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Cleary C, Dupree G, Welling A, Hernandez JF, Cuevas H, Thomas M, Peterson N, Horner SD, Thomas Hebdon M. Experiences and Supportive Care Needs of Latinx Millennial Caregivers. J Transcult Nurs 2024:10436596241274116. [PMID: 39268620 DOI: 10.1177/10436596241274116] [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: 09/17/2024] Open
Abstract
INTRODUCTION Latinx Millennial caregivers are an understudied minority group in the United States. Due to life stage and cultural values, these caregivers struggle to balance conflicting priorities with career, family, and caregiving. They also face systemic barriers and healthcare disparities. METHODS Participants (N = 29) were recruited locally and nationally. Qualitative data were collected using five focus groups and one individual interview. Interviews were analyzed by seven coders using thematic analysis with an inductive approach. RESULTS Meta-themes included (a) the Latinx experience with culture, immigrant status, and structural barriers; and (b) being a super caregiver: being everything to everyone. Additional main themes were identified including family well-being, occupational and financial well-being, social support dynamics, challenges and rewards of family caregiving, and coping strategies. DISCUSSION Clinical interventions for Latinx Millennial caregivers should address cultural background, value of family/community, and systemic barriers for care and support.
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Losada-Baltar A, Falzarano FB, Hancock DW, Márquez-González M, Pillemer K, Huertas-Domingo C, Jiménez-Gonzalo L, Fernandes-Pires JA, Czaja SJ. Cross-National Analysis of the Associations Between Familism and Self-Efficacy in Family Caregivers of People With Dementia: Effects on Burden and Depression. J Aging Health 2024; 36:403-413. [PMID: 37585806 PMCID: PMC10858290 DOI: 10.1177/08982643231193579] [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] [Indexed: 08/18/2023]
Abstract
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.
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Affiliation(s)
| | - Francesca B. Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David W. Hancock
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - María Márquez-González
- Department of Clinical and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, NY, USA
| | | | | | | | - Sara J. Czaja
- Department of Psychology, Universidad Rey Juan Carlos, Madrid, Spain
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Pedreira PB, Fleszar-Pavlović SE, Walsh EA, Noriega Esquives B, Moreno PI, Perdomo D, Heller AS, Antoni MH, Penedo FJ. Familism, family cohesion, and health-related quality of life in Hispanic prostate cancer survivors. J Behav Med 2024; 47:595-608. [PMID: 38429598 PMCID: PMC11293424 DOI: 10.1007/s10865-024-00479-1] [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: 08/08/2023] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Familism, the cultural value that emphasizes feelings of loyalty and dedication to one's family, has been related to both positive and negative outcomes in Hispanic cancer survivors. One potential source of observed inconsistencies may be limited attention to the family environment, as familism may be protective in a cohesive family whereas it can exacerbate distress in a conflictive family. PURPOSE The current study explored the associations of familism with general and disease-specific health-related quality of life (HRQoL) in Hispanic men who completed prostate cancer (PC) treatment, and whether family cohesion may help explain these relationships. METHODS Hispanic men treated for localized PC (e.g., radiation, surgery) were enrolled in a randomized controlled stress management trial and assessed prior to randomization. Familism (familial obligation) was assessed using Sabogal's Familism Scale and family cohesion was measured using the Family Environment Scale (ranging from high to low). The sexual, urinary incontinence, and urinary obstructive/irritative domains of the Expanded Prostate Cancer Index Composite - Short Form measured disease-specific HRQoL. The physical, emotional, and functional well-being subscales of the Functional Assessment of Cancer Therapy - General captured general HRQoL. Hierarchical linear regression and the SPSS PROCESS macro were used to conduct moderation analyses, while controlling for relevant covariates. RESULTS Participants were 202 older men on average 65.7 years of age (SD = 8.0) who had been diagnosed with PC an average of 22 months prior to enrollment. Familism was not directly associated with general and disease-specific HRQoL. Moderation analyses revealed that greater familism was related to poorer urinary functioning in the incontinence (p = .03) and irritative/obstructive domains (p = .01), and lower emotional well-being (p = .02), particularly when family cohesion was low. CONCLUSIONS These findings underscore the importance of considering contextual factors, such as family cohesion, in understanding the influence of familism on general and disease-specific HRQoL among Hispanic PC patients. The combined influence of familism and family cohesion predicts clinically meaningful differences in urinary functioning and emotional well-being during the posttreatment phase. Culturally sensitive psychosocial interventions to boost family cohesion and leverage the positive impact of familistic attitudes are needed to enhance HRQoL outcomes in this population.
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Affiliation(s)
| | - Sara E Fleszar-Pavlović
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emily A Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Blanca Noriega Esquives
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dolores Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aaron S Heller
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Neidre DB, Delgado RE, Peacock KS, Luy LP, White CL. A Scoping Review to Contribute to Knowledge About Culturally Adapting Interventions for Latino Family Caregivers of Persons Living With Dementia. J Transcult Nurs 2024:10436596241256328. [PMID: 38828565 DOI: 10.1177/10436596241256328] [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: 06/05/2024] Open
Abstract
INTRODUCTION Few interventions have focused on Latino family caregivers to persons with dementia, addressing their unique needs. This review aimed to identify best practices in cultural adaptation to make recommendations for adapting interventions for Latino family caregivers of persons living with dementia. METHOD This scoping review was conducted following the Joanna Briggs Institute Scoping Review guidelines, with findings extracted and summarized from 17 studies addressing cultural adaptation. RESULTS Frameworks guiding the adaptations were comprehensive, addressing cultural values and traditions and the social context faced by Latino family caregivers. Features of the adaptations included diverse teams of researchers and community members, including Latino family caregivers, to inform the integration of cultural values into the content, mode, and place of intervention delivery. DISCUSSION Culturally adapting evidence-based interventions will increase the number of available interventions for Latino family caregivers to persons living with dementia, thus reducing inequities in caregiver support.
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Garcia RI, Khemka S, Roghani AK, Reddy RP, Pattoor V, Jacob M, Reddy A, Sehar U, Reddy PH. Caring for Individuals with Alzheimer's Disease: A Spotlight on Hispanic Caregivers. J Alzheimers Dis Rep 2024; 8:877-902. [PMID: 38910940 PMCID: PMC11191631 DOI: 10.3233/adr-240035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/18/2024] [Indexed: 06/25/2024] Open
Abstract
A caregiver is a constantly evolving role that an individual most likely undertakes at some point in their lifetime. With discoveries and research in increasing life expectancy, the prevalence of neurological-related diseases, such as Alzheimer's disease (AD) and dementia, is certainly likely to require more caregivers. The demand for AD caregivers is escalating as the prevalence of the disease continues to rise. The projected rise in AD within the Hispanic population in the United States over the next few decades is expected to be the most significant among all ethnic groups. The Hispanic population faces unique dementia risks due to cultural factors like language barriers, lower education, and limited healthcare access. Higher rates of conditions such as diabetes and cardiovascular disease further elevate dementia risk. Family dynamics and caregiving responsibilities also differ, affecting dementia management within Hispanic households. Addressing these distinct challenges requires culturally sensitive approaches to diagnosis, treatment, and support for Hispanic individuals and their family's facing dementia. With AD and other dementia becoming more prevalent, this article will attempt to expand upon the status of caregivers concerning their economic, health, and cultural statuses. We will attempt to focus on the Hispanic caregivers that live in Texas and more specifically, West Texas due to the lack of current literature that applies to this area of Texas. Lastly, we discuss the ramifications of a multitude of factors that affect caregivers in Texas and attempt to provide tools that can be readily available for Hispanics and others alike.
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Affiliation(s)
- Ricardo Isaiah Garcia
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sachi Khemka
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Aryan Kia Roghani
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Frenship High School, Lubbock, TX, USA
| | - Ruhananhad P. Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Lubbock High School, Lubbock, TX, USA
| | - Vasanthkumar Pattoor
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- University of South Florida, Tampa, FL, USA
| | - Michael Jacob
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Biology, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Aananya Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Lubbock High School, Lubbock, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Nutritional Sciences Department, College of Human Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Speech, Language and Hearing Services, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Mehdipanah R, Morgenstern LB, Bettger JP, Kwicklis M, Case E, Almendarez E, Lisabeth LD. Caring for Stroke Survivors: Ethnic Differences in Informal Caregiver Needs Among Mexican American and Non-Hispanic White Communities. Stroke 2024; 55:1271-1277. [PMID: 38567501 PMCID: PMC11039376 DOI: 10.1161/strokeaha.123.043275] [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] [Received: 03/28/2023] [Accepted: 02/06/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND After stroke, Mexican American (MA) individuals have worse 90-day neurological, functional, cognitive, and quality of life outcomes and a higher prevalence of poststroke depression compared with non-Hispanic White (NHW) individuals. MA individuals receive more help through informal, unpaid caregiving than NHW individuals. We examined ethnic differences in needs identified by MA and NHW stroke caregivers. METHODS Caregivers were identified from the population-based BASIC study (Brain Attack Surveillance in Corpus Christi) in Nueces County, Texas from October 2019 to November 2021. Responses to the Caregiver Needs and Concerns Checklist were collected at 90-day poststroke to assess caregiver needs. Using the cross-sectional sample, prevalence scores and bivariate analyses were used to examine ethnic differences between Caregiver Needs and Concerns Checklist items. Linear regression was used to examine adjusted associations of ethnicity with the total average needs for each domain. Models were adjusted for patient and caregiver age and sex, caregiver education level, and employment status, patient insurance status, prestroke function, cognitive status, language, and functional outcome at 90 days, intensity and duration of caregiving, presence of other caregivers (paid/unpaid), and cohabitation of patient and caregiver. RESULTS A total of 287 were approached, and 186 stroke caregivers were included with a median age of 54.2 years and 80.1% being women caregivers: 74.3% MA and 25.7% NHW individuals. MA caregivers had significantly lower education ( CONCLUSIONS MA stroke caregivers have greater information needs compared with NHW caregivers and a greater number of needs overall. This information can help improve resources to help with poststroke recovery, improve caregiver well-being, and strengthen health equity.
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Affiliation(s)
| | | | | | | | - Erin Case
- School of Public Health, University of Michigan, Ann Arbor, MI
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Mehdipanah R, Briceño EM, Malvitz M, Chang W, Lewandowski-Romps L, Heeringa SG, Levine DA, Zahuranec DB, Langa KM, Gonzales XF, Garcia N, Morgenstern LB. Exploring Pathways to Caregiver Health: The Roles of Caregiver Burden, Familism, and Ethnicity. J Aging Health 2024:8982643241235970. [PMID: 38388008 PMCID: PMC11339238 DOI: 10.1177/08982643241235970] [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] [Indexed: 02/24/2024]
Abstract
OBJECTIVES This study examines the associations of ethnicity, caregiver burden, familism, and physical and mental health among Mexican Americans (MAs) and non-Hispanic Whites (NHWs). METHODS We recruited adults 65+ years with possible cognitive impairment (using the Montreal Cognitive Assessment score<26), and their caregivers living in Nueces County, Texas. We used weighted path analysis to test effects of ethnicity, familism, and caregiver burden on caregiver's mental and physical health. RESULTS 516 caregivers and care-receivers participated. MA caregivers were younger, more likely female, and less educated compared to NHWs. Increased caregiver burden was associated with worse mental (B = -0.53; p < .001) and physical health (B = -0.15; p = .002). Familism was associated with lower burden (B = -0.14; p = .001). MA caregivers had stronger familism scores (B = 0.49; p < .001). DISCUSSION Increased burden is associated with worse caregiver mental and physical health. MA caregivers had stronger familism resulting in better health. Findings can contribute to early identification, intervention, and coordination of services to help reduce caregiver burden.
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Affiliation(s)
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation; Ann Arbor, MI
| | - Madelyn Malvitz
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
| | - Wen Chang
- University of Michigan Institute for Social Research; Ann Arbor, MI
| | | | | | - Deborah A. Levine
- University of Michigan Medical School, Department of Internal Medicine; Ann Arbor, MI
| | - Darin B. Zahuranec
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research; Ann Arbor, MI
- University of Michigan Medical School, Department of Internal Medicine; Ann Arbor, MI
- Veterans Affairs Ann Arbor Center for Clinical Management Research; Ann Arbor, MI
| | - Xavier F. Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences; Ann Arbor, MI
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
| | - Lewis B. Morgenstern
- University of Michigan, School of Public Health; Ann Arbor, MI
- University of Michigan Medical School, Department of Neurology; Ann Arbor, MI
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Duenas-Lopez M, Morgan O, Marshall DC, Carney L, Caban-Martinez A, Huang M, Portelance L, Schnur J. Cuban American Perspectives on Sexual Dysfunction Following Pelvic Radiotherapy: A Qualitative Study. SEXUALITY AND DISABILITY 2023; 41:757-768. [PMID: 38948491 PMCID: PMC11213550 DOI: 10.1007/s11195-023-09812-z] [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: 09/24/2023] [Indexed: 07/02/2024]
Abstract
Participation in sexual medicine research may depend on a patient's willingness to speak openly about sex, sexual function, or other sensitive topics. These topics may be difficult or uncomfortable to talk about, and this discomfort may be further amplified when a patient comes from a cultural background that stigmatizes open conversation about sex and sexuality. We used qualitative analysis to better understand the intersection between cultural identity, the experience of sexual dysfunction as a side-effect of pelvic radiotherapy, and willingness to communicate about sexual dysfunction with healthcare providers, in Cuban American women in Miami, Florida. Doing so, we found four unique themes among Cuban American participants regarding the intersection of national identity, Hispanic identity, Catholic religion, and their experience of radiotherapy-related sexual dysfunction: Marianismo, Machismo, Familismo, and Espiritismo. These themes, a reflection of the cohort's shared identity, were found to have an effect on participant views of sexual health, romantic relationships, coping strategies, and relative comfort discussing problems with intercourse. These cultural values served as barriers to openly discussing sexual dysfunction with not just medical providers and research teams but also their partners, families, and friends. In order to encourage Cuban American participation in sexual medicine studies, future research should evaluate strategies to overcome these barriers.
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Affiliation(s)
| | - Orly Morgan
- Department of Public Health Science, University of Miami, Miami, FL, USA
- University of Miami Miller School of Medicine, 1600 NW 10Th Ave #1140, Miami, FL 33136, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, United States
| | - Deborah C. Marshall
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, Blavatnik Family Women’s Health Research Institute, New York, NY, USA
| | - Lauren Carney
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Marilyn Huang
- Department of Gynecologic Oncology, University of Virginia School of Medicine, Charlottesville, USA
| | - Lorraine Portelance
- University of Miami Miller School of Medicine, 1600 NW 10Th Ave #1140, Miami, FL 33136, USA
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, United States
| | - Julie Schnur
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Jaldin MA, Balbim GM, Colin SJ, Marques IG, Mejia J, Magallanes M, Rocha JS, Marquez DX. The influence of Latino cultural values on the perceived caregiver role of family members with Alzheimer's disease and related dementias. ETHNICITY & HEALTH 2023; 28:619-633. [PMID: 36036081 DOI: 10.1080/13557858.2022.2115018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES We explored how Latino cultural values play a role in perceived caregiving experiences. DESIGN We conducted a qualitative study that used individual, in-depth, semi-structured interviews with middle-aged and older Latinos who were primary caregivers of family members with Alzheimer's disease and related dementias (ADRD). The interview guide consisted of questions about participants' perceptions of family caregiving and interrelationships between the caregiver and care recipient. The interviews were recorded, translated, and transcribed verbatim. We performed direct content analysis. RESULTS Participants were caregivers, 50-75 years old (n = 16), and the majority were female. We identified four cultural values that were salient to participants' caregiving experiences: (a) familismo, (b) fatalismo (c) marianismo, and (d) machismo. CONCLUSION Latino cultural values influenced the role of caregiving and caregiving roles of family members with ADRD. Future research should consider these values as they affect different familial and health dynamics.
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Affiliation(s)
- Michelle A Jaldin
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Guilherme M Balbim
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Stephanie J Colin
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Isabela G Marques
- Division of Rheumatology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jasmine Mejia
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Judith S Rocha
- Social Work Program, College of Arts and Sciences, Northeastern Illinois University, Chicago, IL, USA
| | - David X Marquez
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Quiñones MM, Silva C, Ross C, Sörensen S, Serrano R, Van Orden K, Heffner K. Recruiting Socially Disconnected Latinos Caring for a Person with Alzheimer's Disease and Related Dementias During the COVID-19 Pandemic: Lessons Learned. Clin Gerontol 2023:1-14. [PMID: 37005703 PMCID: PMC10542654 DOI: 10.1080/07317115.2023.2197895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
OBJECTIVES The purpose of this article is to present conceptual and methodological challenges to recruitment strategies in enrolling socially disconnected middle-aged and older Latino caregivers of a loved one with Alzheimer's disease and related dementias (ADRD). METHODS Middle-aged and older Latino ADRD caregivers were recruited into two early stage, intervention development studies during the COVID-19 pandemic via online or in-person methods. Recruitment criteria included Latino ADRD caregivers over the age of 40 reporting elevated loneliness on the UCLA 3-item Loneliness Scale (LS) during screening. RESULTS Middle-aged, Latino caregivers were recruited predominantly from online methods whereas older caregivers were mostly recruited from in-person methods. We report challenges identifying socially disconnected Latino caregivers using the UCLA 3-item LS. CONCLUSIONS Our findings support previously reported disparities in recruitment by age and language and suggest further methodological considerations to assess social disconnection among Latino caregivers. We discuss recommendations to overcome these challenges in future research. CLINICAL IMPLICATIONS Socially disconnected Latino ADRD caregivers have an elevated risk for poor mental health outcomes. Successful recruitment of this population in clinical research will ensure the development of targeted and culturally sensitive interventions to improve the mental health and overall well-being of this marginalized group.
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Affiliation(s)
- Maria M Quiñones
- Elaine C. Hubbard Center for Nursing Research on Aging School of Nursing, University of Rochester Medical Center, New York, USA
| | - Caroline Silva
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
| | - Carmona Ross
- Warner School of Education and Human Development, University of Rochester, New York, USA
| | - Silvia Sörensen
- Warner School of Education and Human Development, University of Rochester, New York, USA
| | | | - Kimberly Van Orden
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
| | - Kathi Heffner
- Elaine C. Hubbard Center for Nursing Research on Aging School of Nursing, University of Rochester Medical Center, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
- Division of Geriatrics & Aging Department of Medicine, University of Rochester Medical Center, New York, USA
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Freytes IM, Schmitzberger MK, Rivera-Rivera N, Lopez J, Motta-Valencia K, Wu SS, Orozco T, Hale-Gallardo J, Eliazar-Macke N, LeLaurin JH, Uphold CR. Study protocol of a telephone problem-solving intervention for Spanish-speaking caregivers of veterans post-stroke: an 8-session investigator-blinded, two-arm parallel (intervention vs usual care), randomized clinical trial. BMC PRIMARY CARE 2023; 24:73. [PMID: 36932321 PMCID: PMC10022053 DOI: 10.1186/s12875-022-01929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/25/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Stroke is one of the leading causes of death and the main cause of long-term disability in the United States. The significant risk factors of stroke among Hispanics are well-documented. The majority of stroke survivors return home following a stroke and are cared for by family caregivers. Due to the abrupt nature of strokes, caregivers experience unexpected changes and demands that oftentimes lead to caregiver burden and depression. Given the significant risk factors for stroke in Hispanics and the influence of culture in family norms and family management, we developed a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers. This study tests the impact of a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers on caregiver outcomes. METHODS The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 290 caregivers from 3 Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a problem-solving intervention that uses telephone and online education and care management tools on the previously developed and nationally available RESCUE en Español Caregiver website. In the usual care group, participants receive the information and/or support caregivers of veterans with stroke normally receive through existing VA resources (e.g., stroke-related information and support). The primary outcome is change in caregiver's depressive symptoms at 1- and 12-weeks post-intervention. Secondary outcomes include changes in stroke caregivers' burden, self-efficacy, problem-solving, and health-related quality of life (HRQOL) and veterans' functional abilities. We will also determine the budgetary impact, the acceptability of the intervention and participation barriers and facilitators for Spanish-speaking stroke caregivers. DISCUSSION This is an ongoing study. It is the first known randomized controlled trial testing the effect of a telephone and online problem-solving intervention in Spanish for caregivers of veterans post-stroke. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post-stroke. TRIAL REGISTRATION ClinicalTrials.gov: NCT03142841- Spanish Intervention for Caregivers of Veterans with Stroke (RESCUE Español). Registered on February 23, 2018. Protocol version 8. 08.11.2022.
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Affiliation(s)
- I Magaly Freytes
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA.
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA.
| | - Magda K Schmitzberger
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Naiomi Rivera-Rivera
- Research Service, VA Caribbean Healthcare System, 10 Casia St, San Juan, PR, 00921, USA
| | - Janet Lopez
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Keryl Motta-Valencia
- Physical Medicine and Rehabilitation Service, VA Caribbean Healthcare System, 10 Casia St, San Juan, PR, 00921, USA
| | - Samuel S Wu
- College of Medicine, Department of Biostatistics, University of Florida, CTRB Room 5243, 2004 Mowry Road, Gainesville, FL, 32610, USA
| | - Tatiana Orozco
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Jennifer Hale-Gallardo
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Nathaniel Eliazar-Macke
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Jennifer H LeLaurin
- Research Service, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
| | - Constance R Uphold
- Geriatric Research Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd #151B, Gainesville, FL, 32608, USA
- College of Medicine, Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32603, USA
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12
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M Hamid G, Maldonado L, Moriarty H, Deatrick JA. Social Determinants of Health in the Lives of Urban-Dwelling, Pregnant Puerto Rican Women and Families: Nursing Implications From a Secondary Narrative Analysis. JOURNAL OF FAMILY NURSING 2023; 29:59-73. [PMID: 36129198 DOI: 10.1177/10748407221121826] [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: 06/15/2023]
Abstract
Urban-dwelling childbearing Puerto Rican women and families on the U.S. mainland face a myriad of social determinants that affect pregnancy and overall health outcomes. Historically, Puerto Ricans have poorest pregnancy outcomes of all Hispanic women. Acknowledgment of the cyclic, structural barriers faced by this patient population is essential to providing wholistic care. Here, we discuss family nursing implications derived from narrative analysis of a parent study that investigated ecological systems affecting 21 pregnant Puerto Rican women residing in an impoverished and crime-ridden neighborhood in Philadelphia. Content analysis of interviews revealed interwoven social determinants of health embedded in participant narratives. Furthermore, we present case vignettes based on integration of participant interviews that encapsulate the everyday experiences of these women and their families and provide clinicians with guidance and strategies for interacting with and advocating for this population.
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13
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Mehdipanah R, Briceño EM, Gonzales X, Heeringa SG, Levine DA, Langa KM, Garcia N, Longoria R, Morgenstern LB. Dementia care needs for individuals and caregivers among Mexican Americans and non-Hispanic Whites. Aging Ment Health 2022; 26:1630-1641. [PMID: 34096422 PMCID: PMC8864934 DOI: 10.1080/13607863.2021.1925222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mexican Americans (MA) are more likely to have cognitive impairment and dementia (CID), be diagnosed at an earlier age and live with CID longer, compared to non-Hispanic Whites (NHW). While studies have examined unmet needs of individuals with CID and their caregivers, few have focused on MA populations in the U.S. This paper examines the needs of community-residing individuals with CID and their caregivers in Nueces County, Texas, a county with one of the largest MA populations in the U.S., while exploring ethnic differences in needs identified. Using concept mapping, a mixed-method approach, qualitative input on perceived needs by informal caregivers and health professionals was collected. Participants then sorted and rated perceived needs. Using this information, multidimensional scaling and cluster analyses were conducted to map the relationship between perceived needs and determine their importance and priority. Five clusters were derived for caregivers and four for the health professionals. Themes across both caregivers and health professionals highlighted the need for specialized and team-based medical care, caregiver support and training, along with socio-economic and physical needs that help with day-to-day care of individuals with CID. Among caregivers, MA rated financial resources as more important and of higher priority compared to NHW. The health professionals' perspectives were aligned with those of all caregivers. By understanding the needs of caregivers and individuals with CID, we can help families deal with this disease and let caregivers thrive. This is especially important for minority populations like MAs.
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Affiliation(s)
| | - Emily M. Briceño
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation
| | - Xavier Gonzales
- Texas A&M University-Corpus Christi, Department of Life Sciences
| | | | - Deborah A. Levine
- University of Michigan Medical School, Department of Internal Medicine
| | - Kenneth M. Langa
- University of Michigan Institute for Social Research,University of Michigan Medical School, Department of Internal Medicine,Veterans Affairs Ann Arbor Center for Clinical Management Research
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology
| | - Ruth Longoria
- University of Michigan Medical School, Department of Neurology
| | - Lewis B. Morgenstern
- University of Michigan, School of Public Health,University of Michigan Medical School, Department of Neurology
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14
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Falzarano F, Moxley J, Pillemer K, Czaja SJ. Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes. J Gerontol B Psychol Sci Soc Sci 2022; 77:1269-1279. [PMID: 34473247 PMCID: PMC9255933 DOI: 10.1093/geronb/gbab160] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Francesca Falzarano
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Karl Pillemer
- College of Human Ecology, Cornell University, Ithaca, New York, USA
| | - Sara J Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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15
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Martinez IL, Acosta Gonzalez E. Care v. Caring: Obligation, Duty, and Love Among Latino Alzheimer's Family Caregivers. J Appl Gerontol 2022; 41:1744-1751. [PMID: 35484911 DOI: 10.1177/07334648221084998] [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: 11/17/2022] Open
Abstract
The number of Latinos living with Alzheimer's disease is projected to grow. Latinos currently make one-fifth of U.S. family caregivers. In this paper, we explore the cultural scripts and gendered practice of care in Latino families in relation to the underutilization of services to persons with Alzheimer's disease and related dementias. We conducted interviews with 24 Latino caregivers in Miami-Dade, Florida representing six Latin American countries of origin. Interviews were analyzed using a grounded theory approach. We critically examined the concept of familism in order to better understand in-depth experiences of diverse Latino caregivers and concluded that an ethics of care model better elucidates the complexities of the care experience. Our analysis illustrates the ambivalence, contradictions, and changes in the beliefs and practice of care. These findings can help advance understanding among researchers and providers to develop a formal support system that is responsive to Latino caregiver needs.
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Affiliation(s)
- Iveris L Martinez
- Center for Successful Aging, 14668California State University Long Beach, Long Beach, CA, USA
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16
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Guerra S, James T, Rapaport P, Livingston G. Experience of UK Latin Americans caring for a relative living with dementia: A qualitative study of family carers. DEMENTIA 2022; 21:1574-1595. [PMID: 35437051 DOI: 10.1177/14713012221076954] [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: 11/15/2022]
Abstract
INTRODUCTION Most studies of the Latin American immigrant experience and care for relatives living with dementia have been in the United States (US). In the United Kingdom (UK), unlike the US, most Latin Americans are first generation immigrants and are a rapidly increasing population. Therefore, we aimed to explore the UK experiences of Latin Americans caring for a relative with dementia. METHODS We purposively recruited UK-based Latin American family carers of people with dementia ensuring maximum diversity. We conducted semi-structured qualitative interviews (in English or Spanish) with 11 family carers, stopping recruiting when we reached thematic saturation. We took an inductive thematic analytic approach. FINDINGS Four main themes were identified: (1) Family comes first, particularly older people, leading to an obligation to care; (2) dementia as an illness that is accepted and talked about, which is regarded as positive with close networks but not wider society; (3) difficult behaviours are not the responsibility of the person with dementia, who is often conceptualised as a child; and (4) caring expectations lead to incompatibility with formal services, and a reluctance to leave people with dementia alone. CONCLUSIONS Familial obligation is the driver for family carers and acceptance of the illness helped despite adversities. Openness to talk about dementia with close networks was distinctive and helpful, contrasting with wider society, where greater awareness of dementia is needed. Considering the person with dementia as a child did not seem to undermine personhood and enabled maintenance of compassion. The relative with dementia was a priority. There was a lack of culturally and linguistically appropriate services, thus restricting family carers' ability to fulfil other roles, such as parental.
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Affiliation(s)
- Stefanny Guerra
- Division of Psychiatry, 4919University College of London, London, UK
| | - Tiffeny James
- Division of Psychiatry, 4919University College of London, London, UK
| | - Penny Rapaport
- Division of Psychiatry, 4919University College of London, London, UK
| | - Gill Livingston
- Division of Psychiatry, 4919University College of London, London, UK
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17
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Martinez IL, Acosta Gonzalez E, Quintero C, Vania MJ. The Experience of Alzheimer's Disease Family Caregivers in a Latino Community: Expectations and incongruences in support services. J Gerontol B Psychol Sci Soc Sci 2021; 77:1083-1093. [PMID: 34543386 DOI: 10.1093/geronb/gbab170] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Current theoretical constructs on the utilization of formal support for Latino caregivers focus on familism and exclude the cultural values represented in the service system. The purpose of this paper is to highlight the experience of care for Latino family caregivers to persons with Alzheimer's disease and related dementias (ADRD). We also examine the cultural congruence between provider perspectives with the expectations of Latino ADRD caregivers. METHOD We conducted extended interviews with 24 Latino ADRD caregivers and 10 service providers. Interview transcripts were coded and analyzed using a grounded theory approach. RESULTS Our study provides a deeper understanding of Latino caregiving experiences and highlights some of the structural and systematic issues in current systems of caregiver support. While Latino families have very specific notions of care, by upholding notions of familism, there is a tendency to not look deeper into how they may be better supported in caregiving and fall into the "culture trap." The assumption that family should be the natural support network for older adults may lead to health and social systems of care to ignore the specific needs of the Latino population. DISCUSSION Services are being provided under a model that was established four decades ago and may not reflect current realities. The concept of "an ethics of care" allows us to move beyond familism and explain that underutilization of services may also be due in part to the cultural incongruence between what service providers offer and the perceived needs of Latino caregivers.
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18
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Cabrera LY, Kelly P, Vega IE. Knowledge and Attitudes of two Latino Groups about Alzheimer Disease: a Qualitative Study. J Cross Cult Gerontol 2021; 36:265-284. [PMID: 34196838 PMCID: PMC8421275 DOI: 10.1007/s10823-021-09432-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
Clustering Latinos under a single group in Alzheimer Disease (AD) research, neglects, among other things cultural and environmental differences. To address this, we examine knowledge and attitudes about AD among two Latino groups. We held 5 focus groups and 2 interviews all in Spanish with Mexicans and Puerto Ricans between 40 and 60 years old living in the Grand Rapids area in Michigan. Using content analysis of the discussions, we identified themes related to knowledge, attitudes and concerns about AD and caregiving. A total of 20 Mexicans and 9 Puerto Ricans participated. Improving knowledge and awareness, barriers and home-based family care were important themes in both Latino groups. Puerto Rican groups raised more concerns about the disease, whereas lack of knowledge was a key theme among Mexican participants. The exploratory study is a first step in promoting research that is attentive to the commonalities and differences of Latino groups and in continuing efforts to enhance health literacy among these groups.
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Affiliation(s)
- Laura Y Cabrera
- Department of Engineering Science and Mechanics, Center for Neural Engineering, College of Engineering, Pennsylvania State University, W-316 Millennium Science Complex, University Park, PA, 16802, USA.
- Rock Ethics Institute and Huck Institute of Life Sciences, Pennsylvania State University, University Park, PA, USA.
| | - P Kelly
- College of Natural Science, Michigan State University, East Lansing, MI, USA
| | - I E Vega
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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19
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Morgenstern LB, Hollenhorst CN, Gallo LC, Hsu CW, Kim S, Gibbs R, Case E, Lisabeth LD. Ethnic Differences in Informal Caregiving After Stroke. Stroke 2021; 52:3938-3943. [PMID: 34455820 DOI: 10.1161/strokeaha.120.032740] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Informal (unpaid) caregiving usually provided by family is important poststroke. We studied whether the prevalence of informal caregiving after stroke differs between Mexican Americans (MAs) and non-Hispanic Whites (NHWs). METHODS Between October 2014 and December 2018, participants in the BASIC (Brain Attack Surveillance in Corpus Christi) project in Nueces County, Texas, were interviewed 90 days after stroke to determine which activities of daily living they required help with and whether family provided informal caregiving. Ethnic differences between MAs and NHWs were determined by logistic regression. The logistic models were stratified by formal (paid) care status. Odds ratios (95% CIs) are reported with NHW as the referent group. Fisher exact tests were used to assess the association of ethnicity with relationship of caregiver and with individual activities of daily living. RESULTS Eight hundred thirty-one patients answered the caregiving questions. Of these, 242 (29%) received family caregiving (33% of MAs and 23% of NHWs), and 142 (17%) received paid caregiving (21% of MAs and 10% of NHWs). There were no ethnic differences in stroke severity. In logistic regression analyses, among those without formal, paid care, MAs were more likely to have informal caregiving (odds ratio, 1.75 [95% CI, 1.12-2.73]) adjusted for age, National Institutes of Health Stroke Scale, prestroke modified Rankin Scale, and insurance. No ethnic differences in informal care were found among those who had formal care. There were no differences between ethnic groups in which family members provided the informal care. MAs were more likely to require help compared with NHWs for walking (P<0.0001), bathing (P<0.0001), hygiene (P=0.0012), eating (P=0.0004), dressing (P<0.0001), ambulating (P=0.0304), and toileting (P=0.0003). CONCLUSIONS MAs required more help poststroke than NHWs for assistance with activities of daily living. MAs received more help for activities of daily living through informal, unpaid caregiving than NHWs if they were not also receiving formal, paid care. Efforts to help minority and low-resource populations provide stroke care are needed.
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Affiliation(s)
- Lewis B Morgenstern
- University of Michigan Medical School, Ann Arbor (L.B.M., C.N.H., L.D.L.).,University of Michigan School of Public Health, Ann Arbor (L.B.M., C.-W.H., R.G., E.C., L.D.L.)
| | | | | | - Chia-Wei Hsu
- University of Michigan School of Public Health, Ann Arbor (L.B.M., C.-W.H., R.G., E.C., L.D.L.)
| | - Sehee Kim
- Asian Medical Center, Seoul, South Korea (S.K.)
| | - River Gibbs
- University of Michigan School of Public Health, Ann Arbor (L.B.M., C.-W.H., R.G., E.C., L.D.L.)
| | - Erin Case
- University of Michigan School of Public Health, Ann Arbor (L.B.M., C.-W.H., R.G., E.C., L.D.L.)
| | - Lynda D Lisabeth
- University of Michigan Medical School, Ann Arbor (L.B.M., C.N.H., L.D.L.).,University of Michigan School of Public Health, Ann Arbor (L.B.M., C.-W.H., R.G., E.C., L.D.L.)
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20
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Massett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, Gallop-Goodman G, McGowan M. Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review. J Alzheimers Dis 2021; 82:107-127. [PMID: 33998537 DOI: 10.3233/jad-201463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.
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Affiliation(s)
- Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, USA
| | - Gerda Gallop-Goodman
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Melissa McGowan
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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21
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Withers M, Cortez-Sanchez K, Herrera J, Ringman JM, Segal-Gidan F. "My backpack is so heavy": Experiences of Latino caregivers of family with early-onset Alzheimer's. J Am Geriatr Soc 2021; 69:1539-1547. [PMID: 33713418 PMCID: PMC8193816 DOI: 10.1111/jgs.17091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND/OBJECTIVES While it is well-known that caregiving can have adverse effects on the physical and mental health of informal caregivers and their families, caregivers of those with early-onset Alzheimer's Disease (EOAD) may have distinct needs. Little is written about the experiences of Latino caregivers of family members with EOAD, especially inherited forms. This study's objective was to explore the experiences and needs of Latino caregivers of persons with EOAD. METHODS Five focus group discussions (FGDs) were conducted among 27 informal caregivers of Latinos with EOAD who were recruited through an AD clinic in Los Angeles. RESULTS The stress of caregiving was compounded by other pressures and worries, such as taking care of young children, providing financially for family, caregivers' own co-morbidities, and contemplating their own risk of inheriting EOAD. Resources for monolingual Spanish speakers were scarce. Participants had two primary unmet needs: information and support services. Participants lacked information about how to provide appropriate care, which heightened fears. Difficulty in obtaining a diagnosis from physicians who were uninformed about EOAD was also common. Recommended topics for informational campaigns included how-to videos on caring for a loved one but also topics related to self-care for caregivers. CONCLUSIONS Our results underscore the need to tailor programs for caregivers of family members with EOAD. Educational campaigns could help to dispel myths and misconceptions, reduce stigma associated with EOAD, and encourage more people to seek timely care. Additional psychosocial support, such as support groups, could build solidarity and self-efficacy. Better access to dual-language information and support could encourage early help-seeking but also improve caregivers' quality of life as they manage long-term caregiving responsibilities.
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Affiliation(s)
- Mellissa Withers
- University of Southern California, Keck School of Medicine, Institute on Inequalities in Global Health, University of Southern California
| | - Kristyan Cortez-Sanchez
- USC/Rancho Los Amigos Geriatric Neurobehavior and Alzheimer’s Center, University of Southern California
| | - Joseph Herrera
- USC/Rancho Los Amigos Geriatric Neurobehavior and Alzheimer’s Center, University of Southern California
| | | | - Freddi Segal-Gidan
- USC/Rancho Los Amigos Geriatric Neurobehavior and Alzheimer’s Center, University of Southern California
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22
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Briceño EM, Mehdipanah R, Gonzales X, Heeringa S, Levine DA, Langa KM, Garcia N, Longoria R, Morgenstern LB. Methods and Early Recruitment of a Community-Based Study of Cognitive Impairment Among Mexican Americans and Non-Hispanic Whites: The BASIC-Cognitive Study. J Alzheimers Dis 2021; 73:185-196. [PMID: 31771059 DOI: 10.3233/jad-190761] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND As the Mexican American (MA) population grows and ages, there is an urgent need to estimate the prevalence of cognitive impairment or dementia (CID), cognitive trajectories, and identify community resource needs. The Brain Attack Surveillance in Corpus Christi (BASIC)-Cognitive project is a population-based study to address these issues among older MAs and non-Hispanic whites (NHW) and their informal care providers. OBJECTIVE Present the methodology and initial recruitment findings for the BASIC-Cognitive project. METHOD Random, door-to-door case ascertainment is used in Nueces County, Texas, to recruit community-dwelling and nursing home residents ≥65 and informal care providers. Households are identified from a two-stage area probability sample, using Census data to aim for equal balance of MAs and NHWs. Individuals with cognitive screens indicative of possible CID complete neuropsychological assessment (Harmonized Cognitive Assessment Protocol from the Health and Retirement Study). Informal care providers complete comprehensive interview and needs assessment. Study pairs repeat procedures at 2-year follow-up. Asset and concept mapping are performed to identify community resources and study care providers' perceptions of needs for individuals with CID. RESULTS 1,030 age-eligible households were identified, or 27% of households for whom age could be determined. 1,320 individuals were age-eligible, corresponding to 1.3 adults per eligible household. Initial recruitment yielded robust participation in the MA eligible population (60% of 689 individuals that completed cognitive screening). CONCLUSION The BASIC-Cognitive study will provide critical information regarding the prevalence of CID in MAs, the impact of caregiving, and allocation of community resources to meet the needs of this population.
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Affiliation(s)
- Emily M Briceño
- University of Michigan Medical School, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI, USA
| | | | - Xavier Gonzales
- Texas A&M University, Department of Life Sciences, Corpus Christi, TX, USA
| | - Steven Heeringa
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Deborah A Levine
- University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI, USA
| | - Kenneth M Langa
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA.,University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI, USA
| | - Nelda Garcia
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI, USA
| | - Ruth Longoria
- University of Michigan Medical School, Department of Neurology, Ann Arbor, MI, USA
| | - Lewis B Morgenstern
- University of Michigan, School of Public Health, Ann Arbor, MI, USA.,University of Michigan Medical School, Department of Neurology, Ann Arbor, MI, USA
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23
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Cacari Stone L, Sanchez V, Bruna SP, Muhammad M, Zamora Mph C. Social Ecology of Hypertension Management Among Latinos Living in the U.S.-Mexico Border Region. Health Promot Pract 2021; 23:650-661. [PMID: 33709805 DOI: 10.1177/1524839921993044] [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: 11/15/2022]
Abstract
INTRODUCTION While a growing body of research examines individual factors affecting the prevalence and management of hypertension among Latinos, less is known about how socioecological factors operate to determine health and affect implementation of interventions in rural communities. METHOD We conducted eight focus groups to assess perceived risks and protective factors associated with managing hypertension among Latino adults and their family members living in two rural/frontier counties in the U.S.-Mexico border region. This analysis is part of a larger study, Corazon por la Vida (Heart for Life), which involved multiple data collection strategies to evaluate the effectiveness of a primary care and a promotora de salud intervention to manage hypertension. RESULTS Of the 49 focus group participants, 70% were female and 30% were male, 39% were Spanish-only speakers, and 84% had hypertension. Participants' ages ranged between 18 and 75 years, and 63% reported annual incomes below $30,000. Drawing from a social-ecological framework to analyze focus group data, four major themes and subthemes emerged as factors facilitating or inhibiting disease management: (1) individual (emotional burdens, coping mechanisms), (2) social relationships (family as a source of support, family as a source of stress), (3) health system (trust/mistrust, patient-provider communication), and (4) environment (lack of access to safe exercise environment, lack of affordable food). CONCLUSION Our findings are relevant to public health practitioners, researchers, and policymakers seeking to shift from individual level or single interventions aimed at improving treatment-modality adherence to multilevel or multiple interventions for rural Latino communities.
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Gao X, Li S, Cong C, Wang Y, Xu L. A Network Pharmacology Approach to Estimate Potential Targets of the Active Ingredients of Epimedium for Alleviating Mild Cognitive Impairment and Treating Alzheimer's Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:2302680. [PMID: 33574879 PMCID: PMC7861915 DOI: 10.1155/2021/2302680] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/21/2020] [Accepted: 01/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The present study made use of a network pharmacological approach to evaluate the mechanisms and potential targets of the active ingredients of Epimedium for alleviating mild cognitive impairment (MCI) and treating Alzheimer's disease (AD). METHODS The active ingredients of Epimedium were acquired from the Traditional Chinese Medicine System Pharmacology database, and potential targets were predicted using the TCMSP target module, SwissTargetPrediction, and PharmMapper database. Target proteins correlating with MCI and AD were downloaded from the GeneCards, DisGeNet, and OMIM databases. The common targets of Epimedium, MCI, and AD were identified using the Jvenn online tool, and a protein-protein interaction (PPI) network was constructed using the String database and Cytoscape. Finally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of the common targets was performed using DAVID, and molecular docking between active ingredients and target genes was modeled using AutoDock Vina. RESULTS A total of 20 active ingredients were analyzed, and 337 compound-related targets were identified for Epimedium. Out of 236 proteins associated with MCI and AD, 54 overlapped with the targets of Epimedium. The top 30 interacting proteins in this set were ranked by topological analysis. GO and KEGG enrichment analysis suggested that the common targets participated in diverse biological processes and pathways, including cell proliferation and apoptosis, inflammatory response, signal transduction, and protein phosphorylation through cancer pathway, MAPK signaling pathway, PI3K-Akt signaling pathway, HIF-1 signaling pathway, sphingolipid signaling pathway, FoxO signaling pathway, and TNF signaling pathway. Molecular docking analysis suggested that the 20 active ingredients could bind to the top 5 protein targets. CONCLUSIONS The present study provides theoretical evidence for in-depth analysis of the mechanisms and molecular targets by which Epimedium protects against MCI, AD, and other neurodegenerative diseases and lays the foundation for pragmatic clinical applications and potential new drug development.
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Affiliation(s)
- Xianwei Gao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Shengnan Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Chao Cong
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yuejiao Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Lianwei Xu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Cadet T, Burke SL, Nedjat-Haiem F, Bakk L, Naseh M, Grudzien A, O’Driscoll J, Alcide A. Timing of Immigration Effects Asset Change Among Hispanic Caregivers of Older Family Members. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2020; 42:561-572. [PMID: 33041610 PMCID: PMC7537373 DOI: 10.1007/s10834-020-09719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 06/11/2023]
Abstract
Given the cultural value of family in Hispanic culture, older Hispanic immigrants are likely to have family caregivers. This study examined the economic implications of caring for older Hispanic adults regarding non-housing financial wealth over time. Using the 2008, 2010, and 2012 waves of the Health and Retirement Study (HRS) and RAND HRS data files, this study compares changes in the non-housing financial wealth between 2008 and 2012 by caregiving and immigration status among Hispanics. This study examined differences in assets between Hispanic caregivers and non-caregivers and more specifically examined the subpopulation of Hispanic caregivers who immigrated prior to and after 1968 as compared to U.S.-born caregivers to better understand the effect of the Immigration and Nationality Amendment Act of 1965 on asset change. Results indicate that caregiving itself did not have a statistically significant association with wealth, but the timing of immigration to the US had a statistically significant correlation (p < .05) with changes in the financial wealth. The findings of this study have implications for policy and program development targeting older adults and caregiving for this population.
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Affiliation(s)
- Tamara Cadet
- School of Social Work, Simmons University, 300 The Fenway, Boston, MA 02115 USA
- Harvard School of Dental Medicine, Oral Health Policy and Epidemiology, Boston, MA USA
| | - Shanna L. Burke
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | | | | | - Mitra Naseh
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | - Adrienne Grudzien
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | - Janice O’Driscoll
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
| | - Amary Alcide
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL USA
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Mendez-Luck CA, Anthony KP, Guerrero LR. Burden and Bad Days Among Mexican-Origin Women Caregivers. J Gerontol B Psychol Sci Soc Sci 2020; 75:1719-1730. [PMID: 31420678 DOI: 10.1093/geronb/gbz102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Indexed: 11/14/2022] Open
Abstract
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.
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Balbim GM, Maldonado AM, Early A, Steinman L, Harkins K, Marquez DX. Evaluation of Public Health Messages Promoting Early Detection of Dementia Among Adult Latinos With a Living Older Adult Parental Figure. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:163-173. [PMID: 32126826 PMCID: PMC7542987 DOI: 10.1177/1540415320908535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We aimed to evaluate the resonance of public health messages promoting early detection of dementia in adult Latinos with a living older adult loved one. METHOD We conducted a mixed-methods study with focus groups and surveys to evaluate eight messages encouraging Latino adults to accompany their older loved one for cognitive assessment. Qualitative data were transcribed and coded, and thematic analysis was conducted. We used descriptive statistics for quantitative data. RESULTS Participants suggested that messages need to be translated into Spanish and images need to be more natural, present balance between positive and serious facial expressions, show more ethnic/racial diversity, and show family members other than the parents. Five major sociocultural themes affected how the messages were received: stigma, gender roles, the importance of the mother figure, guilt, and family togetherness. CONCLUSION Public health messages targeting cultural values are needed to effectively encourage early dementia detection in Latinos. Findings can be used to adapt culturally appropriate public health messages encouraging early dementia detection in Latinos.
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Affiliation(s)
| | | | - Amy Early
- University of Illinois at Chicago, Chicago, IL, USA
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Balbim GM, Magallanes M, Marques IG, Ciruelas K, Aguiñaga S, Guzman J, Marquez DX. Sources of Caregiving Burden in Middle-Aged and Older Latino Caregivers. J Geriatr Psychiatry Neurol 2020; 33:185-194. [PMID: 31510848 DOI: 10.1177/0891988719874119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE We aimed to identify sources of caregiver burden in middle-aged and older Latino caregivers of people with Alzheimer disease and related dementia (ADRD). METHODS Participants were recruited through an agreement with the Rush Alzheimer's Disease Center Clinic Data Repository. We conducted semistructured interviews with 16 middle-aged and older Latinos who were the primary caregiver for a family member diagnosed with ADRD. The interview guide consisted of questions and probes to capture participants' perceptions of family caregiving. Direct content analysis was performed. RESULTS Participants were aged 50 to 75 years (n = 16) and a majority female (n = 12). The sources of burden identified were (1) caregiver responsibilities, (2) caregiving-related health decline, (3) lack of support, (4) financial status, (5) vigilance, and (6) concerns about the future. CONCLUSIONS The influence of gender roles seemed to play a role in caregivers' perceptions of sources of burden, especially on caregiver responsibilities and perceptions of lack of support. Latinos cultural values such as familismo and marianismo likely reinforced gender disparities in family caregiving.
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Affiliation(s)
- Guilherme Moraes Balbim
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, IL, USA
| | | | - Isabela Gouveia Marques
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Karen Ciruelas
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, IL, USA
| | - Susan Aguiñaga
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jacqueline Guzman
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - David Xavier Marquez
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois at Chicago, IL, USA
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Losada A, Márquez-González M, Vara-García C, Barrera-Caballero S, Cabrera I, Gallego-Alberto L, Olmos R, Romero-Moreno R. Measuring familism in dementia family caregivers: the revised familism scale. Aging Ment Health 2020; 24:784-788. [PMID: 30621433 DOI: 10.1080/13607863.2018.1562537] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Andrés Losada
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Carlos Vara-García
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Isabel Cabrera
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Ricardo Olmos
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rosa Romero-Moreno
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
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Rote S, Angel J, Hinton L. Characteristics and Consequences of Family Support in Latino Dementia Care. J Cross Cult Gerontol 2019; 34:337-354. [PMID: 31346891 PMCID: PMC6858530 DOI: 10.1007/s10823-019-09378-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions - including, when appropriate, employing tactics to mobilize family support.
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Affiliation(s)
- Sunshine Rote
- Kent School of Social Work, University of Louisville, Louisville, KY, USA.
| | - Jacqueline Angel
- Lyndon B. Johnson School of Public Affairs and Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Ladson Hinton
- Psychiatry and Behavioral Sciences, University of California- Davis, Davis, CA, USA
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Balbim GM, Marques IG, Cortez C, Magallanes M, Rocha J, Marquez DX. Coping Strategies Utilized by Middle-Aged and Older Latino Caregivers of Loved Ones with Alzheimer’s Disease and Related Dementia. J Cross Cult Gerontol 2019; 34:355-371. [DOI: 10.1007/s10823-019-09390-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Peterson LJ, Hyer K, Meng H, Dobbs D, Gamaldo A, O’Neil K. Discussing End-of-Life Care Preferences With Family: Role of Race and Ethnicity. Res Aging 2019; 41:823-844. [DOI: 10.1177/0164027519858716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined racial, ethnic, and other factors associated with whether older adults discussed their end-of-life (EOL) care wishes with family. A sample of 223 White, 95 African American, and 46 Hispanic adults aged 50 and older from a five-county area of Florida answered questions about sociodemographics, health, and preferences for involving family/friends in health-care decision-making. Analyses describe associations between whether discussions occurred and race/ethnicity and other factors, including preferences for family/friend involvement in health care. In descriptive analyses, one third ( n = 113) had not discussed EOL care. No differences were evident between African Americans and non-Hispanic Whites. In multivariate analyses, EOL care discussions were less likely for Hispanics. Further analysis showed this lower likelihood existed among Hispanics with lesser family/friend involvement. Ethnicity influences EOL care discussion, moderated by family/friend involvement, though results are considered preliminary. Knowing the involvement of patients’ family/friends could help providers initiate EOL care discussions.
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Affiliation(s)
| | - Kathryn Hyer
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Hongdao Meng
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Debra Dobbs
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Alyssa Gamaldo
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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Molina Y, Henderson V, Ornelas IJ, Scheel JR, Bishop S, Doty SL, Patrick DL, Beresford SAA, Coronado GD. Understanding Complex Roles of Family for Latina Health: Evaluating Family Obligation Stress. FAMILY & COMMUNITY HEALTH 2019; 42:254-260. [PMID: 31403986 PMCID: PMC6693639 DOI: 10.1097/fch.0000000000000232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We developed a measure of family obligation stress and compared its relationship to health and unmet health care needs relative to social support among a sample of US-based Latinas. Data come from a randomized controlled trial within 4 clinics to increase mammography among Latinas (n = 539). The 1-factor measure had acceptable reliability and construct validity. Family obligation stress was associated with worse health and greater unmet health care needs. Family obligation stress varied by years in the United States and country of origin. Our measure of family obligation stress contributes new venues to family research among Latino populations.
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Affiliation(s)
- Yamilé Molina
- Community Health Sciences Division, School of Public Health, University of Illinois at Chicago (Dr Molina); University of Illinois Cancer Center, Chicago (Dr Henderson); Departments of Health Services (Drs Ornelas and Patrick) and Epidemiology (Dr Beresford), School of Public Health, University of Washington, Seattle; Department of Radiology, School of Medicine, University of Washington, Seattle (Dr Scheel); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (Ms Bishop); Health Education Program Coordinator, Sea Mar Community Health Centers, Seattle, Washington (Ms Doty); and Kaiser Permanente Research Center for Health Research, Portland, Oregon (Dr Coronado)
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Rivera-Navarro J, Contador I. Family caregivers' perceptions of maltreatment of older adults with dementia: findings from the northwest of Spain. J Elder Abuse Negl 2018; 31:77-95. [PMID: 30430923 DOI: 10.1080/08946566.2018.1543623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dementia is a neurocognitive disorder that implies a risk factor of maltreatment by family caregivers. In this study, we analyzed both informal caregiver's perceptions of maltreatment and aspects of the caregiver and caregiving behavior that may be associated with maltreatment. We conducted five focus groups (FGs) in three Spanish cities: Segovia, Soria and León. The themes that were identified were related to two levels of maltreatment: (a) relational and (b) institutional. At the relational level, we observed the justification of maltreatment of Older Adults with Dementia (OAswD) by family caregivers during the occurrence of behavioral symptoms. At the institutional level, we noted that lack of support from the government was considered a type of maltreatment. These themes suggest that policy issues related to healthcare should be considered.
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Affiliation(s)
- Jesús Rivera-Navarro
- a Faculty of Social Science. Department of Sociology and Communication , University of Salamanca , Salamanca , Spain
| | - Israel Contador
- b Faculty of Psychology. Department of Basic Psychology , Psychobiology and Methodology of Behavioural Sciences, University of Salamanca , Salamanca , Spain
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García-Toro M, Sánchez-Gómez MC, Madrigal Zapata L, Lopera FJ. "In the flesh": Narratives of family caregivers at risk of Early-onset Familial Alzheimer's Disease. DEMENTIA 2018; 19:1474-1491. [PMID: 30253659 DOI: 10.1177/1471301218801501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the growing body of literature dealing with the consequences of family caregiving amongst people with dementia, there are few studies examining the impact of Early-onset Familial Alzheimer's Disease on caregivers. This study exposes the subjective experience of a group of family caregivers who themselves possess a genetic susceptibility to develop this form of dementia. We interviewed and analyzed the accounts of 27 caregivers belonging to family lineages carrying the E280A mutation for Early-onset Alzheimer's Disease. We utilized a phenomenological method to analyze these accounts, initially tracking seven theoretical categories (Anxiety, Depression, Burden, Resilience, Self-efficacy, Social Support, and Coping Strategies) and then subsequently two additional categories which emerged (Conceptions about the Disease and Other Vital Experiences Interfering with Caregiving). The results show that caring for a loved one while simultaneously running the risk of developing the same form of Alzheimer's Disease permeates the caregivers' experience both in a negative and a positive way. The continuous exposition to emotional stress in these caregivers should be seriously considered as they may be at risk of accelerating the onset of symptoms of Alzheimer's Disease, while simultaneously, early psychological symptoms of dementia may be masked by the emotional sequelae of caregiving, interfering with early diagnosis. Certainly, support services for the entire family group are suggested.
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Ramirez Gomez L, Jain FA, D'Orazio LM. Assessment of the Hispanic Cognitively Impaired Elderly Patient. Neurol Clin 2017; 35:207-229. [PMID: 28410657 DOI: 10.1016/j.ncl.2017.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hispanics are the largest minority group in the United States, approximately 7% of the population older than 65. They often encounter challenges related to health care access and quality of care. The prevalence of dementia among Hispanics is higher than that of non-Hispanic whites and they frequently present at a more advanced stage of illness. Cognitive evaluation should take into account sociodemographic information and cultural factors to avoid misdiagnosis and guide management. A provider who has knowledge of Hispanic culture should conduct the neuropsychological assessment, and tests used to measure cognitive functioning should be developed for Hispanics in the United States.
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Affiliation(s)
- Liliana Ramirez Gomez
- Department of Neurology, University of California, San Francisco, 400 Parnassus Avenue, A871, San Francisco, CA 94143, USA.
| | - Felipe A Jain
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143, USA
| | - Lina M D'Orazio
- Department of Neurology, Keck School of Medicine of USC, 1520 San Pablo Street, HCCII, Suite 3000, Los Angeles, CA 90033, USA
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Gallardo-Flores A, Sánchez-Medina JA, Fernández-Portero C. Perception of health, well-being, and quality of life in female caregivers: Comparative study of a sample of adult and older women in Spain. J Women Aging 2017; 30:382-398. [PMID: 28375812 DOI: 10.1080/08952841.2017.1302240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In a study on informal or unpaid care, it is difficult to identify the consequences and effects of care provision on the caregiver's daily life. Thus, it is important to analyze the perceptions of the individual caregiver. This study describes the perceptions of health, well-being, support networks, and quality of life of 13 women aged between 45 and 70 years after completing an intervention program. The data indicate that caregivers' health and quality of life worsen with the intervention, and their well-being and social relations (through new technologies) improve.
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Affiliation(s)
- Ana Gallardo-Flores
- a Social Sciences Department , Pablo de Olavide University , Seville , Spain
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Mahoney DF, Coon DW, Lozano C. Latino/Hispanic Alzheimer's caregivers experiencing dementia-related dressing issues: corroboration of the Preservation of Self model and reactions to a "smart dresser" computer-based dressing aid. Digit Health 2016; 2. [PMID: 27928511 PMCID: PMC5137952 DOI: 10.1177/2055207616677129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To gain an understanding of Latino/Hispanic caregivers' dementia-related dressing issues, their impressions of using a "smart" context-aware dresser to coach dressing, and recommendations to improve its acceptability. METHOD The same Latina moderator conducted all the caregiver focus groups. She followed a semi-structured interview guide that was previously used with White and African American family caregivers who experienced Alzheimer's disease related dressing challenges. From that study, the Preservation of Self model emerged. Using a deductive qualitative analytic approach, we applied the thematic domains from the Preservation of Self model to ascertain relevance to Latino/Hispanic caregivers. RESULTS Twenty Latino/Hispanic experienced caregivers were recruited, enrolled, and participated in one of three focus groups. The majority were female (75%) and either the spouse (25%) or adult child (35%). Striking similarities occurred with the dressing challenges and alignment with the Preservation of Self model. Ethnic differences arose in concerns over assimilation weakening the Latino culture of family caregiving. Regional clothing preferences were noted. Technology improvement recommendations for our system, called DRESS, included developing bilingual prompting dialogs and video modules using the local vernacular to improve cultural sensitivity. Caregivers identified the potential for the technology to enable user privacy, empowerment, and exercise as well as offering respite time for themselves. CONCLUSION Findings suggest dementia-related dressing issues were shared in common by different racial/ethnic groups but the response to them was influenced by cultural dynamics. For the first time Latino/Hispanic voices are heard to reflect their positive technology impressions, concerns, and recommendations in order to begin to address the cultural digital disparities divide.
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Affiliation(s)
| | - David W Coon
- College of Nursing & Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Cecil Lozano
- School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, AZ, USA
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Moreno-Colom S, Recio Càceres C, Torns Martín T, Borràs Català V. Long-term care in Spain: Difficulties in professionalizing services. J Women Aging 2016; 29:200-215. [PMID: 27485259 DOI: 10.1080/08952841.2015.1125699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care-without specific skills, knowledge, and abilities.
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Affiliation(s)
- Sara Moreno-Colom
- a Centre d'Estudis Sociològics sobre la Vida Quotidiana i el Treball (QUIT), Institut d'Estudis del Treball (IET) , Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain
| | - Carolina Recio Càceres
- a Centre d'Estudis Sociològics sobre la Vida Quotidiana i el Treball (QUIT), Institut d'Estudis del Treball (IET) , Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain
| | - Teresa Torns Martín
- a Centre d'Estudis Sociològics sobre la Vida Quotidiana i el Treball (QUIT), Institut d'Estudis del Treball (IET) , Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain
| | - Vicent Borràs Català
- a Centre d'Estudis Sociològics sobre la Vida Quotidiana i el Treball (QUIT), Institut d'Estudis del Treball (IET) , Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallès) , Spain
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Mendez-Luck CA, John Geldhof G, Anthony KP, Neil Steers W, Mangione CM, Hays RD. Orientation to the Caregiver Role Among Latinas of Mexican Origin. THE GERONTOLOGIST 2016; 56:e99-e108. [PMID: 27342443 DOI: 10.1093/geront/gnw087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/01/2016] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | - G John Geldhof
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Katherine P Anthony
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - W Neil Steers
- David Geffen School of Medicine, General Internal Medicine/Health Services Research and
| | - Carol M Mangione
- David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
| | - Ron D Hays
- David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
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Elnasseh AG, Trujillo MA, Peralta SV, Stolfi ME, Morelli E, Perrin PB, Arango-Lasprilla JC. Family Dynamics and Personal Strengths among Dementia Caregivers in Argentina. Int J Alzheimers Dis 2016; 2016:2386728. [PMID: 27413574 PMCID: PMC4931077 DOI: 10.1155/2016/2386728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/21/2022] Open
Abstract
This study examined whether healthier family dynamics were associated with higher personal strengths of resilience, sense of coherence, and optimism among dementia caregivers in Argentina. Caregivers are usually required to assist individuals with dementia, and family members have typically fulfilled that role. Personal strengths such as resilience, sense of coherence, and optimism have been shown to protect caregivers from some of the negative experiences of providing care, though the family-related variables associated with these personal strengths are largely unknown. Hierarchical multiple regressions investigated the extent to which family dynamics variables are associated with each of the caregiver personal strengths after controlling for demographic and caregiver characteristics. A sample of 105 caregivers from Argentina completed a set of questionnaires during a neurologist visit. Family dynamics explained 32% of the variance in resilience and 39% of the variance in sense of coherence. Greater family empathy and decreased family problems were uniquely associated with higher resilience. Greater communication and decreased family problems were uniquely associated with higher sense of coherence. Optimism was not found to be significantly associated with family dynamics. These results suggest that caregiver intervention research focused on the family may help improve caregiver personal strengths in Argentina and other Latin American countries.
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Affiliation(s)
- Aaliah G. Elnasseh
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284, USA
| | - Michael A. Trujillo
- Virginia Commonwealth University, 806 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284, USA
| | | | - Miriam E. Stolfi
- Instituto San Lucas Neurociencias, 1655 Paraguay, Santa Fe, Argentina
| | - Eliana Morelli
- Instituto San Lucas Neurociencias, 1655 Paraguay, Santa Fe, Argentina
| | - Paul B. Perrin
- Virginia Commonwealth University, 800 W. Franklin Street, P.O. Box 842018, Richmond, VA 23284, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain
- Basque Foundation for Science (IKERBASQUE), Bilbao, Spain
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Mendez-Luck CA, Applewhite SR, Lara VE, Toyokawa N. The Concept of Familism in the Lived Experiences of Mexican-Origin Caregivers. JOURNAL OF MARRIAGE AND THE FAMILY 2016; 78:813-829. [PMID: 27594714 PMCID: PMC5007003 DOI: 10.1111/jomf.12300] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
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.
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Savage B, Foli KJ, Edwards NE, Abrahamson K. Familism and Health Care Provision to Hispanic Older Adults. J Gerontol Nurs 2016; 42:21-9; quiz 30-1. [DOI: 10.3928/00989134-20151124-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/27/2015] [Indexed: 11/20/2022]
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Schwingel A, Linares DE, Gálvez P, Adamson B, Aguayo L, Bobitt J, Castañeda Y, Sebastião E, Marquez DX. Developing a Culturally Sensitive Lifestyle Behavior Change Program for Older Latinas. QUALITATIVE HEALTH RESEARCH 2015; 25:1733-1746. [PMID: 25595148 DOI: 10.1177/1049732314568323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite the burgeoning U.S. Latino population and their increased risk of chronic disease, little emphasis had been placed on developing culturally sensitive lifestyle interventions in this area. This article examines older Latinas' sociocultural context relative to health with the goal of developing a culturally sensitive health behavior intervention. Photo-elicitation indicated two emerging themes that influenced lifestyle choices: family caregiving and religion. Researchers partnered with a faith-based organization to develop and implement a 6-month lifestyle intervention for Latinas ages 50 and older: Abuelas en Acción (AEA). At completion, interviews were conducted to understand women's experiences and the influence AEA had on their lifestyles and health. Findings suggest that religious content empowered and deeply affected women; however, the intergenerational content presented significant challenges for instruction, retention, and implementation. We discuss findings in relation to the health intervention literature and provide suggestions for future interventions drawing on religion, family, and health behavior change.
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Affiliation(s)
| | | | | | - Brynn Adamson
- University of Illinois at Urbana-Champaign, Illinois, USA
| | - Liliana Aguayo
- University of Illinois at Urbana-Champaign, Illinois, USA
| | - Julie Bobitt
- University of Illinois at Urbana-Champaign, Illinois, USA
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Villalobos BT, Bridges AJ. Testing an Attribution Model of Caregiving in a Latino Sample: The Roles of Familismo and the Caregiver-Care Recipient Relationship. J Transcult Nurs 2015; 27:322-32. [PMID: 26082428 DOI: 10.1177/1043659615590476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study tests the parameters of Weiner's attribution model of caregiving, which describes how attributions of controllability relate to emotional reactions, which in turn influence willingness to provide support to stigmatized individuals. To date, the model has not been explored in the context of cultural variables, the caregiver-recipient relationship, or types of support. DESIGN The present study examined the attribution model using a Latino community sample (N = 96) that was presented with vignettes describing an individual with depression. RESULTS Support was found for the basic attribution model. Familismo was predictive of attributions of controllability and the basic model was predictive of emotional support, but not instrumental support. Participants were more willing to provide instrumental support to a partner, but had more positive affective reactions toward a sibling. CONCLUSIONS The findings provide important information about contextual factors that may motivate Latino caregivers to provide support.
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Mendez-Luck CA, Bethel JW, Goins RT, Schure MB, McDermott E. Community as a source of health in three racial/ethnic communities in Oregon: a qualitative study. BMC Public Health 2015; 15:127. [PMID: 25884852 PMCID: PMC4340096 DOI: 10.1186/s12889-015-1462-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/26/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A 2011 report by the Oregon Health Authority and the Department of Human Services documented disparities in its Latino and American Indian populations on multiple individual-level health indicators. However, research is lacking on the social contexts in which Latinos and American Indians in Oregon live and how these environments influence the health of communities as a whole. To help fill this gap, this study sought to contextualize the social environments that influence the health of Latinos and American Indian residents in three Oregon communities. METHODS Guided by an ecological framework, we conducted one-time semi-structured qualitative interviews with 26 study participants to identify the prominent health-related issues in the communities and to examine the factors that study participants perceived as enabling or inhibiting healthy lifestyles of community residents. We used a grounded theory approach to perform content and thematic analyses of the data. RESULTS Study participants identified preventable chronic conditions, such as diabetes, obesity, and hypertension, as the most pressing health concerns in their communities. Results showed that traditional and cultural activities and strong family and community cohesion were viewed as facilitators of good community health. Poverty, safety concerns, insufficient community resources, and discrimination were perceived as barriers to community health. Three themes emerged from the thematic analyses: social connectedness is integral to health; trauma has an ongoing negative impact on health; and invisibility of residents in the community underlies poor health. CONCLUSIONS This study's findings provide insight to the social contexts which operate in the lives of some Latinos and American Indians in Oregon. While participants identified community-level factors as important to health, they focused more on the social connections of individuals to each other and the relationships that residents have with their communities at-large. Our findings may also help to explain how the intra- and inter-personal levels, the community/institutional level, and the macro level/public policy contexts can serve to influence health in these communities. For example, trauma and invisibility are not routinely examined in community health assessment and improvement planning activities; nonetheless, these factors appear to be at play affecting the health of residents.
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Affiliation(s)
- Carolyn A Mendez-Luck
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA.
| | - Jeffrey W Bethel
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA.
| | - R Turner Goins
- Department of Social Work, Western Carolina University, Cullowhee, NC, 28723, USA.
| | - Marc B Schure
- Veterans Affairs-Health Services Research & Development, Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, 98108, USA.
| | - Elizabeth McDermott
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, 97331, USA.
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Biologically childless women 60+ often live in extended family households in Latin America. J Cross Cult Gerontol 2014; 29:467-80. [PMID: 25323452 DOI: 10.1007/s10823-014-9240-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rosenthal Gelman C, Sokoloff T, Graziani N, Arias E, Peralta A. Individually-tailored support for ethnically-diverse caregivers: enhancing our understanding of what is needed and what works. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:662-680. [PMID: 24621198 DOI: 10.1080/01634372.2014.881451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Caroline Rosenthal Gelman
- a Silberman School of Social Work and Hartford Silberman Center of Excellence in Aging and Diversity, Hunter College , New York , New York , USA
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Evaluating the linguistic appropriateness and cultural sensitivity of a self-report system for spanish-speaking patients with cancer. Nurs Res Pract 2014; 2014:702683. [PMID: 25045535 PMCID: PMC4089943 DOI: 10.1155/2014/702683] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022] Open
Abstract
Spanish speakers in the United States encounter numerous communication barriers during cancer treatment. Communication-focused interventions may help Spanish speakers communicate better with healthcare providers and manage symptoms and quality of life issues (SQOL). For this study, we developed a Spanish version of the electronic self-report assessment for cancer (ESRA-C), a web-based program that helps people with cancer report, track, and manage cancer-related SQOL. Four methods were used to evaluate the Spanish version. Focus groups and cognitive interviews were conducted with 51 Spanish-speaking individuals to elicit feedback. Readability was assessed using the Fry readability formula. The cultural sensitivity assessment tool was applied by three bilingual, bicultural reviewers. Revisions were made to personalize the introduction using a patient story and photos and to simplify language. Focus group participants endorsed changes to the program in a second round of focus groups. Cultural sensitivity of the program was scored unacceptable ([Formula: see text]) for audiovisual material and acceptable ([Formula: see text]) for written material. Fry reading levels ranged from 4th to 10th grade. Findings from this study provide several next steps to refine ESRA-C for Spanish speakers with cancer.
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