Characterizing Caregiving Intensity Among Mexican-origin Women Caregivers

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Hispanic Caregivers of the Money Follows the Person Program in Connecticut: Satisfaction, Familism, and Burden

Hispanic caregivers provide more assistance than the U.S. average, but underutilize support services and report low levels of program satisfaction. A possible exception is the Money Follows the Person (MFP) program. Using an ordered logit statistical approach, we studied program satisfaction of all Hispanic caregivers assisting Connecticut MFP participants from 2014 to 2019, examining the effects of caregiver familism, burden, and personal characteristics including self-reported health and perceived financial situation. Healthier caregivers with positive perceptions of MFP’s usefulness and lower subjective burden reported higher program satisfaction. In ordered logits for separate blocks, familism elements (finding caregiving worthwhile, feeling well-supported as a caregiver, and having a good relationship with the care recipient) were statistically significant and associated with higher satisfaction. Our exclusive focus on Hispanic caregivers highlights the role of familism in satisfaction, and demonstrates that programs with a supportive caregiver component can supplement familism ties and overcome barriers to service usage.

Depressive symptoms in child caregivers of very old Mexican Americans

OBJECTIVE

To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers.

METHODS

This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms.

RESULTS

Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver.

CONCLUSIONS

In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.

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

BACKGROUND AND OBJECTIVES

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

DISCUSSION AND IMPLICATIONS

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

Burden and Bad Days Among Mexican-Origin Women Caregivers

OBJECTIVES

This article examines the construct of burden and the use of coping strategies among Mexican-origin caregivers of older adults.

METHODS

In-depth semistructured interviews were conducted with 44 Mexican-origin women caregivers living in the East Los Angeles area. Audio files were transcribed and analyzed in Atlas.ti V7.1.8. Data were analyzed using a grounded theory approach.

RESULTS

Caregivers did not typically talk about caregiving as a burden per se; they used other terms for burden that resonated with their experiences. Caregivers viewed caregiving difficulty in physical and emotional terms as it related to specific caregiving circumstances and situations. Caregivers used a variety of coping strategies to get through bad days, including reframing stressful situations to make sense of their circumstances.

DISCUSSION

Findings shed light on the mixed results found in the literature on Latino caregiving burden. Results suggest that Mexican-origin women caregivers have a more nuanced experience of caregiving burden than has been found in prior literature. Results also suggest research using traditional measures of burden may not fully capture situational and cultural distinctions to the extent Mexican-origin caregivers ascribe other language to represent difficult caregiving experiences.

Care Recipient Multimorbidity and Health Impacts on Informal Caregivers: A Systematic Review

BACKGROUND AND OBJECTIVES

Caregiving outcomes have often been reported in terms of care recipients of single disease, rather than multiple health conditions. A systematic review was conducted to outline caregiving health outcomes and its association with care recipient multimorbidity for informal caregivers of older adults.

RESEARCH DESIGN AND METHODS

A search strategy was applied in six databases and grey literature. Inclusion criteria were primary observational studies on informal caregiving for care recipients aged 60 years and above, in the English language. Informal caregivers were those not formally hired and multimorbidity referred to presence of at least two health conditions. From a total of 2,101 titles, 230 abstracts were screened, and 19 articles were included. Quality assessment was conducted with application of the Newcastle-Ottawa-Scale.

RESULTS

Health-related and caregiving-related outcomes have been assessed for informal caregivers of older adults with multimorbidity. Caregiver subjective burden was most commonly evaluated and often reported to be low to moderate. In association with care recipient multimorbidity, caregiver burden, quality of life, and perceived difficulty in assisting the older adults were examined in 14 of the studies with mixed results. Studies were heterogeneous, with nonuniform definitions of informal caregivers and multimorbidity as well as measurement tools.

DISCUSSION AND IMPLICATIONS

This narrative review found that caring for older adults with multimorbidity impacts caregivers, although overall evidence is not conclusive. Despite caregiving-related outcomes being most commonly assessed among the caregivers, particularly subjective burden, findings suggest that it is worthwhile to examine other outcomes to enrich the evidence base.

Caregiving Intensity and Mortality in Older Women, Accounting for Time-Varying and Lagged Caregiver Status: The Caregiver-Study of Osteoporotic Fractures Study

BACKGROUND AND OBJECTIVES

Caregiving is associated with reduced mortality in recent studies. Investigations of caregiving intensity may reveal an underlying mechanism. However, studies of caregiving intensity and mortality have mixed results, perhaps due to imprecise measurement of caregiving intensity, not accounting for healthier persons likely having greater caregiving involvement, or temporal changes in intensity. We examined the relationship between caregiving intensity (based on tasks performed) and mortality, treating intensity and health status as time-varying, and lagging exposure.

RESEARCH DESIGN AND METHODS

Caregiving tasks among 1,069 women in the Caregiver-Study of Osteoporotic Fractures study (35% caregivers) were assessed at 5 interviews conducted between 1999 and 2009. Caregivers were categorized as high intensity if they assisted a person with dressing, transferring, bathing, or toileting; or as low intensity if they assisted with other instrumental or basic activities of daily living (I/ADLs). Alternatively, high intensity was defined as assisting with more than the median number of I/ADL tasks (median-based measure). Mortality was assessed through 2011. Cox proportional hazards models estimated adjusted hazard ratios (aHR) and 95% confidence intervals based on concurrent intensity, and lagging exposure 2 years.

RESULTS

High-intensity caregivers had significantly lower mortality using the median-based measure after lagging exposure (aHR = 0.55, 0.34-0.89). Similar, but not statistically significant associations were observed in non-lagged analyses (aHR = 0.54, 0.29-1.04) and task-specific intensity (aHRs were 0.61 and 0.51). Low-intensity caregivers had similar mortality rates to noncaregivers in all analyses.

DISCUSSION AND IMPLICATIONS

Among older women, high-intensity caregivers had lower mortality rates than noncaregivers. Whether this association extends to other populations merits investigation.