Family Caregiving for Immigrant Seniors Living With Heart Disease and Stroke: Chinese Canadian Perspective

Exploring the lived experiences of family caregivers of patients with stroke in Africa: a scoping review of qualitative evidence

OBJECTIVE

The burden of stroke is immense in African countries, with post-stroke care usually becoming the responsibility of family. This review sought to determine the current breadth and depth of qualitative evidence regarding the lived experiences of family caregivers of patients with stroke in Africa.

METHODS

Informed by Joanna Briggs Institute (JBI) methodology for scoping reviews, six databases were searched. Included articles were appraised for quality using the JBI checklist. A priori themes developed using the study objectives were used to synthesize study findings.

RESULTS

The review included 22 articles, which outlined key patterns in stroke outcomes with most articles focused on rehabilitation and the experiences, outcomes, burdens, and coping mechanisms of caregiving. The intersectionality of socio-economic status, socio-political structures, and religious or traditional beliefs, attitudes, and practices characterized etiology beliefs, treatment trajectories of stroke, and caregiving role assignment. Whereas burdens were driven by limited resources, adopted coping strategies involved spiritual or religious beliefs, optimism, resilience, and social support networks.

CONCLUSIONS

Family caregivers' values must be acknowledged, supported, and integrated into the traditional healthcare system to provide comprehensive stroke care. Caregivers' health and well-being should be given more attention given their necessary contribution to stroke survivorship in Africa.

Caring From a Distance: Experiences of Polish Immigrants in the United States Providing Care to Parents With Dementia Overseas

OBJECTIVES

Aging populations and an increasing number of immigrants in recent years have led to numerous changes in intergenerational relationships. Although many studies have investigated the impact of providing care to a parent with dementia, little is known about the impact of caregiving activities provided from a distance, such as in the case of immigration, and over a long period of time to a person with dementia. Our understanding of how transnational caregiving for a person with dementia affects relationships is also limited. Using the Intergenerational Solidarity Theory as a theoretical framework, this paper examines the experiences of adult children and immigrant caregivers of a parent with dementia living in Poland.

METHODS

A qualitative, semistructured interview was conducted with 37 caregivers living in the United States while providing transnational care to a parent with Alzheimer's disease or other forms of dementia. The data analysis was based on the thematic analysis strategy.

RESULTS

Four themes were identified: (1) filial obligations and solidarity, (2) caregivers' contradictory emotions regarding transnational care, (3) financial and emotional exhaustion, and (4) challenges of nursing home dilemmas.

DISCUSSION

Transnational caregivers represent a unique group who face distinctive challenges related to competing demands and limited resources. This study contributes to a better understanding of their experiences whereas the findings highlight the importance of addressing the mental and physical well-being of immigrant caregivers of individuals with dementia and have important implications for health care professionals and immigration policies. Implications for future research were also identified.

'I wish I had asked for support earlier' - Immigrant family caregivers' experiences of living with a person with dementia

INTRODUCTION

Immigrant family caregivers are increasing worldwide, likewise the number of older people with dementia. Caring for a person with dementia is demanding, with the carer's own life put on hold. Immigrant family caregivers have been less studied. Therefore, the aim of this study was to explore immigrant family caregivers' experiences of living with an older person with dementia.

METHOD

A qualitative approach was chosen, consisting of open-ended interviews analysed using qualitative content analysis. The ethical principles of the Helsinki Declaration were applied in the study, which was duly approved by a regional ethics review board.

RESULTS

The content analysis resulted in three main categories: (i) the diverse roles of a family caregiver; (ii) the impact of language and culture on daily life and (iii) wish for support from society.

CONCLUSIONS

Living with a person with dementia is demanding and burdensome and the consequences of working without any rest may increase social isolation and impair quality of life. Immigrants and country-born family caregivers living with a person with dementia seem to have similar care experiences, but immigrant family caregivers seem to receive help rather late due to a lack of information about the services available, language barriers and to financial reasons. A wish for support earlier on in the caring process was expressed, likewise for care services in the participants' native language. The various Finnish associations and peer support were important sources of information about support services. Together with culturally adjusted care services, these could contribute to better access to care, to quality and to equal care.

Access and Use of Services by Caregivers of Older Adults: A Scoping Review of Cultural and Linguistic Diversity

Westernized countries are home to an increasingly culturally and linguistically diverse (CLD) older adult population. Informal caregivers of CLD older adults face unique challenges accessing and using home- and community-based services (HCBS). This scoping review sought to identify facilitators and barriers to access and use of HCBS for informal caregivers of CLD older adults. Arksey and O'Malley's framework guided a systematic search of five electronic databases. The search strategy retrieved 5979 unique articles. Forty-two studies met the inclusion criteria and informed this review. Facilitators and barriers were identified at three stages of using services: knowledge, access, and use of services. Findings concerning access to HCBS were subdivided into willingness and ability to access HCBS. Results emphasize the need for changes in healthcare systems, organizations, and providers to provide culturally appropriate care and improve the accessibility and acceptability of HCBS for informal caregivers of CLD older adults.

Informal caregivers for the elderly and their ethnocultural background in Quebec: the contribution of a quantitative analysis

INTRODUCTION

The number of informal caregivers is expected to increase along with global aging, particularly in countries struggling with shortages of health care professionals, such as in Quebec (Canada). In a society built on immigration, it is more than relevant to question the prevalence of the role of informal caregivers among ethnocultural communities of immigrant origin. To the best of our knowledge, no study has quantitatively studied ethnic informal caregivers for these communities in Québec. Our exploratory research aims to fill this gap.

PURPOSE OF RESEARCH

This research aims to explore the influence of ethnocultural affiliation in a minority and immigration context, on the probability of becoming a caregiver in Quebec in a minority and immigration context.

RESULTS

The chances of becoming an informal caregiver are high for those born in Canada who participate in religious activities and are female.

CONCLUSIONS

There is a statistically significant association between being an informal caregiver and birth location. Those born outside of Canada have fewer chances of being an informal caregiver, reflecting biases in Canadian immigration policies.

Depression among caregivers of patients with dementia: Associative factors and management approaches

As elderly people increasingly come to represent a higher proportion of the world’s population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.

RESEARCH ON STRATEGIES OF HOME CARE AND INTERVENTION FOR STROKE BASED ON KNOWLEDGE RULES

For patients with stroke at home, strategies have been formulated for emotional nursing, sports rehabilitation nursing, and interventions for poor lifestyle habits such as smoking, drinking, and picky eating. Data were obtained through tracking investigation, effect evaluation indexes were developed according to Hamilton depression scale (HAMD), activities of daily living (ADL) and other rating scale; C4.5 decision tree algorithm was used to analyze the effect of nursing intervention strategy, then we derived the corresponding knowledge rules. We come to conclusions: ① Effective emotional care and bad living habits interventions are contributed to reduce the risk of stroke. ② Smoking, drinking, picky eating, exercising and other factors are associated, so we should combine and intervene them as to better perfect the risk of stroke to provide decision-making reference for home nursing and rehabilitation intervention of stroke patients.

Competing challenges for immigrant seniors: Social isolation and the pandemic

The pandemic has exposed and amplified complex and complicated health and societal challenges while offering immense opportunities to transform societies to improve health for all. Social isolation is a challenging and persistent issue experienced by many older adults, especially among immigrant and refugee seniors. Unique risk factors such as racism, discrimination, language barriers, weak social networks, and separation from friends and family predispose immigrant and refugee seniors to a higher risk of social isolation. The pandemic has magnified the unique risks and has highlighted the differential health and economic impacts. This article examines social isolation among immigrant and refugee seniors in Canada by focusing on the policy context, available programs and services to reduce social isolation, and the conceptualization and measurement considerations for advancing research to address social isolation among this growing population. Drawing on specific examples, we discuss immigration, aging, and social isolation within the context of Canada. While our article focuses on Canada as a case study, our discussion has relevancy and implications for other high-income countries with aging immigrant and refugee populations. In moving forward, we argue that a more complete and targeted understanding of social isolation is essential to informing program and policy development to support immigrant and refugee seniors in Canada and beyond. The transformation needed in our societies to create health for all requires strong equity and determinants of health perspective and a systems approach beyond health to ensure lasting change.

Putting the Patient First: A Scoping Review of Patient Desires in Canada

Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.

Living with heart failure: perspectives of ethnic minority families

Background

The family perspective on heart failure (HF) has an important role in patients’ self-care patterns, adjustment to the disease and quality of life. Little is known about families’ experiences of living with HF, particularly in ethnic minority families. This study describes the experiences of Iranian families living with HF as an ethnic minority family in Denmark.

Methods

In this descriptive qualitative study, we conducted eight face-to-face joint family interviews of Iranian patients with HF and their family members living in Denmark. We used content analysis with an inductive approach for data analysis.

Results

We identified three categories: family daily life, process of independence and family relationships. Families were faced with physical restrictions, emotional distress and social limitations in their daily lives that threatened the patients’ independence. Different strategies were used to promote independence. One strategy was normalisation and avoiding the sick role; another strategy was accepting and adjusting themselves to challenges and limitations. The independence process itself had an impact on family relationships. Adjusting well to the new situation strengthened the relationship, while having problems in adjustment strained the relationship within the family.

Conclusions

This study highlights the process of independence as perceived by families living with HF. It is crucial to both families and healthcare professionals to maintain a balance between providing adequate support and ensuring independence when dealing with patients with HF. Understanding patients’ stories and their needs seems to be helpful in gaining this balance.

Informal Caregiving, Poor Mental Health, and Subjective Cognitive Decline: Results From a Population-Based Sample

The current study examined potential gender differences in the associations between informal caregiving, poor mental health, and subjective cognitive decline (SCD). Data were obtained from the U.S. Behavioral Risk Factor Surveillance System (N = 16,042; 9,410 women, 6,632 men). Multivariate linear and logistic regression models were used to obtain adjusted βs and odds ratios (ORs), and 95% confidence intervals (CIs) depicting the association between informal caregiving, poor mental health, and SCD overall and by gender. Caregiving was positively associated with poor mental health among men (adjusted β = 2.60; 95% CI [2.59, 2.62]) and women (adjusted β = 0.40; 95% CI [0.23, 0.57]). Poor mental health was positively associated with SCD among men (adjusted OR = 1.05; 95% CI [1.02, 1.08]) and women (adjusted OR = 1.07; 95% CI [1.04, 1.10]). Poor mental health may be associated with SCD, irrespective of gender, and additional studies are needed that will identify key variables influencing SCD among male and female informal caregivers. [Journal of Gerontological Nursing, 46(12), 31-41.].

Caregiver Well-Being and Burden: Variations by Race/Ethnicity and Care Recipient Nativity Status

BACKGROUND AND OBJECTIVES

Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others).

RESEARCH DESIGN AND METHODS

The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (N = 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver's outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts of the inclusion of caregiving factors (background factors, primary stressors, secondary stressors, and resources).

RESULTS

Regression analyses showed that only care burden significantly varied by care recipient nativity status after controlling for covariates. Caregivers of foreign-born care recipients reported a higher burden. However, when interactions of care recipient nativity status × caregiver race/ethnicity were introduced, non-Hispanic black and Hispanic caregivers of foreign-born care recipients were more likely to report better psychological well-being and self-rated health compared to their counterparts. Across caregiver groups, better caregiver-care recipient relationship quality and less caregiver chronic conditions were associated with less burden and better caregiver psychological well-being and self-rated health.

DISCUSSION AND IMPLICATIONS

Care recipient nativity status and caregiver race/ethnicity may have complex effects on caregiving experiences. Given the observed significant interaction effects for caregiver psychological well-being and self-rated health, cultural factors may affect the extent to which these caregivers appraise their caregiving. Future research should delve into the appropriate ways to assess care stress as well as resilience among each caregiver group. Our results indicate the need for research, education, and practice that assess cultural and within-group differences among caregivers and inform needed changes to structural barriers.

Social isolation and loneliness among immigrant and refugee seniors in Canada: a scoping review

Purpose

Social isolation and loneliness are global issues experienced by many seniors, especially immigrant and refugee seniors. Guided by the five-stage methodological framework proposed by Arksey and O’Malley and more recently Levac, Colquhoun and O’Brien, the purpose of this paper is to explore the existing literature on social isolation and loneliness among immigrant and refugee seniors in Canada.

Design/methodology/approach

The authors conducted a literature search of several databases including: PubMed; MEDLINE; CINAHL; Web of Science; HealthStar Ovid; PschyInfo Ovid; Social Services Abstracts; AgeLine; Public Health Database, Google Scholar and Cochrane Library. In total, 17 articles met the inclusion criteria.

Findings

Based on the current literature five themes related to social isolation and loneliness emerged: loss; living arrangements; dependency; barriers and challenges; and family conflict.

Research limitations/implications

Given the increasing demographic of aging immigrants in Canada, it is useful to highlight existing knowledge on social isolation and loneliness to facilitate research, policy and programs to support this growing population.

Practical implications

The population is aging around the world and it is also becoming increasingly diverse particularly in the high-income country context. Understanding and addressing social isolation is important for immigrant and refugee seniors, given the sociocultural and other differences.

Social implications

Social isolation is a waste of human resource and value created by seniors in the communities.

Originality/value

The paper makes a unique contribution by focusing on immigrant and refugee seniors.

A survey of service providers' views on care and support provision for older women from Black and minority ethnic backgrounds in Wales: Implications for policy and practice

Drawing on quantitative data from a large study, we explored service providers' perceptions of the care and support provided to older women from Black and minority ethnic backgrounds living in the UK. Analyzing 102 responses to a questionnaire, we found that the care needs of this group of older women were not adequately addressed, with ineffective communication being frequently reported. A number of information pathways and barriers to service provision were identified. More work is needed to explore not only how best to acknowledge diversity in care needs within older populations, but also to design and deliver responsive services accordingly.