The negative impact of global perceptions of and daily care-related family conflict on Hispanic caregivers: familism as a potential moderator

Long-Term Psychological Distress Among Surrogate Decision Makers for Mexican American and Non-Hispanic White Patients With Severe Stroke

BACKGROUND AND OBJECTIVES

During acute hospitalizations, physicians often focus on the stroke patient and not family who may be traumatized by this sudden change to their loved one. We investigated long-term psychological distress among family surrogate decision makers for Mexican American (MA) and non-Hispanic White (NHW) severe stroke patients. Previous work in other diseases suggested worse psychological outcomes in MA than NHW caregivers.

METHODS

This was a population-based, prospective cohort study in Nueces County, TX. Stroke patient participants and their surrogate decision makers were enrolled soon after any stroke between April, 2016, and October, 2020, if surrogates had made decisions about life-sustaining treatments. Surrogates completed validated measures of posttraumatic stress, National Stressful Events Survey for Posttraumatic Stress Disorder Short Scale; anxiety, Generalized Anxiety Disorder-7; and depression, Patient Health Questionnaire-8 at discharge, 3, 6, and 12 months. Ethnic differences were assessed with multilevel linear mixed models, sequentially adjusted for prespecified patient and surrogate demographic, socioeconomic, and clinical covariates.

RESULTS

There were 301 family surrogates for 241 severe stroke patients. The mean follow-up was 315 days. High scores on measures of psychological distress ranged between 17% and 28% of surrogates. One or more high levels of the psychological outcomes were found in 17%-43% of surrogates; 2 or more were found in 12%-27%; and all 3 were found in 5%-16% of surrogates. All psychological outcomes were worse among MAs on unadjusted analyses. In fully adjusted models, posttraumatic stress remained worse among MAs (0.36, 95% CI 0.17-0.56); ethnic differences were attenuated and no longer significant in the final model for anxiety (0.59, 95% CI -0.55 to 1.74) and depression (0.97, 95% CI -0.25 to 2.19). The trajectory for depression did differ by ethnicity (interaction p = 0.03), with depression score improving more rapidly over time among NHWs than MAs. Advance care plans did not seem to confound any ethnic differences.

DISCUSSION

Psychological distress is common among family surrogate decision makers in the year after stroke and may be worse among MAs. Efforts are needed to support family members of all ethnic groups after severe stroke.

Female caregivers' contextual complexities and familial power structures within Alzheimer's care

In 2021, 11.3 million unpaid caregivers of persons with Alzheimer's disease/Alzheimer's disease and related dementias (AD/ADRD) provided 16 billion hours of unpaid caregiving worth $271.6 billion. This study aimed to fully capture the contextual complexities of the caregiving role acquisition articulated by female family caregivers of those with AD/ADRD, emphasizing assigned meaning to one's lived experience with a critical focus on how family power structures influence caregiving practices. Recorded open structured interview transcripts (N = 30) from two qualitative studies with the same two opening questions resulted in a corpus of 481 pages of pooled textual data. The data were analyzed using Utrecht's descriptive and interpretive thematic analysis approach. The interpretive thematic analysis uncovered the theme of intervening to protect and its subthemes of financial exploitation, mistreatment, and endangerment. Based on the evolving analysis, we reanalyzed the data using critical discourse analysis (CDA), drawing from Foucault and feminist CDA to explore the complex but subtle nuances of gender, power, and ideologies. CDA uncovered the theme of compulsory altruism. Ambiguity about violating personhood delayed responses to potentially dangerous behavior and actual harm. Using interpretive thematic and critical discourse analysis, we discovered a deeper understanding of female caregivers' contextual complexities, their journey to becoming a caregiver of a family member with AD/ADRD, and the power structures that relegated caregiving to female family members. This research identified a substantial policy gap in supporting female family caregivers who provide the majority of care to persons with AD/ADRD risking their health and financial security.

A scoping review of intensive longitudinal methods in informal caregivers of people with dementia

BACKGROUND

The daily life of informal caregivers assisting individuals with dementia widely varies throughout the day and week. As an answer, an increasing number of researchers have used intensive longitudinal methods (ILMs) such as diary studies, experience sampling methods, or ecological momentary assessment.

OBJECTIVES AND METHODS

The present scoping review aims at synthesizing the use of ILMs in informal dementia caregivers to clarify what is currently done and how, as well as what remains unaddressed.

RESULTS

The screening process identified 48 studies from 22 different datasets. Synthesis of these studies showed the diversity of devices and uses of ILMs in informal care, including the exploration of associations between variables or accompanying an intervention. ILMs showed the important variability of caregiving phenomena, as well as the important association of momentary stress and well-being. Gaps were nevertheless identified, such as transparency in the construction of the tool or the absence of focus on emotions and dyads.

CONCLUSIONS

For now, this field of research remains in its infancy and does not seem to have reached its full potential as it has in other fields. Nevertheless, it appears that ILMs are promising tools for informal dementia caregivers as they contribute to understanding the complexity of their daily life, with changing resources and challenges. Future directions include focusing more on (emotion) regulation, temporal lags, and the use of ILMs in interventional designs.

TRIAL REGISTRATION

The present review was registered on OSF (osf.io/b2qr4).

Self-management of chronic disease in Latina Kinship caregivers: an integrative review

In the United States, Latinos experience a higher prevalence of chronic diseases with concomitant complications when compared to Non-Latino Whites. Older Latina women often manage a chronic illness while also providing kinship care. This article presents an integrative review of Latina kinship caregivers' self-management of chronic disease. An extensive review of the literature was conducted in seven databases. Four resulting studies included qualitative, quantitative, and mixed methods research and suggested health outcomes for Latina kinship caregivers were often worse when compared to other groups. A major gap in the literature identified an absence of disease-specific self-management behaviors for this population.

Association between familism and mental health in dementia caregivers: a systematic review and meta-analysis

BACKGROUND

Dementia caregivers suffer from mental health problems while caring for dementia patients. As a core value, familism has been linked to the mental health of dementia caregivers. This study aims to systematically review the familism of dementia caregivers and to examine the association between familism and mental health of anxiety, depression, and burden in empirical research studies.

METHODS

We conducted a systematic search in various databases like Medline, PubMed, and Embase databases from inception till April 2021. Fisher's z was calculated with correlation coefficient or regression coefficient values for three familism dimensions and mental health of anxiety, depression, and burden. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 2.0 software.

RESULTS

A total of seven studies with 1178 participants were eligible for the meta-analysis. For caregivers' anxiety, three of seven studies, with 358 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that dementia caregivers' familism was significantly related to anxiety. The pooled z-value was 0.148 (95% CI = 0.043-0.253). In addition, caregivers' familism significantly affected depression (z = 0.080; 95% CI = 0.003-0.156), as did familial obligation (z = 0.122; 95% CI = 0.034-0.211), but perceived family support was not associated with this (z = 0.051, 95% CI = -0.038-0.140). As for caregiver burden, there was no evidence that familism was significantly associated with it (z = -0.073; 95% CI = -0.297 to 0.151), including familial obligation and perceived family support (z = -0.087 and -0.089, respectively; 95% CI = -0.278 to 0.104 and -0.335 to 0.157, respectively).

CONCLUSIONS

An association between caregiver familism and anxiety/depression exists in dementia patients. More research is needed to explore the relationship between familism and burden.

Is Familism a Motivator or Stressor? Relationships Between Confucian Familism, Emotional Labor, Work-Family Conflict, and Emotional Exhaustion Among Chinese Teachers

To reveal the cultural effect in the job demands-resources model, this study examined how Confucian familism, emotional labor, and work-family conflict (WFC) explain the variance in teachers’ emotional exhaustion, with a focus on the mediating roles of emotional labor and WFC. With a sample of 3,312 teachers in China, the results of this study revealed that surface acting and expression of naturally felt emotion (ENFE) and WFC mediated the relationship between familism and emotional exhaustion. Moreover, familism positively predicted deep acting, ENFE, WFC, and emotional exhaustion, while negatively predicted surface acting. These findings suggest that Confucian familism may play the dual role of motivator and stressor for Chinese teachers’ emotional labor and well-being. This study contributes to the job demands-resources theory by revealing the important role of cultural traditions and provides valuable information for interventions to sustain teacher well-being.

Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review

Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.

Uncertainty in Transition of African American Caregivers

The purpose of this study was to gain an understanding of the ambiguities and uncertainties experienced by a diverse group of African-American caregivers. The study applied Schlossberg's transition theory (TT) and Mishel's revised uncertainty theory to narratives of self-identified African-American caregivers who provided care at least 5 h a week. The men (6) and women (8) were mostly unmarried, mostly caring for a parent or grandparent. The caregivers' average age was 52 (SD = 19; ages ranged from 24 to 82 years); and the care recipients' average age was 84 (SD = 9). Six care recipients had dementia and the remainder had multiple disease diagnoses. Narratives were obtained by in-depth interviews or focus group discussions. These were audio-recorded, transcribed verbatim professionally and analyzed independently by trained coders. Schlossberg's TT contextualized whereas Mishel's RUIT illuminated the characteristics of the transition, its associated uncertainty, and their relationship to the development of caregiver stress. Situational factors such as difficulties with illness symptoms of the care recipient, conflict between previous experience and current expectations and the adjustments to the new caregiving role, burdened younger caregivers more than older caregivers. Self-factors related to lack of knowledge about the illness and feelings of lack of control. Social support was predominantly provided by family members, and its absence resulted in conflict among siblings and caregiver stress. The most common coping strategies include religiosity, expectations of reciprocity, and coming to terms with the uncertainty. Understanding the feelings, perceptions and needs of caregivers in transition is tantamount to providing nursing care.

Family Support and Family Negativity as Mediators of the Relation between Acculturation and Postpartum Weight in Low-Income Mexican-Origin Women

BACKGROUND

Obesity presents a significant health concern among low-income, ethnic minority women of childbearing age.

PURPOSE

The study investigated the influence of maternal acculturation, family negativity, and family support on postpartum weight loss among low-income Mexican-origin women.

METHODS

Low-income Mexican-origin women (N=322; 14% born in the U.S.) were recruited from a prenatal clinic in an urban area of the Southwest U.S. Acculturation was assessed during a prenatal home visit (26-38 weeks gestation), and post-birth family support and general family negativity were assessed at 6 weeks postpartum. Objective maternal weight measures were obtained at five time points across the first postpartum year.

RESULTS

Higher acculturation predicted higher family support and family negativity. Higher family support predicted decreasing weight across the first postpartum year, and higher family negativity predicted higher weight at 6 weeks postpartum and increasing weight across the first postpartum year. In combination, family negativity and support mediated the impact of acculturation on postpartum weight gain.

CONCLUSIONS

Cultural and family-related factors play a significant role in postpartum weight gain and loss for low-income Mexican-origin women.

Staged Improvement in Awareness of Disease for Elderly Cancer Patients in Southern China

BACKGROUND

In mainland China, awareness of disease of elderly cancer patients largely relies on the patients' families. We developed a staged procedure to improve their awareness of disease.

MATERIALS AND METHODS

Participants were 224 elderly cancer patients from 9 leading hospitals across Southern China. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between family and patients, patient awareness of their disease and participation in medical decision-making. After first cycles of treatment, increased information of disease was given to patients with cooperation of the family. Then patient awareness of their disease and participation in medical decision-making was documented.

RESULTS

Among the 224 cancer elderly patients, 26 (11.6%) made decisions by themselves and 125 (55.8%) delegated their rights of decision- making to their family. Subordinate family members tended to play a passive role in decision-making significantly. Patients participating more in medical decision-making tended to know more about their disease. However, in contrast to the awareness of disease, patient awareness of violation of medical recommendations was reversely associated with their participation in medical decision-making. Improvement in awareness of diagnosis, stages and prognosis was achieved in about 20% elderly cancer patients. About 5% participated more actively in medical decision-making.

CONCLUSIONS

Chinese elderly cancer patient awareness of disease and participation in medical decision-making is limited and relies on their family status. The staged procedure we developed to improve patient awareness of disease proved effective.

Examining the influence of family dynamics on quality of care by informal caregivers of patients with Alzheimer's dementia in Argentina

PURPOSE

This study examined the pattern of family dynamics of Argentinian individuals with dementia that most heavily influences the quality of care provided by family caregivers (CGs).

METHOD

One hundred and two CGs of individuals with Alzheimer's disease in Argentina participated in this study. The majority (75%) were female, with an average age of 57.8 years (standard deviation = 13.5) and had spent a median of 48 months (interquartile range [IQR]: 36.00-60.00) providing care to their family member with dementia, devoting a median of 60 hours (IQR: 50.00-80.00) per week to these duties. Caregivers completed Spanish versions of instruments assessing their family dynamics and quality-of-care provision.

RESULTS

Hierarchical regression analyses suggested that higher quality of informal care (Provide and Respect) was related to greater levels of empathy and reduced levels of overall dysfunction in CGs' families. Higher quality of care-Provide was also related to shorter duration of time (in months) spent providing care.

CONCLUSION

Dementia CG interventions in Latino populations would likely benefit from addressing difficulties experienced when providing care for a prolonged period of time, as well as programming or techniques to improve family dynamics, especially family empathy and general functioning, given the strong reciprocal influence of these factors on CG quality of care.

Formal and informal support of family caregivers managing medications for patients who receive end-of-life care at home: a cross-sectional survey of caregivers

BACKGROUND

Managing medications is a complex responsibility of family caregivers caring for end-of-life patients. This study characterizes caregivers with and without formal/informal support managing medications for patients who receive end-of-life care at home.

AIM

To explore factors related to caregivers' support with managing medications for end-of-life home hospice patients.

DESIGN

A convenience-sampled, cross-sectional telephone survey.

SETTING/PARTICIPANTS

Computer-assisted telephone interviews were administered to 120 caregivers managing medications, who were referred by five Chicago-based home hospice services. We measured caregivers' additional formal (paid) and informal (unpaid) support with managing medications, and caregiver/patient socio-demographic, relational, and health characteristics.

RESULTS

While 47 (39%) had no additional support with managing medications, 27 (22.5%) had formal support, 37 (31%) informal, and 9 (7.5%) both. Seven caregivers (19%) with formal and 13 (31%) with informal support reported disagreements concerning treatment plans. Caregivers lacking formal support tended to be racial/ethnic minorities, live with the patient in their home, or report greater emotional burden. Caregivers with formal support tended to report higher education/income, lower mutuality, or care for a patient with over 6 months' hospice enrollment. Caregivers lacking informal support tended to be spousal caregivers, live with the patient, or have experience caring for another dying person.

CONCLUSION

Our study suggests that high proportions of caregivers may not have support managing medications for patients receiving hospice care at home. More research should examine whether the observed variations in obtaining support indicate disparities or unmet needs among caregivers. Disagreement about treatment with formal/informal support also warrants further investigation.

Individually-tailored support for ethnically-diverse caregivers: enhancing our understanding of what is needed and what works

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.

Familismo and its impact on the family caregiving of Latinos with Alzheimer's disease: a complex narrative

Despite the long-held view that Latinos' value and reliance on family leads to greater involvement of extended family in caring for sick members and reduced perception of burden, some research reports low levels of social support and high levels of distress among Latino caregivers. We explore this seeming discrepancy in a qualitative study of 41 Latino caregivers of family members with Alzheimer's disease, interviewing them regarding the role of familism in their caregiving experience. For some it facilitates caregiving in the traditional, expected manner. Other caregivers disavow its current relevance. Yet others feel a contrast between familism, which they may value in a general, abstract way and more personal, immediate negative feelings they are experiencing from caregiving. We discuss these complex, multidimensional findings, the variation among caregivers, and present implications for practice, policy, and research.