Attitudes toward community-based services among Japanese American families

Conceptualizing Family Caregivers' Use of Community Support Services: A Scoping Review

BACKGROUND AND OBJECTIVES

Only a fraction of the 53 million caregivers in the United States use available formal community services. This scoping review synthesized the literature on the barriers and facilitators of community support service utilization by adult caregivers of a family member or friend with an illness, disability, or other limitation.

RESEARCH DESIGN AND METHODS

We searched PubMed, CINAHL, PsycInfo, and Web of Science for quantitative and qualitative articles assessing barriers and facilitators of caregivers' access to and utilization of resources, following Preferred Reporting Items for Systematic Review and Meta-Analysis scoping review guidelines. Thematic analysis, drawing on an initial conceptualization, informed key insights around caregivers' resource navigation process.

RESULTS

The review provides support for individual factors affecting service use. Notably, some factors-such as time restrictions and increased caregiving demands-appear to function as barriers to accessing services even as they increase caregivers' need for support. Additionally, contextual barriers including cultural factors and support of friends/family can affect caregivers' access to resources. Finally, experience with health systems and structures and the intersection with other factors can affect service utilization.

DISCUSSION AND IMPLICATIONS

Suboptimal access to and utilization of community support services can be addressed at both the person and system level to mitigate potential inequities. Ensuring that caregivers are aware of, eligible for, and have the capacity and support to access the appropriate resources at the right time is essential for improving caregiver outcomes, reducing burnout, and supporting continued care.

Racial/Ethnic Differences in Caregiving Frequency: Does Immigrant Status Matter?

Objectives

With growing diversity in the older adult and caregiver populations, the purpose of the current study is to describe the extent to which elder care frequency varies by race/ethnicity and immigrant/native status using national data from the United States.

Method

Using pooled data from the 2011-2014 American Time Use Surveys (ATUS; N = 7,855), we present multinomial logistic regressions of caregiving frequency by race/ethnicity and immigrant/native status and explore whether factors within the caregiving domain (duration of care, number of care recipients, and coresidence) attenuate any observed differences.

Results

Compared to non-Latino Whites, non-Latino Black, Mexican-origin, and other Latino caregivers engage in more frequent elder care activities, which is partially attributable to high levels of coresidence among these subpopulations. Although immigrant caregivers, in general, tend to engage in more time-intensive caregiving, for Mexican-origin and other Latino caregivers, U.S.-born caregivers report more frequent elder care provision.

Discussion

More time-intensive and demanding caregiving careers reported by racial/ethnic minority and immigrant caregivers further emphasize the need for culturally competent home- and community-based care options.

Sociodemographic Characteristics and Preferences for Family (Informal) and Formal Caregiver Help With ADLs

The purpose of this article was to compare sociodemographic characteristics and various care preferences for family and formal caregivers help with activities of daily living (ADLs). The sample was 56,337 noninstutionalized U.S. civilian adults, 40 to 65 years of age. This is a cross-sectional study using secondary data from the National Health Interview Survey (NHIS)—2011 to 2014. Respondents’ sociodemographic characteristics and various care preferences for caregiver help with ADLs were analyzed. Subsequent analysis examined associations using adjusted multivariable logistic regression models. Preference for family caregivers help with ADLs was independently and significantly associated with race/ethnicity, age, gender, education, acculturation, and income. Future studies need to examine sociodemographic characteristics and caregiver preferences to tailor health care services for aging adults in the United States.

Association of Filial Responsibility, Ethnicity, and Acculturation Among Japanese American Family Caregivers of Older Adults

Challenges of filial caregiving practices by 1st-generation immigrants due to differences in caregiving values between their home and host countries are well documented. This study explored the filial responsibility of later generation Japanese American caregivers of older adults. Acculturation and filial responsibility were measured using the Suinn-Lew Asian Self Identity Acculturation scale and Filial Values Index, respectively. A qualitative interview guide was developed using Gordon's assimilation theory, and 21 caregivers ( M age = 68 years, 86% female, seven in each generation) were interviewed. Despite the 3rd-generation caregivers' high acculturation level, their filial responsibility scores remained high. Qualitative interviews also revealed later generation caregivers' strong filial responsibility and continued caregiving involvement. Unexpectedly, caregivers' own future expectancy of care included placement in mainstream residential facilities rather than ethnic-specific settings. Findings point to the need to develop caregiver services that consider later generation caregivers' culture and level of assimilation.

A Review of Ethnicity, Culture, and Acculturation Among Asian Caregivers of Older Adults (2000-2012)

This review identified domains of care experiences among studies of Chinese, Filipino, Japanese, Korean, and Vietnamese caregivers in the United States and Canada between 2000 and 2012. Using a narrative approach, 46 peer-reviewed journal articles were found through electronic databases and references. Considering caregivers' assimilation to host countries, attention was given to their culture, socioeconomic resources, immigrant status, filial responsibility, generation, and acculturation. Three primary domains were identified across subgroups. The caregivers' experiences domain was a strong sense of filial responsibility and its varied effects on caregiving experience; in the cultural values domain, reciprocity, and familism. In the acculturation domain, caregivers' generations influenced their experiences. Because our society is rapidly changing demographically and culturally, studies of older adults and their caregivers that are not only inclusive of all racial/ethnic groups but also sensitive to specific racial/ethnic and cultural subgroup differences are necessary to inform policy and practice.

Informal and formal support among community-dwelling Japanese American elders living alone in Chicagoland: an in-depth qualitative study

A key public health approach to promote independent living and avoid nursing home placement is ensuring that elders can obtain adequate informal support from family and friends, as well as formal support from community services. This study aims to describe the use of informal and formal support among community-dwelling Nikkei elders living alone, and explore perceived barriers hindering their use of such support. We conducted English and Japanese semi-structured, open-ended interviews in Chicagoland with a convenience sample of 34 Nikkei elders age 60+ who were functionally independent and living alone; 9 family/friends; and 10 local service providers. According to participants, for informal support, Nikkei elders relied mainly on: family for homemaking and health management; partners for emotional and emergency support; friends for emotional and transportation support; and neighbors for emergency assistance. Perceived barriers to informal support included elders' attitudinal impediments (feeling burdensome, reciprocating support, self-reliance), family-related interpersonal circumstances (poor communication, distance, intergenerational differences); and friendship/neighbor-related interpersonal situations (difficulty making friends, relocation, health decline/death). For formal support, Nikkei elders primarily used adult day care/cultural programs for socializing and learning and in-home care for personal/homemaking assistance and companionship. Barriers to formal support included attitudinal impediments (stoicism, privacy, frugality); perception of care (incompatibility with services, poor opinions of in-home care quality); and accessibility (geographical distance, lack of transportation). In summary, this study provides important preliminary insights for future community strategies that will target resources and training for support networks of Nikkei elders living alone to maximize their likelihood to age in place independently.

Willingness to Use Mental Health Services Among Older Residents in Assisted Living

Examining the importance of mental health care in assisted living (AL) settings, the present study examines older AL residents’ willingness to use mental health services and its predictors. Data based on face-to-face interviews with 150 older residents from 17 AL settings in Florida are used in the analyses ( Mage = 82.8, SD = 9.4). Multivariate logistic regression is used to estimate the likelihood of willingness to use mental health services in relation to predisposing (demographics and physical health), mental health needs (depressive symptoms), and enabling variables (social network, instrumental support, emotional support, informational support, satisfaction with support, and previous use of mental health services). Willingness to use mental health services is predicted by younger age, unmarried status, lower levels of emotional support, and higher levels of informational support. The relationship of informational support to higher willingness to use mental health services suggests that AL residents could benefit from educational interventions on late life depression.

Caregiving and older Japanese adults: lessons learned from the periodical literature

The United States is on the threshold of a substantial growth of older adults that increasingly reflects the cultural diversity inherent in this nation. Culture shapes the experience of aging and caregiving, and thus becomes an important factor when considering social services for older adults. One culturally distinct minority group--Japanese--is reputed to have one of the longest life expectancies in the US population, and, thus, information about their experiences may expand knowledge on aging and culture. A periodical literature review of older Japanese adults was undertaken to assess lessons learned about the association of aging and culture. Two important lessons that emerged emphasized the influence of cultural values on family caregiving, and women as caregivers. Implications for practice with this population are drawn and broad directions for the profession of social work are provided.

Family influence on caregiver resistance, efficacy, and use of services in family elder care

This research investigated how resistance to use of services attributed to family members and primary caregiver self-efficacy and resistance influenced actual use of services. Data were analyzed from questionnaires completed by 224 persons engaged in informal elder care in the community. Tests of 6 hypotheses revealed that family influence on caregivers had a consistent, important influence on behavior and views of caregivers. Family resistance to use of formal services framed caregivers' feelings, preferences, and decisions ranging from their own perceived self-efficacy to actual obtainment of help outside the family. Professionals must include family members in their dialogue with primary caregivers about their plans for elder care. Suggestions for interventions to better understand family and caregiver resistance are discussed.

Willingness to use respite care among family caregivers in Northern Taiwan

AIM AND OBJECTIVES

Investigate the use of respite care among family caregivers and examine factors related to their willingness to use such care.

BACKGROUND

Respite care is a pivotal service for supporting family caregivers. Although research related to respite care is not a new field in western societies, such studies have rarely been done for Asian populations.

DESIGN

A cross-sectional study.

METHODS

The study was conducted using a convenience sample of 100 family caregivers obtained through four home health care agencies in Northern Taiwan. Structured face-to face interviews were conducted in home settings. Caregivers were divided into a willingness group and a non-willingness group. The quantitative data were analysed using t-test, chi-square and multiple logistic regression.

RESULTS

Sixty-five per cent of the caregivers interviewed did not know about respite care services. The prevalence of respite care use was 11%. Eighty-nine per cent of the caregivers had never used respite care: 60.7% of them reported that they would never use it and 39.3% of the caregivers indicated that they were willing to use respite care in the future. This study showed that willingness to use respite care was higher when the respite services matched the needs of the caregivers as well as the caregivers perceived higher caregiving burden.

CONCLUSIONS

These results suggest that respite care services should be explained more explicitly to family caregivers. Also, any respite care plan must consider the family caregivers burden, both perceived and realistically.

RELEVANCE TO CLINICAL PRACTICE

The willingness to use respite care is a culturally sensitive issue. Health care providers must act as advocates to improve respite care policy. They must ensure that respite care fits caregivers' needs and they must help caregivers overcome the social or cultural barriers to respite care.

Examining health-related factors among an ethnically diverse group of Asian-American mental health clients

As currently developed, health policies and practices consider Asian Americans as one homogenous group, ignoring the unique differences of each group regarding its own healthcare needs. In fact, the healthcare needs of mental health clients have received little attention in the professional literature. The purpose of this article is to investigate the diverse healthcare needs of Asian Americans seeking mental health services. The authors reviewed the literature on healthcare for ethnic minority groups while focusing primarily on Asian Americans and analyzing these needs as they relate to mental health-seeking clients. The results indicate that Korean Americans are faring less well than either Japanese or Chinese Americans. The authors discuss the implications for health policy, practice, and education.