1
|
Viens M, Éthier A, Provencher V, Carrier A. WHO, WHEN, HOW: a scoping review on flexible at-home respite for informal caregivers of older adults. BMC Health Serv Res 2024; 24:767. [PMID: 38926712 PMCID: PMC11202319 DOI: 10.1186/s12913-024-11058-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 04/29/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND As the world population is aging, considerable efforts need to be put towards developing and maintaining evidenced-based care for older adults. Respite services are part of the selection of homecare offered to informal caregivers. Although current best practices around respite are rooted in person centeredness, there is no integrated synthesis of its flexible components. Such a synthesis could offer a better understanding of key characteristics of flexible respite and, as such, support its implementation and use. METHODS To map the literature around the characteristics of flexible at-home respite for informal caregivers of older adults, a scoping study was conducted. Qualitative data from the review was analyzed using content analysis. The characterization of flexible at-home respite was built on three dimensions: WHO, WHEN and HOW. To triangulate the scoping results, an online questionnaire was distributed to homecare providers and informal caregivers of older adults. RESULTS A total of 42 documents were included in the review. The questionnaire was completed by 105 participants. The results summarize the characteristics of flexible at-home respite found in the literature. Flexibility in respite can be understood through three dimensions: (1) WHO is tendering it, (2) WHEN it is tendered and (3) HOW it is tendered. Firstly, human resources (WHO) must be compatible with the homecare sector as well as being trained and qualified to offer respite to informal caregivers of older adults. Secondly, flexible respite includes considerations of time, duration, frequency, and predictability (WHEN). Lastly, flexible at-home respite exhibits approachability, appropriateness, affordability, availability, and acceptability (HOW). Overall, flexible at-home respite adjusts to the needs of the informal caregiver and care recipient in terms of WHO, WHEN, and HOW. CONCLUSION This review is a step towards a more precise definition of flexible at-home respite. Flexibility of homecare, in particular respite, must be considered when designing, implementing and evaluating services.
Collapse
Affiliation(s)
- Maude Viens
- Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Research Center on Aging, Sherbrooke, Québec, Canada.
| | - Alexandra Éthier
- Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Center on Aging, Sherbrooke, Québec, Canada
| | - Véronique Provencher
- Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Center on Aging, Sherbrooke, Québec, Canada
| | - Annie Carrier
- Université de Sherbrooke, Sherbrooke, Québec, Canada
- Research Center on Aging, Sherbrooke, Québec, Canada
| |
Collapse
|
2
|
Emerson AJ, Einhorn L, Groover M, Naze G, Baxter GD. Clinical conversations in the management of chronic musculoskeletal pain in vulnerable patient populations: a meta-ethnography. Disabil Rehabil 2023; 45:3409-3434. [PMID: 36205554 DOI: 10.1080/09638288.2022.2130447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations. MATERIALS AND METHODS A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks. RESULTS The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations. CONCLUSION The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes.IMPLICATIONS FOR REHABILITATIONHealthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions.Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain.Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain.Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain.This may include cultural training for healthcare providers that is informed by patients.
Collapse
Affiliation(s)
- Alicia J Emerson
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
- School of Physiotherapy, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | | | - Morgan Groover
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - Garrett Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| | - G David Baxter
- School of Physiotherapy, Activity, and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| |
Collapse
|
3
|
Nadash P, Qu S, Tell EJ. Supporting Diverse Family Caregivers: Key Stakeholder Perspectives. Health Promot Pract 2023:15248399231196854. [PMID: 37694397 DOI: 10.1177/15248399231196854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
This study aimed to understand the perspectives of key stakeholders regarding strategies for better supporting culturally and ethnically diverse family caregivers, aiming to incorporate them into the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Advisory Council's proposed National Strategy. The Strategy, published in 2022, identified priority actions to support the growing population of people providing unpaid care to people of all ages with disabilities, with a goal of improving the health and well-being of both the family caregiver and the person receiving support. Researchers conducted extensive outreach to purposively diverse stakeholder organizations, using six stakeholder strategy sessions with representatives from 42 groups in December 2020 to identify preliminary themes. During July-October 2021, 17 key informant interviews and 16 stakeholder listening sessions were held, involving 103 different organizations. Qualitative data analysis using an inductive approach was used to identify key themes. A significant issue for diverse caregivers is widespread lack of self-identification as caregivers, which is tied to a lack of awareness of potentially helpful services and supports; culturally appropriate outreach is critical to ensure access to services, as well as access to centralized resources and funding for community- and faith-based organizations. A community health worker model was recommended. Tailored activities, involving trusted community- and faith-based groups, as well as investments in caregiver- and culturally-specific supports, are critical for reaching the diverse family caregivers who most need supports. Raising awareness of caregiving among and taking advantage of the expertise of professionals working with diverse communities is also crucial.
Collapse
Affiliation(s)
| | - Shan Qu
- University of Massachusetts Boston, Boston, MA, USA
| | | |
Collapse
|
4
|
Hadidi NN, Gorzycki E, Jones C, Everson-Rose SA, Taylor Z, Gurvich O. Sharing Perspectives in African American Communities to Reduce Stroke Risk Through Community Listening Circles. J Community Health Nurs 2023; 40:119-132. [PMID: 36920113 DOI: 10.1080/07370016.2022.2161306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
PURPOSE To build trust and explore community perception on stroke disparities as well as barriers and strengths to stroke prevention. DESIGN Mixed methods study. METHODS A convenience sample (n = 54) of African Americans responded to questionnaires and participated in focus groups. FINDINGS Although a majority of participants had some knowledge of stroke warning signs and risk factors, there were misconceptions identified through the Community Listening Circles (CLCs). Misconceptions about stroke were identified. Six key themes emerged. CONCLUSIONS Focus groups provided a better understanding of stroke perception. CLINICAL EVIDENCE Community health nurses may be able to use this information to provide care appropriately.
Collapse
Affiliation(s)
| | - Emily Gorzycki
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Clarence Jones
- community organization titled Hue-MAN Partnership, Hue-MAN Organization, Minneapolis, MN, USA
| | | | - Zachary Taylor
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Olga Gurvich
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
5
|
Obaoye JO, Dawson AZ, Thakkar M, Williams JS, Egede LE. Understanding the relationship between perceived discrimination and mortality in United States adults. Aging Ment Health 2023; 27:445-451. [PMID: 35118927 PMCID: PMC9349476 DOI: 10.1080/13607863.2022.2032593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/18/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To understand the relationship between mortality and three types of perceived discrimination (lifetime, daily, chronic job) using a nationally representative sample of U.S. adults. METHODS Data from 4562 adults in the Midlife in the United States (MIDUS) between 2004 and 2006 (MIDUS II and MIDUS African American sample) were analyzed. Unadjusted associations between primary independent discrimination variables (lifetime, chronic job, daily) and mortality were analyzed using univariate Cox's proportional hazards regression models. Covariates were added to the models by group: predisposing (sex, age, race/ethnicity, education, marital status); enabling (household income, employment status, insurance status); and need factors (body mass index, diabetes, hypertension, stroke, cancer) to estimate hazard ratios. RESULTS After adjusting for all covariates, hazard ratios for lifetime discrimination (HR: 1.09, p = 0.034) and daily discrimination (HR: 1.03, p = 0.030) were statistically significant. There was no relationship between mortality and chronic job discrimination (HR:1.03, p = 0.15). CONCLUSIONS Adults experiencing lifetime and daily discrimination had significantly increased risk of mortality after adjusting for predisposing, enabling, and need factors. The findings highlight the importance of screening patients during clinical encounters for experiences of discrimination and providing appropriate resources to mitigate the negative impact of discriminatory events on mortality. Future research should work to fully understand the mechanism by which discrimination increases risk of mortality. These future findings should be used to develop targets for interventions designed to decrease mortality among adults who have experienced discrimination.
Collapse
Affiliation(s)
- Joanna O. Obaoye
- Department of Medicine, Medical School, Medical College of Wisconsin, CLCC – 5 Floor, 9200 W Wisconsin Ave., Milwaukee, WI 53226
| | - Aprill Z. Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Madhuli Thakkar
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Joni S. Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| | - Leonard E. Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226
| |
Collapse
|
6
|
Schouler-Ocak M, Moran JK. Racial discrimination and its impact on mental health. Int Rev Psychiatry 2022:1-9. [PMID: 36519290 DOI: 10.1080/09540261.2022.2155033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.
Collapse
Affiliation(s)
- Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital Berlin, Berlin, Germany
| | - James Kenneth Moran
- Department of Psychiatry and Psychotherapy, Multisensory Integration Lab, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
7
|
Boutin-Foster C. R.E.A.C.T: A framework for role modeling anti-racism in the clinical learning environment. MEDICAL TEACHER 2022; 44:1347-1353. [PMID: 35815705 DOI: 10.1080/0142159x.2022.2094231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE In 2020, medical schools across the U.S. were called to task by students who demanded a response to structural racism in medicine. Many medical schools made anti-racism declarations and pledged to promote more inclusive learning environments. Much of the focus was on changing the pre-clinical curriculum and less on the everyday interactions that occur in clinical settings. As medical educators, we have an obligation to reinforce statements of solidarity by role modeling behaviors that demonstrate anti-racism in clinical practice. METHODS This article proposes a framework that provides practical steps for role modeling anti-racism in the clinical learning environment. These steps are drawn from a review of the literature on role modeling, constructs from Social Cognitive Learning Theory, and anti-racism praxis. RESULTS The resulting framework uses the acronym R.E.A.C.T to describe practical steps that include Reflecting on implicit biases, Educating ourselves on historical and current forms of structural racism, Assessing the use of race in clinical practice and asking how racism is impacting a clinical interaction, Calling out behaviors that perpetuate racism, and Treating everyone with dignity and respect. CONCLUSIONS The R.E.A.C.T framework is of value to medical educators because it provides practical steps on role modeling anti-racism in the clinical learning environment. The framework calls medical educators not to merely passively 'react,' but to be introspective, proactive, and intentional in their response to racism. Examples are provided on how each step can be actualized and adapted for different learning environments.
Collapse
Affiliation(s)
- Carla Boutin-Foster
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| |
Collapse
|
8
|
Brown MJ, Wu M, Zeng C, Harrison S, Haider MR, Li X. Racial disparities in the association between resilience and ART adherence among people living with HIV: the mediating role of depression. AIDS Care 2022; 34:1555-1564. [PMID: 35254174 PMCID: PMC9448828 DOI: 10.1080/09540121.2022.2049194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/28/2022] [Indexed: 01/26/2023]
Abstract
Research examining the mediating role of depressive symptoms in the association between resilience and antiretroviral therapy (ART) adherence is lacking. Therefore, this study aims to examine the mediating role of depression between resilience and ART adherence, as well as to explore whether this relationship varies across racial background. A total of 327 people living with HIV and on ART in South Carolina were surveyed about their ART adherence and mental health, including resilience and depressive symptoms. Path analyses were conducted to determine the direct and indirect effects between resilience, depressive symptoms, and ART adherence. After adjusting for age, gender, income, education, employment and time since diagnosis, among Black individuals, resilience was negatively associated with depressive symptoms (β = --0.248, p < 0.001); depressive symptoms were negatively associated with ART adherence (β = -0.166, p = 0.020); however, resilience was not significantly associated with ART adherence. Among White individuals, there was no statistically significant association. The indirect effect between resilience and ART adherence through depressive symptoms was statistically significant (β = 0.041, p = 0.040) for Black individuals, while not statistically significant for White individuals (β = 0.024, p = 0.578). Interventions aimed at improving ART adherence, which attenuate depressive symptoms through accentuating resilience may be especially beneficial for Black populations living with HIV.
Collapse
Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Miao Wu
- Nanjing Medical University, Jiangsu, China
| | - Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sayward Harrison
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Psychology, College of Arts and Sciences, University of South Carolina
| | - Mohammad Rifat Haider
- Health Policy and Management, College of Public Health, University of Georgia, Athens GA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
9
|
Anderson C, Potts L. Physical health conditions of the Amish and intervening social mechanisms: an exhaustive narrative review. ETHNICITY & HEALTH 2022; 27:1952-1978. [PMID: 34410871 PMCID: PMC8857275 DOI: 10.1080/13557858.2021.1968351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/10/2021] [Indexed: 05/03/2023]
Abstract
As an ethnic religion, the Amish are of interest to population health researchers due to a distinctive health profile arising from ethnic attributes, including a closed genetic pool and shared culture that shapes lifestyle practices. Amish-focused health research both furthers our knowledge of health conditions by comparing Amish with non-Amish and assists health practitioners in serving this rapidly growing population. Amish health research, now representing approximately a quarter of all Amish-focused publications, is in need of review, to the end of strengthening this knowledge body's coherence, clarifying research directions, and identifying knowledge gaps, lapses, and stagnations. Herein, we synthesize and discuss Amish physical health conditions research, both the population's distinctive health profile and mechanisms shaping this profile. Specifically, we summarize research addressing BMI, physical activity, and body image; diet and supplements; cancer; cardiovascular conditions; communicable diseases; immunity; sleep; genetic disorders; tobacco and alcohol use; periodontal conditions; traumatic injuries; natural treatments for burns; fertility; and sexually transmitted diseases. In reflection, we raise questions about the nature of intervening mechanisms shaping the Amish health profile, the strange omission of several common independent variables commonly used when studying other ethnic groups' health, several recurring methodological complications, and public health policy considerations.
Collapse
Affiliation(s)
- Cory Anderson
- Population Research Institute, The Pennsylvania State University, State College, PA, USA
| | - Lindsey Potts
- Occupational Therapy, Maryville University, St. Louis, MO, USA
| |
Collapse
|
10
|
Petteway RJ. On epidemiology as racial-capitalist (re)colonization and epistemic violence. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2107486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ryan J. Petteway
- OHSU-PSU School of Public Health, Portland State University, Portland, OR, USA
| |
Collapse
|
11
|
Adebayo CT, Parcell ES, Mkandawire-Valhmu L, Olukotun O. African American Women's Maternal Healthcare Experiences: A Critical Race Theory Perspective. HEALTH COMMUNICATION 2022; 37:1135-1146. [PMID: 33601991 DOI: 10.1080/10410236.2021.1888453] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black women are experiencing pregnancy-related complications at a significantly higher rate than women of other races in the U.S., as Black women are three to four times likely to die from pregnancy-related complications compared to non-Hispanic White women. Structural barriers and different forms of marginalization continue to limit Black women's access to quality healthcare services. Through critical race theory, we examine what structural barriers exist in the U.S. healthcare system, one that limits access to quality care during their prenatal and postnatal doctor's visits. Using qualitative in-depth interviews, 31 African American women, living in Milwaukee, WI, shared their pregnancy stories. The emergent themes include, institutionalized care - racially insensitive biomedical approach, race and class - unfair treatment based on health insurance, and race as a social concept - dismissed pain concerns because you are a strong Black woman. These themes reveal the experience of racial discrimination toward African American women through healthcare [communicative] practices that are often times seen as "standard" practices, albeit marginalizing minority populations. Findings from this study offer insights for healthcare providers on communicative practices that foster a racially-safe healthcare environment for African American women.
Collapse
|
12
|
Sudhinaraset M, Ling I, Gao L, Chavarin J, Gee GC. The association between Deferred Action for Childhood Arrivals, health access, and mental health: the role of discrimination, medical mistrust, and stigma. ETHNICITY & HEALTH 2022; 27:1075-1087. [PMID: 33276705 DOI: 10.1080/13557858.2020.1850647] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 11/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE There are approximately 11 million undocumented immigrants in the US, including 1.3 million young adults who are eligible for the Deferred Action for Childhood Arrivals (DACA) program. It is unclear how DACA influences engagement in healthcare or depressive symptoms, and the role of discrimination, medical mistrust, and stigma in healthcare settings. This study assesses the association of DACA on undocumented young adults' engagement with health care and depressive symptoms. DESIGN We conducted an internet-based survey examining the health-related experiences of undocumented Latino and Asians and Pacific Islander (API) young adults in California (n = 218) between June and August 2017. Multivariable logistic regressions were conducted to assess the influence of DACA, discrimination, medical mistrust, and stigma on healthcare engagement and depressive symptoms. RESULTS Approximately 78% of respondents had a gap in healthcare, and about 31% reported high levels of depressive symptoms. Controlling for demographic characteristics, compared to those without DACA, DACA-recipients had lower odds of reporting gaps in healthcare engagement (aOR = 0.270, p < 0.05) and depressive symptoms (aOR = 0.115, p < 0.01). Those facing discrimination, medical mistrust, and stigma in healthcare settings were less likely to have a healthcare visit and more likely to have higher depressive symptoms. CONCLUSIONS DACA is a potential strategy to improve healthcare access and address the mental health of undocumented populations. In particular, issues of discrimination, stigma by healthcare providers, and medical mistrust need to be addressed.
Collapse
Affiliation(s)
- May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
- School of Medicine, University of California, San Francisco, CA, USA
| | - Irving Ling
- School of Medicine, University of California, San Francisco, CA, USA
| | - Leiwen Gao
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Gilbert C Gee
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| |
Collapse
|
13
|
Causadias JM, Alcalá L, Morris KS, Yaylaci FT, Zhang N. Future Directions on BIPOC Youth Mental Health: The Importance of Cultural Rituals in the COVID-19 Pandemic. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:577-592. [PMID: 35731555 PMCID: PMC10036168 DOI: 10.1080/15374416.2022.2084744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Culture plays an important role in the development of mental health, especially during childhood and adolescence. However, less is known about how participation in cultural rituals is related to the wellbeing of youth who are Black, Indigenous, and People of Color (BIPOC), and part of the Global Majority. This is crucial amid the COVID-19 pandemic, a global event that has disproportionally affected BIPOC youth and disrupted participation in rituals. The goal of this paper is to promote advances in clinical child and adolescent psychology focused on rituals. We begin by defining culture and rituals and examining their role on development. We illustrate these issues with the Lunar New Year in China, Maya rituals in México, Ramadan in Turkey, and Black graduations and Latinx funerals in the United States. We discuss how the pandemic has affected participation in these rituals and their potential impact on BIPOC children and adolescents' mental health. We propose future directions and recommendations for research.
Collapse
Affiliation(s)
- José M. Causadias
- School of Social and Family Dynamics, Arizona State University, United States
| | - Lucía Alcalá
- Department of Psychology, California State University, Fullerton, United States
| | - Kamryn S. Morris
- School of Social and Family Dynamics, Arizona State University, United States
| | - Fatima T. Yaylaci
- Department of Psychology, Fatih Sultan Mehmet Vakıf University, Turkey
| | - Na Zhang
- Human Development and Family Sciences, University of Connecticut, United States
| |
Collapse
|
14
|
Forrester SN, Zmora R, Schreiner PJ, Jacobs DR, Roger VL, Thorpe RJ, Kiefe CI. Racial differences in the association of accelerated aging with future cardiovascular events and all-cause mortality: the coronary artery risk development in young adults study, 2007-2018. ETHNICITY & HEALTH 2022; 27:997-1009. [PMID: 33222499 PMCID: PMC8137718 DOI: 10.1080/13557858.2020.1839021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Variability of Cardiovascular disease (CVD) risk, including racial difference, is not fully accounted for by the variability of traditional CVD risk factors. We used a multiple biomarker model as a framework to explore known racial differences in CVD burden. DESIGN We measured associations between accelerated aging (AccA) measured by a combination of biomarkers, and cardiovascular morbidity and all-cause mortality using data from the Coronary Artery Risk Development in Young Adults study (CARDIA). AccA was defined as the difference between biological age, calculated using biomarkers with the Klemera and Doubal method, and chronological age. Using logistic regression, we assessed overall and race-specific associations between AccA, CVD, and all-cause mortality. RESULTS Among our cohort of 2959 Black or White middle-aged adults, after adjustment, a one-year increase in AccA was associated with increased odds of CVD (Odds Ratio (OR) = 1.04; 95% CI: 1.02, 1.06), stroke (OR = 1.12; 95% CI: 1.07, 1.17), and all-cause mortality (OR = 1.05; 95% CI: 1.02, 1.08). We did not find significant overall racial differences, but we did find race by sex differences where Black men differed markedly from White men in the strength of association with CVD (OR = 1.06, 95% CI: 1.01, 1.12). CONCLUSIONS We provide evidence that AccA is associated with future CVD.
Collapse
Affiliation(s)
- Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rachel Zmora
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Pamela J Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - David R Jacobs
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Veronique L. Roger, Mayo Clinic, Division of Circulatory Failure, Rochester, MN, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catarina I Kiefe
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
15
|
Petteway RJ. What you should know about RACISM-20 in the U.S.: a fact sheet in the time of COVID-19. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2078180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ryan J. Petteway
- Community Health/Health Promotion, OHSU-PSU School of Public Health, Portland, OR, USA
| |
Collapse
|
16
|
Johnson EEH, Alexander C, Lee GJ, Angers K, Ndiaye D, Suhr J. Examination of race and gender differences in predictors of neuropsychological decline and development of Alzheimer's disease. Clin Neuropsychol 2022; 36:327-352. [PMID: 34218735 PMCID: PMC10496932 DOI: 10.1080/13854046.2021.1940299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
ObjectiveBlack adults are diagnosed with Alzheimer's disease (AD) at higher rates than White adults. Biopsychosocial risk factors that differentially affect individuals by race, including health, education, and APOE e4, may explain these findings. Some research suggests that the risk for AD associated with the APOE e4 allele may differ by race. Gender differences in AD have also been identified but remain understudied. We examined race, APOE status, vascular risk factors, education, and the interaction of APOE e4 status and race as predictors of cognitive decline and the development of Alzheimer's disease between genders in a large longitudinal sample of older adults. Methods: Participants (N = 4336) were selected from the National Alzheimer's Coordinating Center's Uniform Data Set who completed measures of verbal fluency, naming, and immediate/delayed story memory across 5 years. Analyses were stratified by gender. Follow up interactions examined statistical significance of differences. Results: APOE e4 by race interactions were largely non-significant and dropped from most models. When controlling for health, education, referral source, and Uniform Data Set form (when applicable), few racial differences in cognitive performance over time emerged. Black participants obtained lower scores than White participants on a majority of baseline measures. Race findings did not differ by gender. Hypertension was more strongly predictive of decline in delayed memory among women. Conclusions: Analyses did not support that APOE e4 differentially affects Black individuals. Hypertension may be a more relevant risk factor among women. Results raise questions regarding the accuracy of baseline scores in predicting decline for Black individuals.
Collapse
Affiliation(s)
| | | | - Grace J Lee
- Psychology, Ohio University, Athens, OH00, USA
| | | | | | - Julie Suhr
- Psychology, Ohio University, Athens, OH00, USA
| |
Collapse
|
17
|
Cothran FA, Paun O, Strayhorn S, Barnes LL. 'Walk a mile in my shoes:' African American caregiver perceptions of caregiving and self-care. ETHNICITY & HEALTH 2022; 27:435-452. [PMID: 32116006 PMCID: PMC9137429 DOI: 10.1080/13557858.2020.1734777] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
African American Alzheimer's disease and related dementia (ADRD) family caregivers are understudied in intervention research with discrepant evidence existing on their mental and physical health outcomes. The stress toll of ADRD caregiving, coupled with the well-documented health disparities for African Americans, place these caregivers at higher risk for morbidity and mortality.Objectives: The purpose of this study was to explore African American ADRD family caregivers' perceptions of caregiving and self-care.Design: Qualitative descriptive study based on individual, one-time, semi-structured interviews from a purposeful sample of current/former African American ADRD community-dwelling family caregivers. Participants agreed to either face-to-face or telephonic interviews between 60 and 90 minutes in length.Results: Twenty-one caregiver interviews were conducted with primarily adult children (mean age = 62.61 (SD = 12.88); 81% completed college; 57% women). Content analysis yielded three major themes: Stressors, Resources, and Coping. The results demonstrate a complex interaction of sociocultural and environmental stressors and perceptions of resources that influence the coping strategies adopted by caregivers to navigate their caregiving experience.Conclusions: These findings suggest a broadened perspective to further inform the development and testing of interventions to address the health outcomes and caregiving needs of African American ADRD caregivers.
Collapse
Affiliation(s)
- Fawn A Cothran
- Department of Adult Health and Gerontological Nursing, College of Nursing, Chicago, IL, USA
| | - Olimpia Paun
- Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Shaila Strayhorn
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Lisa L Barnes
- Department of Neurological Sciences, Rush Alzheimer's Disease Center, Chicago, IL, USA
| |
Collapse
|
18
|
Anderson RE, Heard-Garris N, DeLapp RCT. Future Directions for Vaccinating Children against the American Endemic: Treating Racism as a Virus. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:127-142. [PMID: 34605727 DOI: 10.1080/15374416.2021.1969940] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
For Black American youth and their families, the racial terror that claimed the life of George Floyd in May 2020 is nothing new, as stories of people who look just like them have been part and parcel of their lived experience in the United States. Beyond state-sanctioned murder, Black youth were also witnessing the disproportionate transmission, treatment, and travesty plaguing their community with COVID-19 - all predictable outcomes given the inequitable systems supporting the American pipeline from cradle to grave. Why, then, were so many White Americans just coming into awareness of this deadly disease of individual and systemic racism that has ravaged Black American communities for centuries? In this work, we seek to explain in what ways racism is tantamount to a social virus and how its permeation is endemic to the American body, rather than an emerging threat, like a pandemic. We will also address how better conceptualizing racism as a virus allows for more accurate, precise, and feasible treatments for transmitters and targets of racism with respect to prevention (e.g., inoculation) and intervention (e.g., healing and vaccination). Finally, we will describe clinical therapeutic trials that will help to decipher whether our treatment of this social disease is effective, including family-level interventions and systemic shifts in prevention through clinical training.
Collapse
Affiliation(s)
| | - Nia Heard-Garris
- Feinberg School of Medicine, Northwestern University.,Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago
| | | |
Collapse
|
19
|
LaForett DR, Bivona MA, Mendez Smith J, Williford AP. Training Future School and Clinical Psychology Leaders in Consultation for Early Childhood Education Settings. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2021. [DOI: 10.1080/10474412.2021.1977138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
Murchison CF, Kennedy RE, McConathy JE, Roberson ED. Racial Differences in Alzheimer's Disease Specialist Encounters Are Associated with Usage of Molecular Imaging and Dementia Medications: An Enterprise-Wide Analysis Using i2b2. J Alzheimers Dis 2021; 79:543-557. [PMID: 33337364 PMCID: PMC7902957 DOI: 10.3233/jad-200796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: African Americans are at increased risk for Alzheimer’s disease (AD) but barriers to optimal clinical care are unclear. Objective: To comprehensively evaluate potential racial differences in the diagnosis and treatment of AD in an academic medical center. Methods: We used the clinical informatics tool, i2b2, to analyze all patient encounters for AD or mild cognitive impairment (MCI) in the University of Alabama at Birmingham Health System over a three-year period, examining neuroimaging rates and dementia-related medication use by race and clinic site using ratio tests on contingency tables of stratified patient counts. Results: Enterprise-wide, African Americans were not underrepresented among outpatients seen for AD/MCI. However, there were differences in the clinic setting where visits occurred, with African Americans overrepresented in Geriatrics and primary care clinics and underrepresented in Memory Disorders specialty clinics. There were no racial differences in the rates at which any clinic ordered PET neuroimaging tests or dementia-related medications. However, unsurprisingly, specialty clinics ordered both PET neuroimaging and dementia-related medications at a higher rate than primary care clinics, and overall across the medical enterprise, African Americans were statistically less likely to have PET neuroimaging or dementia-related medications ordered. Conclusion: African Americans with AD/MCI were not underrepresented at this academic medical center but were somewhat less likely to have PET neuroimaging or to be on dementia-related medications, potentially in part from underrepresentation in the specialty clinics where these orders are more likely. The reasons for this underrepresentation in specialty clinics are likely multifactorial and important to better understand.
Collapse
Affiliation(s)
- Charles F Murchison
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Integrative Center for Aging Research, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jonathan E McConathy
- Molecular Imaging and Therapeutics, Department of Radiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erik D Roberson
- Alzheimer's Disease Research Center, Department of Neurology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Center for Neurodegeneration and Experimental Therapeutics, Department of Neurobiology, School of Medicine, Birmingham, AL, USA
| |
Collapse
|
21
|
Fabius CD, Wolff JL, Kasper JD. Race Differences in Characteristics and Experiences of Black and White Caregivers of Older Americans. THE GERONTOLOGIST 2021; 60:1244-1253. [PMID: 32400881 DOI: 10.1093/geront/gnaa042] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects. RESEARCH DESIGN AND METHODS Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources. RESULTS Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race. DISCUSSION AND IMPLICATIONS Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers.
Collapse
Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer L Wolff
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Judith D Kasper
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
22
|
Croce EA, Rew L. Sociocultural Influences on Disparities in United States Children with Atopic Dermatitis: A Narrative Review of the Literature. Compr Child Adolesc Nurs 2020:1-16. [PMID: 32809868 DOI: 10.1080/24694193.2020.1799113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Approximately 13% of United States (US) children have atopic dermatitis (AD), also known as eczema. AD is a chronic skin condition associated with significant burdens on quality of life and both individual and overall health-care system costs. The pathogenesis of AD is considered to be multifactorial, with biologic factors such as family history and genetics often reported as influencing risk. Some lesser discussed determinants of AD prevalence and severity are sociocultural, such as race/ethnicity, neighborhood, housing type, income level, and family structure. While several factors appear to contribute to disparities in childhood AD, black or African American race/ethnicity most significantly predicts AD prevalence, severity, disease control, access to care, and family impact. There is a shortage of research related to disparities in AD, an important topic considering the large percentage of families that are affected by the disease. This article is a narrative literature review of sociocultural influences on AD disparities in US children. The purpose of this review is to increase awareness of these important risk factors and to suggest related, future areas of research that may positively impact overall outcomes in children with AD. Much work remains to be done in order to ensure equitable care and outcomes among all children with AD.
Collapse
Affiliation(s)
- Emily A Croce
- Pediatric and Adolescent Dermatology, Dell Children's Medical Group, Austin, Texas, USA
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Lynn Rew
- Denton & Louise Cooley and Family Centennial Professor of Nursing, The University of Texas at Austin School of Nursing, Austin, Texas, USA
| |
Collapse
|
23
|
Knight KR. Structural Factors That Affect Life Contexts of Pregnant People With Opioid Use Disorders: The Role of Structural Racism and the Need for Structural Competency. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23293691.2020.1780400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Kelly Ray Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
24
|
James D. The seemingly 'protective' effect of internalised racism on overall health among 780 Black/African Americans: the serial mediation of stigma consciousness and locus of control. Psychol Health 2020; 36:427-443. [PMID: 32705894 DOI: 10.1080/08870446.2020.1797028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Internalised racism (IR) is associated with better and worse health outcomes among racial/ethnic minorities. However, the underlying mechanisms associating IR with either positive or negative health outcomes are not well understood.Design & main outcomes measures: To address this gap, this study investigated two pathways that associate increased IR with better self-reported overall health (OH; i.e. dental, mental, physical and vision health) among 780 Black/African American adults (mean age 37.68 years, 57.6% female): (1) via stigma consciousness and (2) via stigma consciousness and locus of control beliefs. RESULTS Consistent with predictions, stigma consciousness mediated the indirect effect of IR on OH, such that higher IR was associated with lower stigma consciousness, which was associated with better self-reported OH. Confirming predictions, this indirect effect was also carried through locus of control beliefs, such that higher IR was associated with lower stigma consciousness; lower stigma consciousness was also associated with internal locus of control beliefs, which were associated with better self-reported OH. CONCLUSIONS Although seemingly protective, this adaptive, strategic and short-term response to race-based threat in which group stereotypes are internalised can lead to negative health outcomes over time. These findings have implications for understanding IR and associated health disparities.
Collapse
Affiliation(s)
- Drexler James
- Department of Psychology, Denison University, Granville, OH, USA
| |
Collapse
|
25
|
Fields NL, Xu L, Richardson VE, Parekh R, Ivey D, Calhoun M. Utilizing the Senior Companion Program as a platform for a culturally informed caregiver intervention: Results from a mixed methods pilot study. DEMENTIA 2019; 20:161-187. [PMID: 31488021 DOI: 10.1177/1471301219871192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To address the need for accessible, affordable, and sustainable Alzheimer's disease and related dementia caregiver interventions with minority populations, we developed the Senior Companion Program Plus, a three-phase pilot study that used a mixed methods experimental design. The intent was to determine if participation in a lay provider, peer-led psychoeducational intervention designed for African American Alzheimer's disease and related dementia caregivers (N = 16) improved caregiver burden and/or stress, coping skills, and social support. Focus groups with Senior Companions informed the intervention design. Quantitative results indicated that caregivers experienced improvement in their overall level of social support and well-being in meeting basic needs. Qualitative findings suggested that caregivers experienced improvement in their knowledge about the disease, experienced increased coping with Alzheimer's disease and related dementia caregiving, and reported benefits of using a lay provider model. Overall, the data suggest that the Senior Companion Program Plus is a promising intervention for African American Alzheimer's disease and related dementia caregivers.
Collapse
Affiliation(s)
| | - Ling Xu
- The University of Texas at Arlington, TX, USA
| | | | | | | | | |
Collapse
|
26
|
Shi J, Chan K, Ferretti L, McCallion P. Caregiving Load and Respite Service Use: A Comparison between Older Caregivers and Younger Caregivers. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:31-44. [PMID: 29058525 DOI: 10.1080/01634372.2017.1391364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Study aims were to explore differences in predictors of respite care use between older (aged 65+) and younger caregivers (aged 18-64 years), and associations between caregiving load and respite care use using multivariate logistic regression analysis and unpaid caregiver (n= 10,500) data from the 2009 California Health Interview Survey. Caregiving load comprised number of care recipients, weekly hours in caregiving, and caregiving duration. Variables with a significant association with respite care for older caregivers were female gender, income, and health insurance. For younger caregivers, respite care use associations were with ethnicity, caregiving relationship, education, and availability of substitute help.
Collapse
Affiliation(s)
- Junrong Shi
- a School of Social Welfare , University at Albany, State University of New York , Albany , NY , USA
| | - Keith Chan
- a School of Social Welfare , University at Albany, State University of New York , Albany , NY , USA
| | - Lisa Ferretti
- a School of Social Welfare , University at Albany, State University of New York , Albany , NY , USA
| | - Phillip McCallion
- a School of Social Welfare , University at Albany, State University of New York , Albany , NY , USA
| |
Collapse
|
27
|
Richardson VE, Fields N, Won S, Bradley E, Gibson A, Rivera G, Holmes SD. At the intersection of culture: Ethnically diverse dementia caregivers' service use. DEMENTIA 2017; 18:1790-1809. [PMID: 29254375 DOI: 10.1177/1471301217721304] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study used an ethnocultural approach to explore how cultural factors influenced ethnically diverse dementia caregivers’ experiences and use of services. A modified thematic analysis of in-depth interviews with 15 caregivers, ranging in age from 50 to 75 years, including spouses, daughters, sons, cousins, and a friend, from three minority groups—African American, Hispanic, and South Korean caregivers—was conducted by a team of multi-lingual researchers. Caregiver stress was pervasive across all subgroups. Several themes emerged that were qualitatively different across groups, including knowledge about dementia, language barriers, religion and spirituality, and cultural differences in attitudes about caring and formal services. A two-pronged intervention model that includes a generic intervention to reduce caregiver stress along with a culturally targeted intervention tailored to a family’s language, food preferences, religious practices, gender norms, and other values was recommended to more successfully reach and support these caregivers.
Collapse
|
28
|
Wharton T, Zivin K. Relationships Among Caregiving, Income, Gender, and Health: A Cross-Sectional Examination of a Representative Sample of Older Americans. JOURNAL OF SOCIAL SERVICE RESEARCH 2016; 43:141-148. [PMID: 28553004 PMCID: PMC5441305 DOI: 10.1080/01488376.2016.1239597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although there is substantial evidence to support the impact of burden on caregivers, few studies have compared caregivers to their non-caregiving counterparts on the basis of health and wellbeing outcomes. This study examines the relationship between caregiving and health, and whether other factors may have stronger influence on well-being measures. Using a nationally representative sample of older adults in the United States (N=3,005), this study examines relationships between caregiving status, gender, and income, and nine outcomes (self-rated physical and mental health, time since seeing a doctor, time since most recent pap smear or prostate-specific antigen [PSA] test, depression, loneliness, stress, anxiety), using logistic and linear regression models. Results support that paradoxically, caregiving was associated with increased likelihood of PSA test in male caregivers, although data also indicated higher levels of anxiety and stress, as might be expected. Income was associated with eight of nine outcomes, and gender predicted depression, anxiety, stress, and self-rated mental health. The study highlighted the importance of psychosocial stressors, such as income and gender on the health outcomes of older adults who may be caregiving. Considering complexity of unique experience is necessary to accurately assess vulnerability to poor mental health or health related outcomes.
Collapse
Affiliation(s)
- Tracy Wharton
- School of Social Work, College of Health & Public Affairs, University of Central Florida
| | - Kara Zivin
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI
- University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
29
|
Desin PJ, Caban-Holt AM, Abner EL, Van Eldik LJ, Schmitt FA. Factors Associated with Unmet Needs among African-American Dementia Care Providers. JOURNAL OF GERONTOLOGY & GERIATRIC RESEARCH 2016; 5. [PMID: 27182464 PMCID: PMC4864855 DOI: 10.4172/2167-7182.1000267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Racial and ethnic minorities currently comprise 20% of the U.S. population; in 2050, this figure is expected to rise to 42%. As a result, Alzheimer’s disease (AD), the 5th leading cause of death for people aged 65 and older, is likely to increase in these groups. Most dementia caregiving for these populations comes from family and friends, especially among families with lower socioeconomic status. A convenience sample of 30 African-American dementia caregivers was interviewed to determine unmet needs. Participants expressed a limited desire for formal services, such as support groups, legal advice, case management, and homemaker services. Instead, commonly expressed needs were daytime respite care and especially a desire for family and social support. Many caregivers expressed a need for other family members to share responsibility in the process; therefore, methods for caregiver support that address multiple family members in care provision may be beneficial for this group.
Collapse
Affiliation(s)
- P J Desin
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky, USA
| | - A M Caban-Holt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - E L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - L J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, Kentucky, USA
| | - F A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
30
|
Rosenthal Gelman C, Sokoloff T, Graziani N, Arias E, Peralta A. Individually-tailored support for ethnically-diverse caregivers: enhancing our understanding of what is needed and what works. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:662-680. [PMID: 24621198 DOI: 10.1080/01634372.2014.881451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Family caregivers play a crucial role in maintaining older adults in the community, often at great cost to themselves. We discuss a program serving ethnically-diverse caregivers in New York, offering, on average, 11 case-management hr per client. Participants reported statistically significantly reduced stress and burden. Respite was the most requested service, belying an assumption underlying policies and services that families, particularly among minority populations, can and will care for their older members. Thus, services must be carefully tailored to meet actual caregiver needs, including provision of alternatives that reduce caregiver involvement. We discuss practice and policy implications.
Collapse
Affiliation(s)
- Caroline Rosenthal Gelman
- a Silberman School of Social Work and Hartford Silberman Center of Excellence in Aging and Diversity, Hunter College , New York , New York , USA
| | | | | | | | | |
Collapse
|
31
|
Gelman C, Sokoloff T, Graziani N, Arias E, Peralta A. Brief report #2: the caregiver ombudsman outreach program (co-op): lessons learned for engaging students and impacting the community. GERONTOLOGY & GERIATRICS EDUCATION 2014; 35:235-239. [PMID: 24874249 DOI: 10.1080/02701960.2014.921103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We discuss a program designed collaboratively by eight community-based agencies and a school of social work to serve ethnically-diverse caregivers of older adults in an under-resourced area of New York City. The program offered comprehensive assessments, referrals and information, and respite care to maximize use of existing resources and build a stronger web of support for caregivers. Social work and nursing students participated in all aspects of the project, including development, implementation, and evaluation. This level of involvement facilitates a deep understanding of the interconnections among practice, research, policy, and education, and fosters an interest in and commitment to working with older adults and their families.
Collapse
Affiliation(s)
- Caroline Gelman
- a Silberman Center of Excellence in Aging and Diversity (SCEAD), Silberman School of Social Work , Hunter College, City University of New York , New York , New York , USA
| | | | | | | | | |
Collapse
|
32
|
Gash J, Washington OGM, Moxley DP, Feen-Calligan H. The relationship between spiritual resources and life attitudes of African American homeless women. Issues Ment Health Nurs 2014; 35:238-50. [PMID: 24702208 DOI: 10.3109/01612840.2013.797062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is known about the relationships between spiritual resources and life attitudes of homeless African American women. Spiritual resources may serve as protective factors for women leaving homelessness. This descriptive study examines spiritual resources, life attitudes, and selected demographics of 160 African American women who were homeless in the Midwestern United States. Participants ranged in age from 30-62 years of age and reported being homeless 1-9 times, with a mean of 1.94 (SD = 1.53) times. The authors draw inferences for how spiritual resources and life attitudes can influence women's efforts to leave homelessness and identify implications for nursing practice.
Collapse
Affiliation(s)
- Jean Gash
- University of Detroit Mercy, School of Nursing, Detroit, Michigan, USA
| | | | | | | |
Collapse
|
33
|
Sheets DJ, Black K, Kaye LW. Who cares for caregivers? Evidence-based approaches to family support. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:525-530. [PMID: 25105462 DOI: 10.1080/01634372.2014.920606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Debra J Sheets
- a School of Nursing , University of Victoria , Victoria , Canada
| | | | | |
Collapse
|