1
|
Chen S, Lou VWQ, Leung R, Yu DSF. Meaning-making of dementia caregiving: A systematic review of qualitative studies. Int J Nurs Stud 2024; 158:104848. [PMID: 39043114 DOI: 10.1016/j.ijnurstu.2024.104848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Being the backbone of informal care for people living with dementia, caregivers suffer overwhelming physical and psychological challenges in their daily caregiving experience. Proactive coping strategies to alleviate the caregiving burden are of utmost importance. Meaning-making emerges as an effective coping approach to benefit caregivers and mitigate their care burden. However, the conceptualisation of meaning-making on its dimensions and process has been ambiguously identified. OBJECTIVES To synthesise the qualitative research evidence on meaning-making in a dementia context to identify: (1) the situational dimension in making sense of caregiving scenarios, and (2) how the meaning-making process evolves during dementia caregiving. METHODS This systematic review identified 62 qualitative studies published between 1969 and 2022 from the major databases. Eligible studies met the following inclusion criteria: (1) having informal caregivers of people living with dementia; (2) involving meaning-making of care experience; (3) adopting qualitative design; and (4) full-text of research articles. The risk of bias was evaluated using the Clinical Appraisal Skills Programme checklist. By using Qualitative Evidence Synthesis, themes relevant to critical dimensions and phases of meaning-making were generated from the extracted data. RESULTS Sixty-two studies involving 2487 subjects were synthesised investigating the critical dimensions and process of meaning-making of dementia care experience. Results indicated that the dementia care experience can be made sense of in several folds: (1) it involved complicated demands from people living with dementia and requires customised care; (2) the dynamics of dyadic interactions with dilemma and ambivalence; and (3) adaptive coping encapsulating perceptions of loss and growth, complied and integrated values, balanced expectations of care and self, and improvement in self-efficacy. The meaning-making process underwent phases of meaning creation (meaning created in initial encounter with dementia symptoms), meaning appraisal (assimilation and accommodation pathways for appraisal), and meaning adherence (integration of the appraised meanings). CONCLUSION Findings suggest meaning-making of dementia caregiving is a multi-faceted and multi-phased recursive process. Future implications give directions on the facilitation of meaning-oriented interventions to enhance the awareness of caregiving role and the knowledge of dementia care, learn techniques of reframing and restructuring, and seek meaningful perspectives; and to adopt strategies to overcome the barriers for meaning-making by empowering self-identity, roles and expectations, and the dyadic relationship. In addition, our findings inform future advancement in the conceptualisation and measurement of meaning-making in the context of family caregiving. Optimisation of the meaning-making process inspires professional assistance to enhance caregivers' coping for dementia care experience.
Collapse
Affiliation(s)
- Shuangzhou Chen
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Reynold Leung
- Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, Sau Po Center on Ageing, The University of Hong Kong, Hong Kong.
| |
Collapse
|
2
|
Pruitt A, Croff R, Boise L, Kaye J. Are We Talking About the Same Thing? Black/African Americans' Response to the BRFSS Cognitive Decline and Caregiver Modules. J Cross Cult Gerontol 2024:10.1007/s10823-024-09507-8. [PMID: 38861052 DOI: 10.1007/s10823-024-09507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/12/2024]
Abstract
The Behavioral Risk Factor Surveillance System (BRFSS) is a randomized national U.S. telephone survey administered by state health departments. This study aimed to identify how Black/African Americans understand BRFSS caregiver and cognitive decline surveys and terminology to inform health messaging that centers the Black/African American experience. In focus groups, BRFSS surveys were administered to Black/African Americans (n = 30) aged ≥ 45 in Oregon. Participants were asked how they interpreted BRFSS terms 'memory loss' and 'confusion,' how these terms related to Alzheimer's and dementia, and about caregiving and cognitive decline experiences. The culturally responsive Africana Worldview guided interpretation, which centers the Black/African American experience and individuals within interdependent relationships and community identity when explaining behaviors of people from the African diaspora. BRFSS survey responses differed from focus group responses to the same questions. Two participants reported providing care in the past two years on the survey; in discussions, 21 participants reported providing care in the past two years. Interpretations of BRFSS terminology varied greatly. Differences between age-related cognitive changes, dementia and Alzheimer's disease were unclear. Cognitive decline was largely understood in terms of identity loss and relationship changes with the affected individual, and how that individual's relationship changed within community. Caution is advised when using BRFSS data to frame messaging because key cognitive health terms are not universally understood. Messaging that apply the Africana Worldview centralizes relationships and community rather than impact on individual's day-to-day activities, may be more effective for Black/African Americans and for other groups with different cultural and life experiences.
Collapse
Affiliation(s)
- Andre Pruitt
- School of Social Work, Portland State University, Portland, OR, USA
| | - Raina Croff
- Department of Neurology, Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, OR, USA.
| | - Linda Boise
- Department of Neurology, Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
3
|
Ng YH, Jiao K, Suen MHP, Wang J, Chow AYM. The role of the social environment on dementia caregivers' pre-death grief: A mixed- methods systematic review. DEATH STUDIES 2024:1-20. [PMID: 38497324 DOI: 10.1080/07481187.2024.2329755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
This systematic review examined the role of social environment in pre-death grief experiences of dementia caregivers. Ninety-three Chinese and English articles were included from a comprehensive search of empirical studies using nine databases. Six social environment domains were generated: the person with dementia, dyadic relationship, family members and the wider community, health and social care services, place of care, and social-cultural contexts. A complex interplay between caregivers and their social environments that aggravate and attenuate pre-death grief experiences is evident. Research has focused mainly on the effects of people with dementia and dyadic relationships and has paid modest attention to the effects of family, relatives, and health and social care services. Caregivers' experiences with their friends, fellow caregivers, the wider community, and social-cultural norms are influential but understudied. Future research could adopt a systems thinking approach with sociological perspectives to generate a comprehensive and nuanced understanding of pre-death grief experiences.
Collapse
Affiliation(s)
- Yong Hao Ng
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Margaret H P Suen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| |
Collapse
|
4
|
Bonds Johnson K, Higgins M, Epps F, Brewster GS, Alexander K, Hepburn K. Tele-Savvy Outcomes of Non-Hispanic Black American and White Caregivers. THE GERONTOLOGIST 2024; 64:gnad044. [PMID: 37067896 PMCID: PMC10733122 DOI: 10.1093/geront/gnad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tele-Savvy is a synchronous/asynchronous psychoeducation program for caregivers of community-dwelling persons living with Alzheimer's disease and related dementias (ADRD) designed to increase caregivers' competence and confidence (mastery) in caregiving. Its overall efficacy was tested in a randomized controlled trial. RESEARCH DESIGN AND METHODS This secondary data analysis examined the caregiver mastery and psychological health (i.e., perceived stress, depressive symptoms, and burden) outcome of 153 non-Hispanic Black American and White caregivers (31 non-Hispanic Black American and 122 White caregivers) from baseline to 6 months postintervention. Given the difference in the sample sizes of Black and White caregivers, a descriptive post hoc subgroup analysis was conducted of 21 non-Hispanic Black American and 20 White adult children and grandchildren caregivers. RESULTS In the overall sample, Black American caregivers demonstrated higher levels of mastery and lower levels of distress than White caregivers at baseline and across all time points. Over time, White caregivers, but not Black American caregivers, experienced significantly improved levels of mastery and significantly lowered levels of depression. Within the subgroup analysis, except for a moderate effect size in the management of situation scores over time among Black American adult children caregivers, similar results were obtained. DISCUSSION AND IMPLICATIONS The findings highlight the strengths and shortcomings of the Tele-Savvy program in improving caregiver mastery and reducing negative psychological health outcomes. Intentionally tailoring the Tele-Savvy program to certain racial and caregiving groups may hold promise in meeting the needs of more ADRD caregivers. CLINICAL TRIAL REGISTRATION NCT03033875.
Collapse
Affiliation(s)
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Glenna S Brewster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Karah Alexander
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Kopel J, Sehar U, Choudhury M, Reddy PH. Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in African Americans: Focus on Caregivers. Healthcare (Basel) 2023; 11:healthcare11060868. [PMID: 36981525 PMCID: PMC10048201 DOI: 10.3390/healthcare11060868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023] Open
Abstract
Alzheimer’s disease (AD) and Alzheimer’s Disease-Related Dementias (ADRD) are chronic illnesses that are highly prevalent in African Americans (AA). AD and ADRD are caused by multiple factors, such as genetic mutations, modifiable and non-modifiable risk factors, and lifestyle. Histopathological, morphological, and cellular studies revealed how multiple cellular changes are implicated in AD and ADRD, including synaptic damage, inflammatory responses, hormonal imbalance, mitochondrial abnormalities, and neuronal loss, in addition to the accumulation of amyloid beta and phosphorylated tau in the brain. The contributions of race, ethnicity, location and socioeconomic status all have a significant impact on the care and support services available to dementia patients. Furthermore, disparities in health care are entangled with social, economic, and environmental variables that perpetuate disadvantages among different groups, particularly African Americans. As such, it remains important to understand how various racial and ethnic groups perceive, access, and experience health care. Considering that the mounting data shows AA may be more susceptible to AD than white people, the demographic transition creates significant hurdles in providing adequate care from family caregivers. Furthermore, there is growing recognition that AD and ADRD pose a significant stress on AA caregivers compared to white people. In this review, we examine the current literature on racial disparities in AD and ADRD, particularly concerning AA caregivers.
Collapse
Affiliation(s)
- Jonathan Kopel
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Moumita Choudhury
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Correspondence: ; Tel.: +1-806-743-3194
| |
Collapse
|
6
|
Hovland CA, Fuller KA. African American Family Caregivers Share How they Prepared for the Death of an Older Adult with Dementia: A Pilot Study of Hospice Care in A Nursing Home. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2022; 18:129-145. [PMID: 35226595 DOI: 10.1080/15524256.2022.2042458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The focus of this pilot study was to ascertain how bereaved African American caregivers prepared for the death of an older family member who died from a dementia-related diagnosis and the role of hospice care; an area with little research to date. Because African American older adults in the United States are at greater risk than Caucasian older adults for dementia-related health problems though less likely to be diagnosed, treated, or to enroll in hospice services, this exploratory study asked questions of the family caregivers' experiences in preparing for the death. Purposive criterion sampling was used to identify six African American bereaved caregivers whose family member lived in a nursing home (five who were enrolled in hospice services) who were extensively interviewed, with the use of conventional content analysis of the transcripts to identify the findings. Because of the limited sample size, themes identified were considered preliminary and may help guide ongoing and further research. Five primary themes revealed ways caregivers prepared: accepting reality; "I just kind of knew;" person with dementia "was ready;" "spending time;" and, getting your "business in order." All caregivers believed it was important to be prepared for the death, with the five who received hospice services reporting that they were prepared. Further research is needed to explore these preliminary findings of African American caregivers of family members with dementia at end-of-life to further inform social work and hospice team care.
Collapse
Affiliation(s)
- Cynthia A Hovland
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
| | - Kimberly A Fuller
- School of Social Work, Cleveland State University, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Singh S. Belonging through a communicative lens in dementia caregiving: qualitative study of autobiographical caregivers narratives. Home Health Care Serv Q 2022; 41:183-199. [PMID: 35343394 DOI: 10.1080/01621424.2022.2053769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This qualitative study examined 23 autobiographical narratives to understand how dementia caregivers discursively construct a sense of belonging through In this study, belonging is understood as an individual feeling valued by a group that is communicatively enacted by both the individual and members of the group. This exploratory study revealed two characteristics of belonging as a communicative concept: (a) two-way street and (b) multi-faceted. Findings suggest that belonging is a more nuanced concept than previously thought.
Collapse
Affiliation(s)
- Sabrina Singh
- Department of Communication, Rutgers University-New Brunswick, 4 Huntington Street, New Brunswick, NJ United States
| |
Collapse
|
8
|
Racial and ethnic disparities in cancer caregiver burden and potential sociocultural mediators. Support Care Cancer 2022; 30:9625-9633. [PMID: 36190556 PMCID: PMC9633462 DOI: 10.1007/s00520-022-07367-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/16/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Black and Hispanic cancer patients experience many worse care quality and health outcomes than non-Hispanic White patients, yet less is known about disparities in caregiving responsibilities and burden among cancer caregivers. METHODS We analyzed cross-sectional data from Cancer Care Outcomes Research and Surveillance consortium, a large multi-regional, population-based study of colorectal and lung cancer patients and their caregivers. Bivariate and multivariable regression models assessed differences by racial and ethnic groups in caregiving responsibilities and social/emotional, financial, and health burdens. Structural equation models estimated whether sociocultural resources (social support, caregiving preparedness, caregiver-patient communication) mediated racial and ethnic differences in caregiver burden. RESULTS Compared with non-Hispanic White caregivers (N = 1,169), Black (N = 220) and Hispanic (N = 84) caregivers spent more time caregiving (18 vs. 26 vs. 26 h/week; P < 0.001), completed more tasks (6.8 vs. 7.6 vs. 8.7; P < 0.05), and reported greater financial burden (P = 0.02). Yet, compared to non-Hispanic Whites, Hispanic caregivers reported similar social/emotional and health burdens, while Black caregivers reported lower levels (P < 0.01). In adjusted models, disparities in financial burden disappeared, and Hispanic caregivers had less health burden than non-Hispanic White caregivers (P = 0.01). Social support and/or caregiving preparedness partially mediated the Black-White gap for all three types of burdens. CONCLUSIONS Black and Hispanic cancer caregivers perform more caregiving and report greater financial burden than non-Hispanic White caregivers, but experience lower or equivalent social/emotional and health burdens. Racial differences in caregivers' social support and caregiving preparedness levels partially explain Black-White burden differences. Research and policy should address Black and Hispanic caregivers' increased financial burden.
Collapse
|
9
|
Hovland CA, Mallett CA. Family caregivers for older persons with dementia offer recommendations to current caregivers: a qualitative investigation. J Res Nurs 2021; 26:796-806. [PMID: 35251288 PMCID: PMC8894757 DOI: 10.1177/17449871211041682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND AND AIMS Family members who care for older adults with dementia encounter significant difficulties across many domains. There is limited research in this area; thus, the aim here is to share the actual experiences of 30 family caregivers to other family caregivers and to show how these experiences can provide help and recommendations. METHODS This qualitative study of 30 family caregivers of family members aged 65 and older who died with dementia-related diagnoses used in-depth qualitative interviews conducted over a 12-month period for data collection and content analysis to understand the data. The study asked what they learned and what subsequent recommendations these caregivers had for other family caregivers taking care of an older person with dementia. RESULTS Four primary themes emerged from the content data analysis and included the following: (1) "do not do it alone"; (2) patience, love, and kindness; (3) "first of all, take care of yourself"; and (4) "get educated." CONCLUSIONS This study is unique in asking directly of family caregivers of older persons who died of dementia what they learned and what they want to share and recommend to ongoing and future family caregivers.
Collapse
Affiliation(s)
- Cynthia A Hovland
- Associate Professor of Social Work, School of Social Work, Cleveland State University, Cleveland, OH, USA
| | - Christopher A Mallett
- Professor of Social Work, School of Social Work, Cleveland State University, Cleveland, OH, USA
| |
Collapse
|
10
|
Kartoz CR, Wells M, Hammell P. Measuring Anticipated Loss of Aging Parents: Development of the Parent Anticipatory Loss Scale. J Nurs Meas 2021; 30:21-39. [PMID: 34518421 DOI: 10.1891/jnm-d-20-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Research indicates non-caregiving adult children with aging parents experience anticipatory loss for parents that consists of feelings of gratitude, sadness, and worry. The purpose of this research was to develop the Parent Anticipatory Loss Scale. METHODS Interview data from non-caregiving adult children and extant literature formed the basis for creating items measuring three components of Parent Anticipatory Loss. Expert content validity was established prior to administering the survey to a convenience sample of non-caregiving (N = 315), mostly Caucasian (n = 182, 57.6%) men (n = 202, 63.9%). The crowdsourcing platform, Mechanical Turk, provided an innovative method for sample recruitment. RESULTS Questions were eliminated as indicated during analysis, yielding a 19-item scale (α = 0.93) with three subscales (α = 0.897 for Gratitude, α = 0.841 for Sadness, and α = 0.833 for Worry). Exploratory factor analysis (Varimax rotation) showed gratitude accounted for 46% of the variance, with sadness and worry accounting for 9.5% and 5.3%. CONCLUSIONS The Parent Anticipatory Loss scale demonstrates good initial reliability and validity and can be used to measure anticipatory loss for aging parents. Further testing with cross cultural samples is warranted.
Collapse
|
11
|
Roche M, Higgs P, Aworinde J, Cooper C. A Review of Qualitative Research of Perception and Experiences of Dementia Among Adults From Black, African, and Caribbean Background: What and Whom Are We Researching? THE GERONTOLOGIST 2021; 61:e195-e208. [PMID: 32077938 PMCID: PMC8276611 DOI: 10.1093/geront/gnaa004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Black, African, and Caribbean (BAC) families are disproportionately affected by dementia but engage less with services. Studies reporting their experiences of dementia have tended to aggregate people from diverse backgrounds, without considering the impact of this diversity, or researchers' ethnicities. We investigated participants' and researchers' ethnic identities, exploring how this relates to findings. RESEARCH DESIGN AND METHODS We searched electronic databases in September 2018, for qualitative studies exploring how participants of Black ethnicity understand and experience dementia and dementia care. We reported participants' and researchers' ethnicities, and meta-synthesized qualitative findings regarding how ethnicity influences experiences and understanding of dementia. RESULTS Twenty-eight papers reported 25 studies; in United States (n = 17), United Kingdom (n = 7), and Netherlands (n = 1). 350/492 (71%) of participants were in U.S. studies and described as African American; participants in U.K. studies as Caribbean (n = 45), African/Caribbean (n = 44), African (n = 28), Black British (n = 7), or Indo-Caribbean (n = 1); and in Netherlands as Surinamese Creole (n = 17). 6/25 (24%) of studies reported involving recruiters/interviewers matching participants' ethnicity; and 14/25 (56%) involved an author/advisor from a BAC background during analysis/procedures. We identified four themes: Dementia does not relate to me; Inappropriate and disrespectful services; Kinship and responsibility; Importance of religion. DISCUSSION AND IMPLICATIONS Studies were mostly from a U.S. African American perspective, by researchers who were not of BAC background. Themes of dementia diagnosis and services feeling less relevant to participants than the majority population resonated across studies. We caution against the racialization of these findings, which can apply to many differing minority groups.
Collapse
Affiliation(s)
- Moïse Roche
- Division of Psychiatry, University College London, UK
| | - Paul Higgs
- Division of Psychiatry, University College London, UK
| | - Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, UK
| | | |
Collapse
|
12
|
Bonds Johnson K, Epps FR, Song M, Lyons KS, Driessnack M. Using poetry as data to explore daily and formal care decision making within African American dementia dyads. Geriatr Nurs 2021; 42:919-925. [PMID: 34098446 PMCID: PMC8335738 DOI: 10.1016/j.gerinurse.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
There is limited research exploring how daily and formal care decision making occurs within African American dementia dyads as well as how these dyads navigate decision making across the dementia trajectory. Through semi-structured interviews, five African American dementia dyads shared their decision-making processes. We used a multimethod approach to the analysis of data, including qualitative and quantitative content analysis and the creation of I Poems. This novel use of I Poems provided a uniquely personal account of the lived experiences of the African American persons living with dementia, while other analyses revealed that within dyads, daily care decision making was led by African American persons living with dementia, whereas formal care decision making varied between dyads. There was intra-dyad congruence regarding who the final decision maker was in daily and formal care. Clinicians and researchers may be able to tailor interventions based on the dyad's involvement in these decision-making processes.
Collapse
Affiliation(s)
- Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States.
| | - Fayron R Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322, United States
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, MA, United States
| | - Martha Driessnack
- School of Nursing, Oregon Health & Science University, Portland, OR, United States
| |
Collapse
|
13
|
Bonds K, Song M, Whitlatch CJ, Lyons KS, Kaye JA, Lee CS. Patterns of Dyadic Appraisal of Decision-Making Involvement of African American Persons Living With Dementia. THE GERONTOLOGIST 2021; 61:383-391. [PMID: 32609831 DOI: 10.1093/geront/gnaa086] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Greater everyday decision-making involvement by persons living with dementia (PLWD) and congruent appraisal between PLWDs and their caregivers have been associated with a better quality of life (QOL) for both members of the dyad. However, no study has examined the association between the appraisals of everyday decision-making involvement of PLWDs and their QOL among African Americans. RESEARCH DESIGN AND METHODS A secondary analysis of cross-sectional data from 62 African American dementia dyads was conducted. Multilevel and latent class mixture modeling was used to characterize dyadic appraisal of the decision-making involvement of African American PLWDs and identify distinct patterns thereof. RESULTS Three distinct patterns were observed. "Incongruent, PLWD Low Involvement" labeled 19.4% of the sample, 53.2% were labeled "Incongruent, PLWD Moderate Involvement," and 27.4% were labeled "Congruent, PLWD High Involvement." The Congruent, PLWD High Involvement pattern consisted of PLWDs who were significantly younger and had significantly less cognitive impairment than PLWDs in the other patterns. In the Incongruent, PLWD Moderate Involvement pattern, PLWDs had significantly better QOL than PLWDs in the Incongruent, PLWD Low Involvement pattern, but QOL did not significantly differ from PLWDs in the Congruent, PLWD High Involvement pattern. DISCUSSION AND IMPLICATIONS There is a need to tailor strategies to optimize QOL in African American dementia dyads. While increasing everyday decision-making involvement for PLWDs in the Incongruent, PLWD Low Involvement pattern is an important goal, other strategies may be needed to improve the QOL of PLWDs in the remaining patterns.
Collapse
Affiliation(s)
- Kalisha Bonds
- School of Nursing, Oregon Health & Science University, Portland
| | - MinKyoung Song
- School of Nursing, Oregon Health & Science University, Portland
| | - Carol J Whitlatch
- Benjamin Rose Institute on Aging, Center for Research and Education, Cleveland, Ohio
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Jeffrey A Kaye
- Department of Neurology, Layton Aging & Alzheimer's Disease Center, Oregon Health & Science University, Portland
| | - Christopher S Lee
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| |
Collapse
|
14
|
Dilworth-Anderson P, Moon H, Aranda MP. Dementia Caregiving Research: Expanding and Reframing the Lens of Diversity, Inclusivity, and Intersectionality. THE GERONTOLOGIST 2020; 60:797-805. [PMID: 32667672 DOI: 10.1093/geront/gnaa050] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Indexed: 02/04/2023] Open
Abstract
This forum expands and reframes the lens of dementia caregiving research among diverse racial and ethnic groups to better understand the unique needs, stressors, and strengths of multicultural and racial-ethnic family caregivers in the United States. By providing more diverse and inclusive knowledge on caregiving to older adults in the United States, we can create a new path forward with regards to caregiving research. Throughout the article, major questions and answers are supported by critiquing some of the caregiving literature. Discussions are provided to help create inclusive ways of conceptualizing caregiving research and using methodological approaches to reflect the diversity of caregivers and care recipients in the United States. Expanding and reframing the conceptual and methodological lens of diversity, inclusivity and intersectionality can provide evidence to support effective policy, practice, and care in addressing the needs of diverse groups of caregivers and older adults living with dementia.
Collapse
Affiliation(s)
- Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill
| | - Heehyul Moon
- Kent School of Social Work, University of Louisville, Kentucky
| | - María P Aranda
- USC Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles.,USC Alzheimer's Disease Center, University of Southern California, Los Angeles
| |
Collapse
|
15
|
Brewster GS, Epps F, Dye CE, Hepburn K, Higgins MK, Parker ML. The Effect of the " Great Village" on Psychological Outcomes, Burden, and Mastery in African American Caregivers of Persons Living With Dementia. J Appl Gerontol 2020; 39:1059-1068. [PMID: 31535922 PMCID: PMC7080571 DOI: 10.1177/0733464819874574] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The "Great Village," a cultural adaptation of a psychoeducation intervention the "Savvy Caregiver" for African American caregivers of persons living with dementia (PLwD), aims to develop caregivers' skills and improve the quality of the lives of both the PLwD and their caregivers. The goal of this study was to determine the effectiveness of the Great Village on depressive symptoms, anxiety, burden, and mastery in African American caregivers (N = 142). A three-arm randomized control trial (Great Village, Great Village + exercise, and attention control) was conducted over a period of 6 months. Caregivers who received either Great Village or Great Village + exercise reported significant reduction in depressive symptoms and improvement in mastery. Caregivers who received only Great Village reported a reduction in anxiety. Receiving no intervention worsened caregiver burden. African American caregivers should receive culturally tailored interventions to support their health and well-being and improve their competence in caregiving.
Collapse
Affiliation(s)
- Glenna S. Brewster
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Fayron Epps
- Georgia State University, Byrdine F. Lewis College of Nursing & Health Professions, Atlanta, GA, USA
| | - Clinton E. Dye
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Kenneth Hepburn
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Melinda K. Higgins
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | | |
Collapse
|
16
|
Fields NL, Xu L, Richardson VE, Parekh R, Ivey D, Calhoun M. Utilizing the Senior Companion Program as a platform for a culturally informed caregiver intervention: Results from a mixed methods pilot study. DEMENTIA 2019; 20:161-187. [PMID: 31488021 DOI: 10.1177/1471301219871192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To address the need for accessible, affordable, and sustainable Alzheimer's disease and related dementia caregiver interventions with minority populations, we developed the Senior Companion Program Plus, a three-phase pilot study that used a mixed methods experimental design. The intent was to determine if participation in a lay provider, peer-led psychoeducational intervention designed for African American Alzheimer's disease and related dementia caregivers (N = 16) improved caregiver burden and/or stress, coping skills, and social support. Focus groups with Senior Companions informed the intervention design. Quantitative results indicated that caregivers experienced improvement in their overall level of social support and well-being in meeting basic needs. Qualitative findings suggested that caregivers experienced improvement in their knowledge about the disease, experienced increased coping with Alzheimer's disease and related dementia caregiving, and reported benefits of using a lay provider model. Overall, the data suggest that the Senior Companion Program Plus is a promising intervention for African American Alzheimer's disease and related dementia caregivers.
Collapse
Affiliation(s)
| | - Ling Xu
- The University of Texas at Arlington, TX, USA
| | | | | | | | | |
Collapse
|
17
|
Epps F, Rose KM, Lopez RP. Who's Your Family?: African American Caregivers of Older Adults With Dementia. Res Gerontol Nurs 2019; 12:20-26. [PMID: 30653648 DOI: 10.3928/19404921-20181212-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022]
Abstract
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.].
Collapse
|
18
|
Wells M, Kartoz CR. Anticipatory loss in noncaregiving adult children: A hybrid concept analysis. Nurs Forum 2019; 54:16-22. [PMID: 30132909 DOI: 10.1111/nuf.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/21/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
AIM The aim of this article is to describe the concept of anticipatory loss in adult children for independent aging parents. BACKGROUND The existing literature, with numerous definitions of anticipatory loss, is disease and event specific. The literature on anticipation of the normative losses experienced by adult children is sparse. DESIGN The Schwartz-Barcott and Kim hybrid concept analysis was used to examine anticipatory loss in adult noncaregiving children. This three-step approach, involving literature review, fieldwork, and final analysis, has been used successfully to compare, revise, and expand a number of existing definitions. DATA SOURCE Empirical and conceptual literature as well as qualitative fieldwork. RESULTS Defining attributes of anticipatory loss in healthy aging families are worry, sadness, and gratitude. Worry about future loss is tempered by gratitude for current parental good health. Anticipatory loss acts as an impetus for adult children to connect with parents and siblings. A conceptual definition of anticipatory loss is proposed based on the findings. CONCLUSIONS Anticipating the loss of a healthy aging parent is different from existing conceptualizations of anticipatory loss and related concepts. Future research is needed to validate this concept and explore connections with health outcomes.
Collapse
Affiliation(s)
- Munira Wells
- Undergraduate Nursing Department, College of Nursing, Seton Hall University, South Orange, New Jersey
| | - Connie R Kartoz
- Department of Nursing, The College of New Jersey, Ewing, New Jersey
| |
Collapse
|
19
|
Hovland-Scafe CA, Kramer BJ. Preparedness for Death: How Caregivers of Elders With Dementia Define and Perceive its Value. THE GERONTOLOGIST 2018; 57:1093-1102. [PMID: 27342441 DOI: 10.1093/geront/gnw092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/20/2016] [Indexed: 11/14/2022] Open
Abstract
Purpose The purpose of this study is to ascertain how bereaved caregivers of a family member who died from a dementia-related diagnosis (a) define preparedness and (b) perceive its value. Design and Methods Purposive criterion sampling was employed to identify 30 bereaved caregivers of family members aged 65 and older who died with a dementia-related diagnosis. In-depth, qualitative interviews were conducted over a 12-month period, and qualitative content analysis was used to analyze the data. Results Only one third (n = 10) of caregivers interviewed were prepared for the death, and the majority who were prepared were enrolled in hospice. Five primary themes revealed ways that caregivers define various domains of preparedness: (i) accepting reality; (ii) knowing death is near; (iii) getting your "house in order"; (iv) saying "what you need to say"; and (v) giving "permission" to die. The majority (87%) believed that it is important for caregivers to be prepared, and the value of preparedness was exemplified in five domains reflecting the benefits of being prepared. Implications The results support further attention to the development and testing of interventions to address the unmet needs of caregivers of family members with dementia to help prepare them for the death in a variety of contexts.
Collapse
|
20
|
Hansen BR, Hodgson NA, Gitlin LN. African-American caregivers' perspectives on aggressive behaviors in dementia. DEMENTIA 2018; 18:3036-3058. [PMID: 29578357 DOI: 10.1177/1471301218765946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose Although African-American dementia caregivers report less upset and more confidence managing aggressive behaviors when compared to whites, their contextual experience remains unclear and this study explores that context. Methods Semi-structured interviews with 13 African-American family caregivers were analyzed using content analysis. Results Two themes emerged, “It’s the disease…not the person” and “You got to pick your battles.” “It’s the disease…not the person,” reframing aggressive behavior, included three sub-themes. Sometimes the person with dementia seemed like a stranger but caregivers remembered “In there somewhere is that person.” Aggressive behavior made this perspective difficult as they reported, “Sometimes it’s hard not to take it personal.” Premorbid dyadic conflict made caregiving difficult but caregivers remembered they were “Not who they were then.” “You got to pick your battles,” reflecting cognitive and behavioral strategies, also included three sub-themes. Participants prioritized caregiving over other commitments by reminding themselves “I got to do what I gotta do.” Preventing aggressive behaviors was most successful when “We didn’t argue…we didn’t insist” and caregivers remembered “Don’t put her in a position to fail” when involving the person with dementia in activities. Implications African-American caregivers described substantial challenges when confronted by aggressive behaviors. Strategies employed by caregivers enabled them to maintain a caring perspective and the person with dementia to maintain calm. Interventions that help caregivers manage aggressive behaviors may benefit by considering the challenges, cultural values, and effective strategies used by African-Americans.
Collapse
Affiliation(s)
| | - Nancy A Hodgson
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
21
|
Gil E, Agmon M, Hirsch A, Ziv M, Zisberg A. Dilemmas for guardians of advanced dementia patients regarding tube feeding. Age Ageing 2018; 47:138-143. [PMID: 29040344 DOI: 10.1093/ageing/afx161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 09/23/2017] [Indexed: 02/03/2023] Open
Abstract
Background advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure. Nevertheless, the great majority of guardians choose to have it performed. Purpose to probe the considerations underlying the decision for gastrostomy, despite the data and the recommendations. Method qualitative research, including participant observation at the clinic and in-depth interviews with guardians. Findings the families of most patients did not discuss end-of-life issues with them. The overwhelming preference for using the technology was interpreted as life-saving, in contrast to comfort feeding, which was deemed euthanasia. The reasons given for the decision to tube feed were drawn from a range of outlooks: religion, the patient's earlier survival capacity, and pragmatic considerations involving relations with nursing home staff. Conclusion study of the decision-making process of advanced dementia patients' guardians sheds light on the layers of meaning of the Israeli discourse regarding end-of-life issues.
Collapse
Affiliation(s)
- Efrat Gil
- Geriatric Unit, Bnai Zion MC, Haifa, Israel
- Technion Israel Institute of Technology Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Ayal Hirsch
- Gastroenterology Institute, Bnai Zion MC, Haifa, Israel
| | - Miriam Ziv
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Anna Zisberg
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| |
Collapse
|
22
|
Karasik RJ, Kishimoto K. Is gerontology ready for anti-racist pedagogy? A survey of educators' practices and perspectives. GERONTOLOGY & GERIATRICS EDUCATION 2018; 39:3-20. [PMID: 26886051 DOI: 10.1080/02701960.2015.1115984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
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.
Collapse
Affiliation(s)
- Rona J Karasik
- a Gerontology , St. Cloud State University , St. Cloud , Minnesota , USA
| | - Kyoko Kishimoto
- b Ethnic and Women's Studies , St. Cloud State University , St. Cloud , Minnesota , USA
| |
Collapse
|
23
|
Richardson VE, Fields N, Won S, Bradley E, Gibson A, Rivera G, Holmes SD. At the intersection of culture: Ethnically diverse dementia caregivers' service use. DEMENTIA 2017; 18:1790-1809. [PMID: 29254375 DOI: 10.1177/1471301217721304] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study used an ethnocultural approach to explore how cultural factors influenced ethnically diverse dementia caregivers’ experiences and use of services. A modified thematic analysis of in-depth interviews with 15 caregivers, ranging in age from 50 to 75 years, including spouses, daughters, sons, cousins, and a friend, from three minority groups—African American, Hispanic, and South Korean caregivers—was conducted by a team of multi-lingual researchers. Caregiver stress was pervasive across all subgroups. Several themes emerged that were qualitatively different across groups, including knowledge about dementia, language barriers, religion and spirituality, and cultural differences in attitudes about caring and formal services. A two-pronged intervention model that includes a generic intervention to reduce caregiver stress along with a culturally targeted intervention tailored to a family’s language, food preferences, religious practices, gender norms, and other values was recommended to more successfully reach and support these caregivers.
Collapse
|