In 1995, Houston starred alongside Angela Bassett, Loretta Devine and Lela Rochon in her second film, Waiting to Exhale, a motion picture about four African-American women struggling with relationships. Houston played the lead character Savannah Jackson, a TV producer in love with a married man. She chose the role because she saw the film as "a breakthrough for the image of black women because it presents them both as professionals and as caring mothers".[161] After opening at number one and grossing $67 million in the US at the box office and $81 million worldwide,[162] it proved that a movie primarily targeting a black audience can cross over to success, while paving the way for other all-black movies such as How Stella Got Her Groove Back and the Tyler Perry movies that became popular in the 2000s.[163][164][165] The film is also notable for its portrayal of black women as strong middle class citizens rather than as stereotypes.[166] The reviews were mainly positive for the ensemble cast. The New York Times said: "Ms. Houston has shed the defensive hauteur that made her portrayal of a pop star in 'The Bodyguard' seem so distant."[167] Houston was nominated for an NAACP Image Award for "Outstanding Actress in a Motion Picture", but lost to her co-star Bassett.[168]
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Houston's remake of Sparkle was filmed in late 2011 over two months[262] and was released by TriStar Pictures.[263] On May 21, 2012, "Celebrate", the last song Houston recorded with Sparks, premiered at RyanSeacrest.com. It was made available for digital download on iTunes on June 5. The song was featured on the Sparkle: Music from the Motion Picture soundtrack as the first official single.[264] The movie was released on August 17, 2012, in the United States.
By now you have all learned of the unspeakably tragic news of our beloved Whitney's passing. I don't have to mask my emotion in front of a room full of so many dear friends. I am personally devastated by the loss of someone who has meant so much to me for so many years. Whitney was so full of life. She was so looking forward to tonight even though she wasn't scheduled to perform. Whitney was a beautiful person and a talent beyond compare. She graced this stage with her regal presence and gave so many memorable performances here over the years. Simply put, Whitney would have wanted the music to go on and her family asked that we carry on.[288]
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This phase along the care trajectory may also involve nursing home care and repeated hospitalizations as the care recipient declines and ultimately dies. Although many caregivers become involved in end-of-life caregiving, few studies make explicit distinctions among the needs and experiences of family caregivers during disease-directed treatment, palliative or supportive care, and end-of-life phases (Schulz, 2013). The few studies that do focus on caregivers during the end-of-life phase suggest that caregiving demands become more urgent and intensive (Gibbons et al., 2014; Penrod et al., 2012). Caregivers continue to report high levels of burden and stress, but also find greater meaning and purpose in the experience of caregiving at the end of life (Emanuel et al., 2000; Gibbons et al., 2014; Wolff et al., 2007). To better understand caregiving during this critical phase in the trajectory, more fine-grained prospective studies are needed that clearly delineate the transition from disease management to supportive care to end-of-life care, and how these transitions affect the caregiver and formal care provided to the care recipient.
Despite the unique nature of any given caregiver's role over time, broad domains of activity characterize family caregiving. Caregiving ranges from assistance with daily activities and providing direct care to the care recipient to navigating complex health care and social services systems. The domains of the caregiving role include: assistance with household tasks, self-care tasks, and mobility; provision of emotional and social support; health and medical care; advocacy and care coordination; and surrogacy. Each domain has multiple tasks and activities (see Table 3-1). Cutting across these domains are ongoing cognitive and interpersonal processes in which caregivers engage including, for example, continual problem solving, decision making, communicating with others (family members and health and human service professionals), and constant vigilance over the care recipient's well-being (Gitlin and Wolff, 2012). How caregivers manage these tasks depends on their values, preferences, knowledge, and skills, as well as the accessibility, affordability, and adequacy of health care, LTSS, and other resources, as described further in Chapter 6.
The role of family caregivers following discharge of their care recipient from a hospital or skilled nursing facility is important but currently understudied. The caregiver's specific role during this process may vary based on the care needs of the older adult, the caregiver's relationship to the older adult, and where the caregiver lives in relation to the older adult (Gitlin and Wolff, 2012). Given that current research shows the availability and preparedness of caregivers can affect the quality and course of care recipients' post-hospitalization care and that caregivers are often underequipped, outlining and defining these roles is important to designing possible interventions to help caregivers during the discharge process (Gitlin and Wolff, 2012). Chapter 6 discusses current interventions that seek to support caregivers during the discharge and care transition process.
Most individuals prefer to involve family members in medical decisions and have family serve as surrogate decision makers when the individual loses decision-making capacity (Kelly et al., 2012). Some individuals step into the role of surrogate formally by being appointed under an advance directive or power of attorney or by a court in a guardianship proceeding. Others may fall into the role by default by virtue of being a close family member or friend. For health care decisions, the prevailing paradigm for default surrogate decision makers is a nuclear family hierarchy although some states also recognize close friends at the end of the hierarchy (ABA Commission on Law and Aging, 2014). This next-of-kin model lacks flexibility for accommodating diverse family structures and decision-making practices.
Family caregiver depressive symptoms and anxiety persist when the care recipient moves to a long-term care facility with similar severity as when they were providing in-home care, and antianxiety medication use has been found to increase before and after placement (Schulz et al., 2004). Indeed, the greater the hands-on care provided by the family caregivers, the higher their distress, and the lower their satisfaction with care provided by the nursing home staff (Tornatore and Grant, 2004). Causes of distress among caregivers include inadequate resident self-care, lack of communication with nursing home physicians, and challenges of surrogate decision making, including the need for education to support advance care planning and end-of-life decisions (Givens et al., 2012). Although the findings on the experience and impact of family caregiving in LTSS settings are consistent across studies (Gaugler, 2005), individual study samples are not necessarily representative of this population, making it difficult to generate population-level estimates for these indicators.
Care recipients' behavioral symptoms (e.g., agitation, irritability, combativeness) are also associated with negative effects for caregivers (Ballard et al. 2000; Gitlin et al. 2012; Pinquart and Sörensen, 2003; Schoenmakers et al., 2010; Schulz et al., 1995; Torti et al., 2004; van der Lee et al., 2014). In their examination of multivariate models predicting dementia caregiver burden, depression, and mental health, van der Lee and colleagues (2014) concluded that care recipient behavioral symptoms (e.g., waking up at night, rejecting needed care, agitation, and verbal and physical aggressiveness) were stronger predictors of caregiver burden and depression than the cognitive or functional status of the care recipient. Pinquart and Sörensen (2003) also found that care recipients' behavior problems had a greater impact on caregivers' burden and depression than care recipients' physical and cognitive impairments. Torti and colleagues (2004) reported that behavioral problems are associated with caregiver burden across geographic regions and cultures. Hinton and colleagues (2003) reported that behavioral problems are associated with depressive symptoms among family caregivers of cognitively impaired Latinos but that this association was most pronounced among non-spousal caregivers.
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