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.

Cross-National Analysis of the Associations Between Familism and Self-Efficacy in Family Caregivers of People With Dementia: Effects on Burden and Depression

Objectives: To examine the cross-national associations between familism and self-efficacy dimensions, and levels of burden and depression. Methods: Sociodemographic, familism, self-efficacy, depressive symptoms, and burden variables were measured in 349 dementia family caregivers from the US and Spain. Results: US sample: greater support from family was positively related to self-efficacy for obtaining respite and self-efficacy for controlling upsetting thoughts and behaviors. Both self-efficacy constructs were negatively related to depression. Similar findings were obtained for burden. Spanish sample: higher scores on family as referents were associated with lower scores on self-efficacy for obtaining respite; lower scores on self-efficacy for obtaining respite were associated with higher depressive symptomatology. Discussion: Study findings suggest that a significant interplay exists between the various facets of familism and self-efficacy, leading to differential caregiving outcomes. Unique cultural contexts and values derived from each country may exert distinct influences on how the caregiving role is perceived and appraised.

Examining Global Wellness, Anxiety Severity, and Depression Severity among Black and Latinx Adults: Implications for Counseling

The effectiveness of Global Wellness (combined mental and physical health) among samples of primarily White clients is well-documented in the literature. However, the Global Wellness literature is lacking research among ethnic minority populations who tend to face healthcare inequities. For example, Black and Latinx adults in the U.S. face inequities in the quality and accessibility of mental and physical healthcare services, including unique risks for anxiety and depression. In this study, a national random sample, (N = 4,009) was recruited (stratified by age, gender, and geographic region of the U.S.) of Latinx and Black adults to examine the association between Anxiety Severity and Depression Severity with Global Wellness as well as demographic differences in Global Wellness. Anxiety and depression emerged as significant negative predictors of Global Wellness and results revealed a number of demographic differences in Global Wellness. Implications for counseling practice and how mental health counselors can reduce healthcare disparities are discussed.

Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes

OBJECTIVES

The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics.

METHODS

Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden.

RESULTS

African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans' endorsement of familism predicted more positive caregiving appraisals. African Americans also reported greater levels of social support, which in turn predicted lower burden and depressive symptoms when compared with Whites. Exploratory analyses demonstrated significant associations between familism and self-efficacy. In the Hispanic subgroup, familism varied as a function of acculturation.

DISCUSSION

Results indicate that greater levels of familism and social support may exert a protective influence against adverse psychosocial caregiving outcomes. These findings can be used to inform intervention efforts targeting culturally congruent, family-centered approaches.

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.

A scoping review of cross-cultural experiences of siblings of individuals with intellectual and developmental disabilities in the United States

BACKGROUND

Siblings undergo unique experiences in growing up with brothers and sisters with intellectual and developmental disabilities (IDD). Although sibling relationships or adjustments among individuals with IDD have received greater attention from the disability field, there has been still less attention to how cultural identities (e.g., race, ethnicity) may influence experiences of siblings of individuals with IDD.

AIM

This study used scoping review methodology to understand cross-cultural experiences of siblings of individuals with IDD in the United States.

METHOD

Eight articles met inclusion criteria, using the PubMed, Web of Knowledge, PsycINFO, and ERIC databases.

RESULTS

Studies reported the impact of cultural identities on sibling emotional and behavioral functioning, school functioning, and caregiving responsibilities.

CONCLUSIONS

The need for culturally responsive sibling interventions and implications for international contexts is discussed.

Measuring familism in dementia family caregivers: the revised familism scale

Objectives: Familism is a cultural value that has been shown to be important for understanding the dementia caregiving process. The aim of this study is to analyze the psychometric properties of the Revised Familism Scale (RFS).Method: Face-to-face assessments were done with 199 dementia family caregivers. Exploratory factor analysis, discriminant validity, and reliability analyses of the RFS were carried out.Results: The results suggest that the RFS has good psychometric properties and is composed of three factors: "Familial interconnectedness", "Familial obligations", and "Extended family support".Conclusion: The RFS seems to be a reliable measure of familism, a multidimensional construct measuring a relevant cultural value for dementia family caregivers.

Understanding Culture in Context: An Important Next Step for Patient Emotional Well-Being and Nursing

The impact of culture on health has gained considerable importance in care delivery. This review discusses the complex interaction of culture and social determinants, and the combined impact of these on emotional well-being. Examples of this interaction are presented and recommendations for change within nursing to improve care are discussed.

Who's Your Family?: African American Caregivers of Older Adults With Dementia

The nature and outcome of family caregiving is different for various racial and ethnic groups. The purpose of the current study was to use qualitative methods to examine and characterize family networks of African American family caregivers (N = 26) who provided care to family members with dementia (N = 18). Researchers used data generated from a parent study that addressed family involvement in health promotion activities for African American older adults with dementia. Data were analyzed using sociograms and thematic analysis. Three themes that characterized African American family caregiving networks were identified: (a) Complexity, (b) Familism, and (c) Religiosity. Findings suggest that narrowly defining family caregivers as a dyad of a caregiver and care recipient does not reflect how these family networks function. A better understanding of the complex functioning of these networks may help explain physical and psychological well-being outcomes for individuals with dementia and their family members. [Res Gerontol Nurs. 2019; 12(1):20-26.].

[Motives and perceptions of family care for dependent elderly]

OBJECTIVE

To identify and analyze the motives that lead people to take care of a dependent relative and their perceptions of the care situation.

DESIGN

Phenomenological qualitative study.

LOCATION

The study was conducted in the Jaén-Norte Sanitary District, during 2013 and 2014.

PARTICIPANTS

A total of 13 primary caregivers of dependent elderly relatives with a minimum experience of one year in care participated, selected by intentional sampling.

METHOD

Discourse analysis of 13 in-depth interviews considering the semantic and pragmatic content and field notes. Triangulation was performed in the analysis to favor the credibility of the study.

RESULTS

The motives for caring for a dependent relative are:'Familism','Material gains' and'Social pressure'. In turn, the'Familism' include 7 dimensions/motives:'Family obligation','Affection to the person taken care of','Return the received','Well-being of the person taken care of','Respect to the decision of the person taken care of','Agreement','Habit'. When the main motive to take care of is the'Family obligation', the'Material gains' or the'Social pressure' caregivers do not manifest positive perceptions for caring, and vice versa.

CONCLUSION

This study has identified that'Familism','Material gains' and'Social pressure' are reasons why people care for a dependent relative in our sociocultural environment, as well as the relationship with the perception of the care situation. This will facilitate the identification of caregivers with greater predisposition to suffer negative consequences for caring and the development of interventions aimed at the prevention of such consequences.

Cultural Values and Coparenting Quality in Families of Mexican Origin

This study examined associations between Mexican-origin parents’ cultural values in relation to supportive and undermining coparenting behavior. Data were collected from 80 sets of parents, 160 parents total, with a preschool-age child ( M = 63.60 months old; 39 boys, 41 girls) who were of Mexican origin (22% of mothers and 28% of fathers born in Mexico). Mothers and fathers independently completed questionnaires assessing their cultural values of (a) familismo (i.e., loyalty to family), (b) machismo (i.e., adherence to masculine/feminine gender roles), (c) respeto (i.e., respect for self and others), and (d) simpatía (i.e., maintenance of interpersonal harmony). Mother–father–child triads were observed during a structured play session from which supportive and undermining coparenting behavior was coded. Mothers and fathers who held stronger familism beliefs were characterized by more supportive coparenting behavior. Mothers and fathers who held stronger simpatía beliefs were characterized by less undermining coparenting behavior. Fathers who held stronger respeto beliefs showed more supportive coparenting behavior, whereas mothers who held stronger machismo beliefs were characterized by more undermining coparenting behavior. Mother–father dyads with higher agreement on familism displayed more supportive coparenting behavior, and mothers and fathers who had higher agreement on simpatía beliefs engaged in less undermining coparenting. Results suggest that the cultural values held by both mothers and fathers of Mexican origin are significantly associated with the quality of their coparenting relationship.

Is gerontology ready for anti-racist pedagogy? A survey of educators' practices and perspectives

The older population in the United States is becoming more diverse, bringing increasing attention to the ways in which diversity and multiculturalism are addressed in gerontological education. Although diversity and multiculturalism have long been recognized as important components of the aging experience, our approach to understanding their significance and impact continues to grow and change. Anti-racist pedagogy represents one catalyst to stimulate such change. To evaluate the potential for anti-racist pedagogy in gerontology, this study explored gerontological educators' (N = 121) current practices and perspectives regarding the inclusion of diversity content in their courses, as well as the extent to which they are familiar with and/or use anti-racist pedagogy in their classes. The findings suggest that greater attention to issues of race, ethnicity, and multicultural diversity throughout the gerontological curriculum is needed and wanted. Although respondents were generally unfamiliar with the name anti-racist pedagogy, many indicated that their current teaching practices employed select components of it. Overall, the findings point toward the need for continued exploration of how anti-racist pedagogy may be brought into the gerontological classroom, as well as its implications for future research, policy, and practice.

"It Has Changed My Life": An Exploration of Caregiver Experiences in Serious Illness

Background:

Informal, unpaid caregivers shoulder much of the care burden for individuals with serious illness. As part of a project to create an innovative model of supportive care for serious illness, a series of user interviews were conducted, forming the basis for this article.

Objective:

To understand both individual and interpersonal aspects of caregiving for serious illness.

Methods:

Twelve semistructured group interviews were conducted with patients, families, and professionals as part of a larger study of late-life serious illness. Transcript data were analyzed with descriptive coding, and then coded material was analyzed to elicit major themes and subthemes.

Results:

A total of 73 individuals participated in group interview sessions. Using descriptive coding, quotes were assigned to first-order codes of rewards, challenges, and a category of learnings and adaptations. Subthemes of reward included gratitude, a sense of accomplishment or mastery, and closeness in personal relationships. The most oft-cited challenges included emotional and physical stresses of caregiving and feeling unprepared or unsupported in caregiving. Reflecting on their experiences, caregivers cited new ways in which they had learned to be creative, to show assertiveness and advocacy, and to create personal balance in a demanding situation.

Conclusions:

The experience of caregiving is a life-altering journey as individuals rise to challenges and reflect on the rewards. Caregivers described intensive caregiving, often without acknowledgment or understanding of their role from the health-care system. This invisibility created its own iatrogenic caregiving challenge. The identified themes suggest avenues of meaningful caregiver support that bear further exploration.

Emotional suppression, caregiving burden, mastery, coping strategies and mental health in spousal caregivers

OBJECTIVES

The main aim was to explore the multiple mediation effects of personal resources (mastery, engagement and disengagement coping strategies) between caregiving burden and depression in spousal caregivers, based on integrated stress process models. A further aim was to examine whether emotional suppression moderates the relationship between perceived burden and depression.

METHOD

Cross-sectional data were collected in 2010-2011 by structured interviews from a sample of 110 spousal caregivers. Coefficients strategy with bootstrapping tested the strength and significance of the conditional indirect effects of simultaneous multiple mediators; and the conditional effect of burden on depression at different emotional suppression values.

RESULTS

Caregiving burden was indirectly associated with depression, through mastery and disengagement coping, but not through engagement coping. Mastery was negatively associated with depression, while disengagement coping was positively associated with depression. Emotional suppression and functional disability were positively associated with depressive symptoms. A significant burden-by-emotional suppression interaction was found for predicting depressive symptoms.

CONCLUSION

The study supports the conditional indirect effect in which burden can affect depression by reducing the mastery and increasing the disengagement coping simultaneously. The study provides also initial support for the moderating effect of emotional suppression, which can increase the deleterious effects of burden on depression. Researchers and practitioners should be aware of these issues of family care in spousal caregivers.

Orientation to the Caregiver Role Among Latinas of Mexican Origin

PURPOSE OF THE STUDY

To develop the Caregiver Orientation Scale for Mexican-Origin Women and evaluate its psychometric properties.

DESIGN AND METHODS

We developed a questionnaire to measure domains of cultural orientation to the caregiver role based on formative research and on the Cultural Justifications for Caregiving Scale. We conducted a series of exploratory factor analyses (EFAs) on data collected from 163 caregivers. We estimated internal consistency reliability (Cronbach's coefficient alpha) and assessed construct validity by estimating correlations between all latent factors and self-rated health, interview language, and weekly hours of care.

RESULTS

EFAs suggested four factors representing familism, obligation, burden, and caregiving intensity that displayed good fit (χ² (df = 63) = 70.52, p = .24; RMSEA = .03 [90% CI: 0.00, 0.06]; comparative fit index = .99). Multi-item scales representing the four domains had coefficient alphas ranging from .68 to .86. Obligation was positively associated with burden (.46, p < .001) and intensity (.34, p < .01), which were themselves positively correlated (.63, p < .001). Familism was positively associated with obligation (.25, p < .05) yet negatively associated with burden (-.35, p < .01) and intensity (-.22, p < .05). Weekly hours of care were positively associated with burden (.26, p < .01) and intensity (.18, p < .05), whereas self-rated health and burden (-.21, p < .05) and Spanish language and intensity (-.31, p < .001) were negatively correlated.

IMPLICATIONS

The study shows that Mexican-origin caregiver orientation is multidimensional and that caregivers may have conflicting motivations for caregiving.

The Concept of Familism in the Lived Experiences of Mexican-Origin Caregivers

This study qualitatively examined the experiences of Mexican-origin women caring for elderly family members in order to identify aspects of familism in their caregiving situations. Data were collected from onetime interviews with 44 caregivers living in the greater East Los Angeles area. Kinscripts guided the framing of familism in this study. Data were analyzed using a grounded theory approach. Caregivers' descriptions of the Mexican family reflected an idealized view of familism. Caregivers reported a lack of support from others and relying for support on fewer family members than were potentially available to them. Findings suggest that the construct of familism has evolved from its long-standing portrayals in the literature. More research is needed to reexamine familism as a theoretical perspective to explain how Mexican-origin families negotiate and construct elder care over the family life course.

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.

"It's like big mama's house": examining extended family influences on the dietary behaviors of African American children

The family environment plays an important role in influencing children's dietary behaviors. Traditionally, African American extended family members play a key role in child socialization. We examine the role of extended families in how children are socialized to adopt dietary norms. We conducted in-depth, semi-structured interviews with 24 individuals across eight family units to elicit information regarding the influences of culture and families on children's dietary behaviors. Findings suggest that families teach children to value activities that combine quality time and enjoying food together; adults are inconsistent in how they teach children to adopt desired dietary behaviors. This work has implications for improving family-based interventions for African American children through promoting healthful behaviors that are also respectful of family dietary traditions, improving communication between adults and children, and leveraging family members as attitudinal and behavioral referents.

Effects of social ties on self-rated physical health among African American adults

OBJECTIVES

To examine associations between social ties and self-rated physical health among midlife and older African Americans.

METHODS

Cross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with betterself-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH: this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality.

RESULTS

In adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval (CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99).

DISCUSSION

Results suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.

Social support provided by and strain experienced by African-American cancer caregivers

BACKGROUND

Cancer is the second most common condition among people over 50, behind only dementia, associated with caregiving. As treatments improve, the number of cancer caregivers will increase. However, there is limited research about African-American cancer caregivers (AACCs).

PURPOSE

The purpose of this mixed methods study is to describe (1) the types of social support provided by and (2) the levels of strain reported by AACCs.

METHODS

Cancer patients from a regional safety net hospital nominated family caregivers who helped them after their cancer diagnosis. Consented caregivers were interviewed in the waiting room while the patient received treatment or later by phone using the Modified Caregiver Strain Index (MCSI), five structured interview questions, and demographic questions-20 min. Responses to the interview questions were processed using Miles and Huberman's content analysis guide. Descriptive statistics for demographics and the MCSI were performed using SPSS.

RESULTS

Of the 45 AACCs, 64 % had medical conditions. Caregivers reported patients' pain (31 %), stress (9 %), and nausea (7 %) as the most common symptoms. AACCs most commonly provided instrumental (67 %) or emotional (42 %) support; spiritual (20 %) and informational (20 %) support were less common.

CONCLUSION

Emphasis is needed in providing care assistance information to the AACCs to ensure effective support for their loved ones. This study highlights areas of support where assistance can be useful among AACCs.

Facilitators of home and community-based service use by urban African American elders

OBJECTIVE

To examine the factors associated with urban African American elders' utilization of home and community-based services and explore whether these factors differ by category of service.

METHODS

Data came from a representative sample of 1,099 African American older adults living in Detroit. Logistic regression models were used to explore the predisposing, enabling, and need factors associated with any service use and five categories of service use: in-home care, household services, functional care, out-of-home services, and financial/legal services.

RESULTS

Findings suggest that previous studies using the Andersen model may not be generalizable to an urban African American population. Service use was related primarily to enabling resources, particularly in terms of financial resources, not driving a car, and social resources and support. Future research should further examine the facilitators and barriers to service use by urban African Americans to improve their access to care.

Contributing factors of depressive symptoms among elderly Korean immigrants in Texas

This study examined various life stresses associated with relocation that may contribute to depressive symptoms among Korean immigrant elders in Texas. A sample of 120 elders was assessed using the Geriatric Depression Scale-Short Form and a 90-min face-to-face interview. Over 1/3 of respondents (37.5%) had symptoms of depression. Regression analyses (R(2) = .331) indicate that self-rated health, stressful life events, English language proficiency, satisfaction of visiting one's birth place, and watching TV were correlates of depressive symptoms among them. The findings of this observational study may be used as a baseline for designing service program for this population.

Differences in problem behaviour among ethnic minority and majority preschoolers in the Netherlands and the role of family functioning and parenting factors as mediators: the Generation R Study

Background

Studies have shown that, compared to native counterparts, preschoolers from ethnic minorities are at an increased risk of problem behaviour. Socio-economic factors only partly explain this increased risk. This study aimed to further unravel the differences in problem behaviour among ethnic minority and native preschoolers by examining the mediating role of family functioning and parenting factors.

Methods

We included 4,282 preschoolers participating in the Generation R Study, an ethnically-diverse cohort study with inclusion in early pregnancy. At child age 3 years, parents completed the Child Behavior Checklist (CBCL/1,5-5); information on demographics, socio-economic status and measures of family functioning (maternal psychopathology; general family functioning) and parenting (parenting stress; harsh parenting) were retrieved from questionnaires. CBCL Total Problems scores in each ethnic subgroup were compared with scores in the Dutch reference population. Mediation was evaluated using multivariate regression models.

Results

After adjustment for confounders, preschoolers from ethnic minorities were more likely to present problem behaviour than the Dutch subgroup (e.g. CBCL Total Problems Turkish subgroup (OR 7.0 (95% CI 4.9; 10.1)). When considering generational status, children of first generation immigrants were worse off than the second generation (P<0.01). Adjustment for socio-economic factors mediated the association between the ethnic minority status and child problem behaviour (e.g. attenuation in OR by 54.4% (P<0.05) from OR 5.1 (95% CI 2.8; 9.4) to OR 2.9 (95% CI 1.5; 5.6) in Cape Verdean subgroup). However, associations remained significant in most ethnic subgroups. A final adjustment for family functioning and parenting factors further attenuated the association (e.g. attenuation in OR by 55.5% (P<0.05) from OR 2.2 (95% CI 1.3; 4.4) to OR 1.5 (95% CI 1.0; 2.4) in European other subgroup).

Conclusions

This study showed that preschoolers from ethnic minorities and particularly children of first generation immigrants are at an increased risk of problem behaviour compared to children born to a Dutch mother. Although socio-economic factors were found to partly explain the association between the ethnic minority status and child problem behaviour, a similar part was explained by family functioning and parenting factors. Considering these findings, it is important for health care workers to also be attentive to symptoms of parental psychopathology (e.g. depression), poor family functioning, high levels of parenting stress or harsh parenting in first and second generation immigrants with young children.

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.

Longitudinal study of perceived negative impact in African American and Caucasian mothers of children with autism spectrum disorder

The purpose of this study was to examine the stability of mothers' perceptions of the negative impact of having a child with ASD in a sample of African American and Caucasian families as their children transitioned to early adolescence. Participants were mothers and children participating in an ongoing longitudinal study of children referred for diagnosis of ASD at age two. Analyses included data from two time points, when child participants were approximately 9 and 14 years old. Linear mixed model analyses were used to examine the relationship between the primary outcome variable, mothers' perceived negative impact across time, and hypothesized predictors. Negative impact increased significantly from late childhood to into adolescence. However, African American mothers with lower education reported significantly lower levels of perceived negative impact at both time points. Findings show that for some families, the transition to adolescence is a period in which mothers experience increased amounts of negative impact and highlight the importance of examining the influence of socioeconomic variables. Furthermore, data suggest that there may be cultural differences mediating the relationship between maternal education, ethnicity, and perceived negative impact. Implications for the importance of including families from varying levels of socioeconomic status in ASD research are discussed.

Korean American Dementia Caregivers’ Attitudes Toward Caregiving

The purpose of this study was to explore how Korean American family caregivers view the services they offer to patients with dementia. It also investigated the roles of social networks and satisfaction with social support on attitudes toward caregiving. Social network, satisfaction with social support, demographic characteristics, caregiving-related stress factors, and cultural factors were examined. We used a convenience sample of 85 Korean American dementia caregivers. The results from hierarchical multiple regression models show that the level of satisfaction with social support significantly contributed to Korean American caregivers’ attitudes toward working with patients with dementia, while no statistically significant associate was found for social network. Higher levels of satisfaction with social support were associated with greater positive attitudes toward caregiving among Korean American caregivers ( b = 0.26, p = .024). The implications for mental health professionals and policy makers are discussed.

Associations Between Social Relationships and Emotional Well-Being in Middle-Aged and Older African Americans

Social relationships may enhance emotional health in older age. The authors examined associations between social relationships and emotional health using data from the Milwaukee African American sample of the second Midlife Development in the United States (MIDUS II) study, 2005-2006 ( n = 592). Self-reports indicated good, very good, or excellent emotional health, distinguished from fair or poor. Social relationships were measured by relationship type (family or friend), contact frequency, and levels of emotional support and strain. Control variables included demographic characteristics, types of lifetime and daily discrimination, neighborhood quality, and other social factors. In adjusted results, each increase on a family emotional support scale was associated with 118% greater odds of reporting better emotional health (odds ratio [OR] = 2.18, 95% confidence interval [CI] [1.43, 3.32]). Friend emotional support also was associated with better emotional health (OR = 1.59, CI [1.07, 2.34]). Daily discrimination substantially reduced reported emotional health; family and friend support buffered this effect.

Does filial piety decrease depression among family caregivers?

OBJECTIVES

To examine the effects of filial piety - the practice of filial respect of and care for parents - on depressive symptoms among adult children caregivers of elderly Arab parents in Israel, and to identify factors that may mediate the association.

METHOD

Cross-sectional data were collected in 2006-2007 by a structured interview from 250 randomly sampled Arab-Israeli adult children caregivers (response rate, 94%). Path analysis was used to examine the study objectives.

RESULTS

Filial piety was not directly related to depression, but rather worked indirectly through caregiving burden. Caregiver depression was predicted positively by caregiving burden, while burden was predicted negatively by filial piety. Sense of mastery emerged as a major (negative) predictor and as a mediator between caregiving burden and depressive symptoms.

CONCLUSION

The analysis showed that caregiving burden in this population of traditional caregivers was associated with depressive symptoms, while most other variables were mediated through caregiving burden, sense of mastery, or filial piety. Researchers and practitioners should be sensitive to issues of family care among such traditional populations in transition.

Association between cultural factors and the caregiving burden for Chinese spousal caregivers of frail elderly in Hong Kong

OBJECTIVES

The aim of this study was to explore the relationship between cultural factors and the caregiving burden of Chinese spousal caregivers who provided care to their frail partners.

METHOD

A sample consisting of 102 Chinese caregivers for frail elderly spouses was recruited from home care services across various districts in Hong Kong. Structured interviews were conducted with the participants in their homes, measuring demographics, the functional status of the spouse, the degree of assistance required in daily care, perceived health, the caregiver's orientation to traditional Chinese family values, social support, coping, and caregiver burden.

RESULTS

Findings of regression analysis indicated that gender, activities of daily living (ADL) status, orientation to traditional Chinese family values, passive coping, and marital satisfaction associated with caregiver burden. Being female, having lower functioning in ADL or a strong orientation toward traditional Chinese family values, employing the strategies of passive coping more frequent, or experiencing a low degree of marital satisfaction were associated with high levels of caregiver burden.

CONCLUSION

These findings provided a basis for developing appropriate interventions to minimize the caregiver burden of spousal family caregivers.

American Indian family caregivers' experiences with helping elders

In recent years, a vast literature has accumulated on the negative effects on family caregivers of providing care to elders, while relatively little research has explored caregiving as a positive experience. Only a handful of studies have examined any aspect of informal caregiving among American Indians. This mixed methods study explores the negative and positive aspects of providing elder care among 19 northern plains American Indian family members. These caregivers described low levels of burden and high levels of reward, attributable to cultural attitudes toward elders and caregiving, collective care provision, strong reciprocal relationships with elders, enjoyment of elders, and relatively low levels of care provision. Caregiving manifested as part of a complex exchange of assistance rather than a unidirectional provision of assistance from the family member to the elder. That caregiving emerged as such an overwhelmingly positive experience in a community faced with poverty, alcohol disorders, trauma, and cultural traumatization is testimony to the important roles that elders often continue to play in these communities.

Urban-rural comparisons of outcomes for informal carers of elderly people in the community: a systematic review

As the age of the general population increases, the number of elderly people who need care is increasing. It has been suggested that rural carers may be disadvantaged compared to urban carers, but it is not clear what affect geographic location has on carers. This paper presents a systematic review of the literature on urban-rural comparisons on various outcomes for informal carers who provide care for elderly people in the community. Of 150 articles that were reviewed, eight articles were included with three themes in the outcomes for carers: service use, health promotion behaviors and psychological health (such as carer stress, burden or depressive symptoms). Overall, there were few consistent or statistically significant differences between urban and rural carers. Many of the differences observed were explained by other factors, such as carer or care recipient characteristics. The literature search was limited to papers in the English language, involving quantitative methods and published in peer-reviewed journals. There were not enough studies found to examine other outcomes or to pool data across studies. There is too little evidence comparing urban and rural carers to inform clinicians and policy makers. More good-quality research is urgently needed.

Chronically Ill Midlife and Older Lesbians, Gay Men, and Bisexuals and Their Informal Caregivers: The Impact of the Social Context

With the exception of HIV care, informal caregiving of chronically ill lesbian, gay, and bisexual (LGB) adults has received very limited attention in the extensive caregiving literature. This article reports on research that considered the social context of care and a dyadic caregiving approach for 36 chronically ill LGB adults ages 50 and older and their informal caregivers. In this study, both discrimination and relationship quality were associated with depression among chronically ill LGB adults and their caregivers. Furthermore, preliminary findings suggested that relationship quality moderates the impact of discrimination as a risk factor for depression in chronically ill LGB adults. The authors discuss the implications of these findings for social policy and future research. Given the changing demographics in the United States with the aging of the baby boomers, as well as an increase in chronic illness, fostering better understanding of caregiving across diverse sexualities and families is critical.