family conflict, intrapsychic strains and hospice utilization. Omega (Westport), 62(3), 201-220.

Kehl, K., Kirchoff, K., Kramer, B. J., & Hovland-Scafe, C. (2009). Challenges facing families at the end-of-life in three settings. Journal of Social Work in End-of-Life & Palliative Care, 5(3-4), 144-168.
View publication via DOI: DOI:10.1080/15524250903555080

Gardner, D. S. & Kramer, B.J. (2009). End of life concerns and care preferences: Congruence among terminally ill elders and their family members. OMEGA: Journal of Death and Dying, 60(3), 273-297.
View publication via DOI: DOI:10.2190/OM.60.3.e

Kramer, B.J., Kavanaugh, M., Trentham-Dietz, A., Walsh, M., & Yonker, J.A. (2009). Predictors of family conflict at the end of life: The experience of spouses and adult children of persons with lung cancer. The Gerontologist, 10(1093), 121.
View publication via DOI: DOI:10.1093/geront/gnp121

Kramer, B.J., Boelk, A., & Auer, C. (2006). Family conflict at the end-of-life: Lessons learned in a model program for vulnerable older adults. Journal of Palliative Medicine, 9, 791-801.

Hooyman, N.R., & Kramer, B.J. (2006). Living through loss: Interventions across the lifespan. Columbia University Press.

Kramer, B.J., & Auer, C. (2005). Challenges to providing end-of-life care to low-income elders with advanced chronic disease: Lessons learned from a model program. The Gerontologist, 45, 651-660.
View publication via DOI: DOI:10.1093/geront/45.5.651

Kramer, B.J., Christ, G.H., Bern-Klug, M., & Francoeur, R.B. (2005). A national agenda for social work research in palliative and end-of-life care. Journal of Palliative Medicine, 8, 418-431.

Bern-Klug, M. , Kramer, B.J., & Linder, J.F. (2005). All aboard: Advancing the social work research agenda in end-of-life care. Journal of Social Work in End-of-life and Palliative Care, 1(2), 71-86.
View publication via DOI: DOI:10.1300/J457v01n02_06

Waldrop, D.P., Kramer, B.J., Skrentny, J.A., Milch, R.A., & Finn, W. (2005). Final transitions: Family caregiving at the end of life. Journal of Palliative Medicine, 8, 623-638.

Gwyther, L., Altilio, T., Blacker, S., Christ, G., Csikai, E.L., Hooyman, N., Kramer, B.J., Linton, L.M., Raymer, M., & Howe, J. (2005). Social work competencies in palliative and end-of-life care. Journal of Social Work in End-of-life and Palliative Care, 1, 87-120.

Hauser, J., & Kramer, B.J. (2004). Family caregivers in palliative care. Clinics in Geriatric Medicine: Special Issue on End-of-Life Care, 20, 671-88.
View publication via DOI: DOI:10.1016/j.cger.2004.07.003

Kramer, B.J., Pacourek, L., & Hovland-Scafe, C. (2003). Analysis of end-of-life content in social work textbooks. Journal of Social Work Education, 39, 299-320.

Kramer, B.J. (2002). Men caregivers: An overview. In B.J. Kramer & E.H. Thompson (Eds.), Men caregivers: Theory, research, and service implications (pp. 3-19). Springer Publishers.

Kramer, B.J., & Lambert, J.D. (1999). Caregiving as a life course transition among older husbands: A prospective study. The Gerontologist, 39(6), 658-667.
View publication via DOI: DOI:10.1093/geront/39.6.658

Beach, D.L., & Kramer, B.J. (1999). Communicating with the Alzheimer's resident: Perceptions of care providers in a residential facility. Journal of Gerontological Social Work, 32(3), 5-26.
View publication via DOI: DOI:10.1300/J083v32n03_02

Kramer, B.J. (1997). Differential predictors of strain and gain among husbands caring for wives with dementia. The Gerontologist, 37(2), 239-249.

Kramer, B.J. (1997). Gain in the caregiving experience: Where are we? What next? The Gerontologist, 37(2), 218-232.
View publication via DOI: DOI:10.1093/geront/37.2.218

Kramer, B.J., & Kipnis, S. (1995). Elder care and work role strain: Toward an understanding of gender differences in caregiver burden. The Gerontologist, 35(3), 340-348.
View publication via DOI: DOI:10.1093/geront/35.3.340

Kramer, B.J. (1994). Coping: A review of measures used among caregivers of individuals with dementia. Journal of Gerontological Social Work, 23(1/2), 151-174.
View publication via DOI: DOI:10.1300/J083V23N01_09

Kramer, B.J. (1993). Expanding the conceptualization of caregiver coping: The importance of relationship-focused coping strategies. Family Relations, 42, 383- 391.

Kramer, B.J. (1993). Marital history and prior relationship as predictors of positive and negative outcomes among wife caregivers. Family Relations, 42, 367-375.
View publication via DOI: DOI:10.2307/585336

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