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White Makinde K, Pitzer KA, Benson JJ, Mitchell M, Oliver DP, Demiris G, Washington KT. Does Family Functioning Matter? Understanding the Relationship Between Family Interactions and Depressive Symptoms for Caregivers of Cancer Patients. Am J Hosp Palliat Care 2024:10499091241263016. [PMID: 38881044 DOI: 10.1177/10499091241263016] [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: 06/18/2024] Open
Abstract
BACKGROUND Caregivers of cancer patients are at increased risk of depression and other health challenges. There is limited understanding of the role of the caregiver's own family members in promoting or discouraging mental wellbeing. Family functioning conceptualizes how family members interact to promote a positive family environment and has the potential to impact caregiver mental health. The purpose of this study is to assess the association between family interactions and depressive symptoms among family caregivers of cancer patients. METHODS Secondary analysis of baseline data from an NIH-funded randomized control trial of family caregivers of cancer patients recruited from academic palliative care clinics at three sites (2 Midwest, 1 East). We tested for an association between caregiver responses to the Family Quality of Life in Dementia-Family Interactions Subscale and Patient-Reported Outcomes Measurement Information System Depression Short Form 8A using a block-wise approach to linear modeling. RESULTS A total of 246 caregivers were included in analysis; caregivers were mostly White (82%), not Hispanic or Latina/o (96%), and female (65%), with an average age of 55 years. Overall, participants had high family interactions (mean 57.7, sd 11.7) and an average depressive symptom burden (t-score 52.4, SD 8.57). Family interactions was significantly negatively associated with depressive symptoms (b = -.163, se = .057) when accounting for relevant covariates. CONCLUSION Family caregivers with more positive family interactions are likely to have fewer depressive symptoms, suggesting family functioning may play a key role in bolstering family caregiver mental health and wellbeing.
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Affiliation(s)
| | - Kyle A Pitzer
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Jacquelyn J Benson
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Maysara Mitchell
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
| | - Debra Parker Oliver
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
- Goldfarb School of Nursing at Barnes-Jewish College, St Louis, MO, USA
| | - George Demiris
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Karla T Washington
- Washington University in St. Louis School of Medicine, St Louis, MO, USA
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Mildrum Chana S, Álvarez L, Poe A, Bibriescas N, Wang DH, DiFiglia S, Azuero A, Crowe M, Puga F. The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study. JMIR Res Protoc 2024; 13:e55216. [PMID: 38869929 PMCID: PMC11211706 DOI: 10.2196/55216] [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: 12/22/2023] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. OBJECTIVE The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for "Nuestros Días" (Spanish for "our days"), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. METHODS The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. RESULTS Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. CONCLUSIONS Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55216.
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Affiliation(s)
- Sofía Mildrum Chana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lorelí Álvarez
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Abigail Poe
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Natashia Bibriescas
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, United States
| | - Danny Hai Wang
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States
| | - Andrés Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frank Puga
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
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Kiso H, Collazo JL, Avila ML. "Mi Familia Quiere Que Regrese": Retired Latiné Immigrants' Families' Expectations to Return to Their Country of Origin. Int J Aging Hum Dev 2024; 98:267-283. [PMID: 37593771 DOI: 10.1177/00914150231194237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
We conducted a quantitative, interdisciplinary study that investigated how financial concerns and varying family connections influence the retirement choices of Latiné immigrants in terms of returning to their country of origin. We hypothesized that being worried about one's finances for retirement, and having strong transnational ties, would lead to familial expectations to return to one's country of origin. Through data collected from a survey through Qualtrics, we found that higher levels of financial worry significantly affected greater familial expectations to return to their country of origin. The transnational ties that influenced the families' expectations to return to their country of origin was having children, friends, and family not residing in the U.S. Following our findings, we discuss potential future directions and implications relating to transnational ties, remittances, and older Latiné immigrants.
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Affiliation(s)
- Helen Kiso
- Department of Psychology, Susquehanna University, Selinsgrove, PA, USA
| | - José Luis Collazo
- Department of Sociology, California State University, Channel Islands, Camarillo, CA, USA
| | - Mayra L Avila
- Department of History, University of Texas at Rio Grande Valley, Edinburg, TX, USA
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Morgenstern LB, Becker CJ, Lank R, Ortiz C, Zhang G, He K, Case E, Zahuranec DB. Long-Term Psychological Distress Among Surrogate Decision Makers for Mexican American and Non-Hispanic White Patients With Severe Stroke. Neurology 2024; 102:e207960. [PMID: 38165320 PMCID: PMC10870740 DOI: 10.1212/wnl.0000000000207960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/06/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES During acute hospitalizations, physicians often focus on the stroke patient and not family who may be traumatized by this sudden change to their loved one. We investigated long-term psychological distress among family surrogate decision makers for Mexican American (MA) and non-Hispanic White (NHW) severe stroke patients. Previous work in other diseases suggested worse psychological outcomes in MA than NHW caregivers. METHODS This was a population-based, prospective cohort study in Nueces County, TX. Stroke patient participants and their surrogate decision makers were enrolled soon after any stroke between April, 2016, and October, 2020, if surrogates had made decisions about life-sustaining treatments. Surrogates completed validated measures of posttraumatic stress, National Stressful Events Survey for Posttraumatic Stress Disorder Short Scale; anxiety, Generalized Anxiety Disorder-7; and depression, Patient Health Questionnaire-8 at discharge, 3, 6, and 12 months. Ethnic differences were assessed with multilevel linear mixed models, sequentially adjusted for prespecified patient and surrogate demographic, socioeconomic, and clinical covariates. RESULTS There were 301 family surrogates for 241 severe stroke patients. The mean follow-up was 315 days. High scores on measures of psychological distress ranged between 17% and 28% of surrogates. One or more high levels of the psychological outcomes were found in 17%-43% of surrogates; 2 or more were found in 12%-27%; and all 3 were found in 5%-16% of surrogates. All psychological outcomes were worse among MAs on unadjusted analyses. In fully adjusted models, posttraumatic stress remained worse among MAs (0.36, 95% CI 0.17-0.56); ethnic differences were attenuated and no longer significant in the final model for anxiety (0.59, 95% CI -0.55 to 1.74) and depression (0.97, 95% CI -0.25 to 2.19). The trajectory for depression did differ by ethnicity (interaction p = 0.03), with depression score improving more rapidly over time among NHWs than MAs. Advance care plans did not seem to confound any ethnic differences. DISCUSSION Psychological distress is common among family surrogate decision makers in the year after stroke and may be worse among MAs. Efforts are needed to support family members of all ethnic groups after severe stroke.
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Affiliation(s)
- Lewis B Morgenstern
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Christopher J Becker
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Rebecca Lank
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Carmen Ortiz
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Guanghao Zhang
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Kevin He
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Erin Case
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
| | - Darin B Zahuranec
- From the Department of Neurology (L.B.M., C.J.B., C.O., D.B.Z.), Michigan Medicine; Center for Social Epidemiology and Population Health (L.B.M.), University of Michigan School of Public Health, Ann Arbor; University of Iowa (R.L.), Iowa City; and Departments of Biostatistics (G.Z., K.H.), and Epidemiology (E.C.), University of Michigan School of Public Health, Ann Arbor
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Fink RM, Valenti KG, Kline DM, Fischer SM. Reality of Family Caregiving for Hispanics With Alzheimer's Disease and Related Dementias: A Qualitative Analysis. J Palliat Med 2023; 26:1618-1626. [PMID: 37311202 PMCID: PMC10714113 DOI: 10.1089/jpm.2023.0008] [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] [Accepted: 05/23/2023] [Indexed: 06/15/2023] Open
Abstract
Background: Underserved Hispanic patients often experience unmet palliative care (PC) needs, particularly those with noncancer diagnoses such as Alzheimer's disease and related dementias. Most caregivers for Hispanic patients are family relatives who are less likely to use health care and community resources and experience high caregiver burden. We adapted a culturally tailored patient navigator (PN) intervention to provide support and improve PC outcomes for Hispanics with Alzheimer's disease and related dementias and their family caregivers (FCGs). Objectives: To explore Hispanic FCGs' experiences and perceptions of caregiving for a loved one, and how our PN intervention impacted their needs. Design: Qualitative descriptive. Setting/Subjects: FCG participants (n = 10) from our randomized control trial's intervention group were recruited from academic and safety net hospitals and community-based clinics across urban and rural Colorado in the United States. Measurements: Data obtained from individual, semistructured, 30-minute telephone interviews were recorded, transcribed, translated, and analyzed using NVivo and qualitative thematic analyses. Results: Four major themes emerged: Methods of Support, Cultural Expectations and Varying Family Contributions, Lack of Self-Care, and Awareness. Subthemes highlighted differing definitions of "contributing," role resentment, and interpersonal issues. Varying familial expectations underscore FCG strain when the burden of caregiving is not shared. Participants used various coping strategies as necessary support and gained awareness through education, guidance, and referrals to resources. Conclusions: PNs helped FCGs and patients beyond the intervention's scope. Providing support and awareness to FCGs, and incorporating cultural beliefs, may improve PC access to disparate populations and guide future interventions. Clinical Trial Registration Number NCT03181750.
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Affiliation(s)
- Regina M. Fink
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Korijna G. Valenti
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Danielle M. Kline
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stacy M. Fischer
- School of Medicine and College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Cantu P, Chyu J, Mehta N, Markides K. Profiles of COVID-19 Impact on Informal Caregivers of Older Mexican Americans. J Aging Health 2023; 35:819-825. [PMID: 37625170 PMCID: PMC10792534 DOI: 10.1177/08982643231195669] [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: 08/27/2023]
Abstract
Objectives: This manuscript is a descriptive exploratory study of the impact of the COVID-19 pandemic for caregivers of very old Mexican Americans. Methods: Using data from Wave 10 of the Hispanic Established Population for the Epidemiological Study of Elderly (2021), we examined the characteristics of caregivers of very old Mexican Americans by their perceived level of impact from the pandemic. We examined sociodemographic characteristics, COVID-19 testing and vaccination, stress and depression, and health of caregivers and care recipients. Results: Caregivers who reported the most impact were more likely to report financial and emotional stress. They reported more depressive symptoms and high levels of distress related to neuropsychological behavior symptoms of their care recipient. Discussion: High levels of depressive symptoms, financial stress, and neuropsychological behavior symptoms illustrate that the concerns of caregivers before the pandemic were heightened during the pandemic.
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Affiliation(s)
- Phillip Cantu
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Joanna Chyu
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Neil Mehta
- Department of Epidemiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- Department of Population Health & Health Disparities, University of Texas Medical Branch, Galveston, TX, USA
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Krishnan S, Chen HT, Caston S, Rho S. Physical and Psychological Burden among Caregivers of Latinx Older Adults with Stroke and Multimorbidity. Ethn Dis 2023; 33:156-162. [PMID: 38854409 PMCID: PMC11155624 DOI: 10.18865/ed.33.4.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Objective To investigate the association between Latinx older adults' stroke, multimorbidity, and caregiver burden. Methods For this retrospective cohort study, we used the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) Wave-7 data set. The caregiver's physical burden was defined by using the Level of Burden Index. The caregiver's psychological burden was measured by using the Perceived Stress Scale (PSS-4). Multimorbidity was defined as the presence of 3 or more chronic conditions. Results The average age of the Latinx adults was 86 years, and the caregivers were 56 years. Latinx older adults and caregivers were more likely to be females (66% and 75%). Most caregivers were children (71%). Twelve percent of Latinx older adults presented with stroke, and 50% presented with multimorbidity. Caregiver physical burden was stratified into 3 levels: low (43%), medium (17%), and high (40%) burden. The cumulative logit model revealed that caregivers caring for those with stroke or multimorbidity had a high physical burden. Family caregivers and caregivers with a higher household income had a low physical burden. Caregivers with multimorbidity had a higher psychological burden. Caregivers who were interviewed in Spanish and those with higher household incomes had decreased psychological burden. Conclusion This study revealed that caregivers had a higher physical burden among caregivers of Latinx adults with stroke or multimorbidity. Future studies must investigate the relationship between Latinx adults' stroke and caregiver psychological health, and build culturally tailored policies and community interventions to support caregivers susceptible to high stress and burden.
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Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Haobin Tony Chen
- Department of Quantitative Theory and Methods, Emory College of Arts and Sciences, Atlanta, GA
| | - Sarah Caston
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Seunghwa Rho
- Department of Quantitative Theory and Methods, Emory College of Arts and Sciences, Atlanta, GA
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Lee KH, Lee S, Ryu J, Chun S, Heo J. Geographically varying associations between mentally unhealthy days and social vulnerability in the USA. Public Health 2023; 222:13-20. [PMID: 37499437 DOI: 10.1016/j.puhe.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES A growing body of research has incorporated the Social Vulnerability Index (SVI) into an expanded understanding of the social determinants of health. Although each component of SVI and its association with individual-level mental health conditions have been well discussed, variation in mentally unhealthy days (MUDs) at a county level is still unexplored. To systematically examine the geographically varying relationships between SVI and MUDs across the US counties, our study adopted two different methods: 1) aspatial regression modeling (ordinary least square [OLS]); and 2) locally calibrated spatial regression (geographically weighted regression [GWR]). STUDY DESIGN This study used a cross-sectional statistical design and geospatial data manipulation/analysis techniques. Analytical unit is each of the 3109 counties in the continental USA. METHODS We tested the model performance of two different methods and suggest using both methods to reduce potential issues (e.g., Simpson's paradox) when researchers apply aspatial analysis to spatially coded data sets. We applied GWR after checking the spatial dependence of residuals and non-stationary issues in OLS. GWR split a single OLS equation into 3109 equations for each county. RESULTS Among 15 SVI variables, a combination of eight variables showed the best model performance. Notably, unemployment, person with a disability, and single-parent households with children aged under 18 years especially impacted the variation of MUDs in OLS. GWR showed better model performance than OLS and specified each county's varying relationships between subcomponents of SVI and MUDs. For example, GWR specified that 69.3% (2157 of 3109) of counties showed positive relationships between single-parent households and MUDs across the USA. Higher positive relationships were concentrated in Michigan, Kansas, Texas, and Louisiana. CONCLUSIONS Our findings could contribute to the literature regarding social determinants of community mental health by specifying spatially varying relationships between SVI and MUDs across US counties. Regarding policy implementation, in counties containing more social and physical minorities (e.g., single-parent households and disabled population), policymakers should attend to these groups of people and increase intervention programs to reduce potential or current mental health illness. The results of GWR could help policymakers determine the specific counties that need more support to reduce regional mental health disparities.
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Affiliation(s)
- Kyung Hee Lee
- Department of Recreation, Parks and Leisure Services Administration, Central Michigan University, USA.
| | - Sunwoo Lee
- The Faculty of Physical Culture, Palacký University Olomouc, Třída Míru 117, 77111 Olomouc, Czech Republic
| | - Jungsu Ryu
- Department of Sport Management, Marshall University, USA
| | - Sanghee Chun
- Department of Recreation & Leisure Studies, Brock University, Canada
| | - Jinmoo Heo
- Department of Sports Industry Studies, Yonsei University, South Korea
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Parker LJ, Fabius C. Who's Helping Whom? Examination of Care Arrangements for Racially and Ethnically Diverse People Living With Dementia in the Community. J Appl Gerontol 2022; 41:2589-2593. [PMID: 35960528 PMCID: PMC10348595 DOI: 10.1177/07334648221120247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To address notions around care arrangements for Black and Hispanic people living with dementia (PLwD), the study examined if racial and ethnic differences exist for community-dwelling PLwD. Methods: Using cross-sectional data from the 2015 National Health and Aging Trends Study, we used Pearson's chi-square and mean comparison to examine differences among a sample of n = 863 community-dwelling White, Black, and Hispanic older PLwD. Results: Black PLwD were less likely than White PLwD to use paid help (26.8% vs. 32.6%), but Hispanic PLwD were most likely to use paid help (46.2%, p < 0.05). Black and Hispanic older adults were more often receiving help from a child (65.8% and 72.2%, respectively; p = 0.01) or other family member (40.3% and 31.0%, respectively; p < 0.01). Discussion: Our findings highlight the important role of familial support in care provision for Black and Hispanic communities. Caregiving supports should be intentional in centering services on the family, not a sole caregiver.
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Affiliation(s)
- Lauren J Parker
- Department of Health, Behavior, and Society, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chanee Fabius
- Department of Health, Policy, and Management, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cantu PA, Aranda MP. Neuropsychiatric symptoms and caregiver relationship quality for older Mexican Americans. Aging Ment Health 2022; 27:896-903. [PMID: 35266850 PMCID: PMC9463394 DOI: 10.1080/13607863.2022.2048358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Caregivers play a key role in supporting older Mexican Americans, who are less likely to enter nursing facilities than other racial/ethnic groups in the US. However, there is little research on how Neuropsychiatric symptoms (NPS) affect relationship quality between caregivers and care recipients. METHOD Using data from the 2015 wave of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) (n = 416) study of older (age 85+) Mexican Americans, we examined relationship quality and NPS with ordered logistic regression. Relationship quality was measured using positive (enjoyment, appreciation) and negative (nerves, argue) assessments. NPS were categorized into hyperactivity, affective, and psychosis symptoms. RESULTS Hyperactivity symptoms were associated with appreciation, arguing, and nerves. Psychosis symptoms were associated with arguing and nerves. Spousal caregivers were more likely to report arguing and nerves and less likely to report feeling appreciated. Enjoyment assessments were not associated with NPS. CONCLUSION Relationship quality is related to behavioral changes in late life. Mexican American caregivers negatively evaluate their relationships, not in response to care tasks per se, but when the older person exhibits behavioral problems. The relationship between NPS and negative relationship assessments may be due to unanticipated behavior changes in late life and stigma around psychiatric symptomatology.
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Affiliation(s)
- Phillip A. Cantu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - María P. Aranda
- Suzanne Dworak-Peck School of Social Work, Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
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Rote SM, Angel JL, Kim J, Markides KS. Dual Trajectories of Dementia and Social Support in the Mexican-Origin Population. THE GERONTOLOGIST 2021; 61:374-382. [PMID: 32756950 DOI: 10.1093/geront/gnaa100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In the next few decades, the number of Mexican American older adults with Alzheimer's disease and related disorders will increase dramatically. Given that this population underutilizes formal care services, the degree of care responsibilities in Mexican American families is likely to increase at the same time. However, little is known about the changing need for assistance with instrumental day-to-day activities and emotional support by long-term patterns of cognitive impairment. RESEARCH DESIGN AND METHODS We use 7 waves of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (1992/1993-2010/2011) and trajectory modeling to describe long-term patterns of perceived emotional and instrumental support, and dementia. RESULTS Results revealed 2 latent classes of both emotional and instrumental support trajectories: low and high support. Specifically, those living alone were more likely to belong to the group with low support than to that with high support. Three latent classes for likely dementia were also revealed: likely dementia, increasing impairment, and no impairment. Those living alone were more likely to belong to the increasing impairment and likely dementia groups. The dual trajectory of emotional and instrumental support with likely dementia revealed that the probability of belonging to the low-support group was highest for those with increasing impairment. DISCUSSION AND IMPLICATIONS These findings highlight the risk and vulnerability of those who live alone concerning perceived social support and dementia. Implications of the findings for the potential dependency burden on Latino caregivers are discussed.
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Affiliation(s)
- Sunshine M Rote
- Kent School of Social Work, University of Louisville, Kentucky
| | - Jacqueline L Angel
- LBJ School of Public Affairs and Department of Sociology, The University of Texas at Austin
| | - Jiwon Kim
- Department of Educational Psychology-Quantitative Methods, The University of Texas at Austin
| | - Kyriakos S Markides
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
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Rote SM, Angel JL. Gender-Based Pathways to Cognitive Aging in the Mexican-Origin Population in the United States: The Significance of Work and Family. J Gerontol B Psychol Sci Soc Sci 2021; 76:e165-e175. [PMID: 33141216 DOI: 10.1093/geronb/gbaa189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study uses the life course perspective to explore the role of key midlife factors (occupation and number of children) for gender- and nativity-based pathways to cognitive aging for older Mexican Americans. METHOD Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE, 1993/1994-2016, n = 2,779), this study presents (a) cognitive impairment trajectories over 20 years of data and (b) multinomial logistic regression analyses of trajectory group membership by lifetime occupation and number of children, controlling for educational attainment. RESULTS For older Mexican American men, lifetime employment in agricultural occupations is associated with elevated risk for late-life cognitive impairment. Delayed risk for impairment is observed for U.S.-born men who were employed in factory work (e.g., production and repair) and in Mexican-born men who were employed in occupations with skilled or supervisory requirements. For all women, labor force participation, especially in skilled occupations, is related to a delayed risk of cognitive impairment. Number of children is unrelated to impairment for men; however, women with five or more children (compared to women with two to four children) are at risk for consistent and rapid cognitive impairment in late life. DISCUSSION Late-life cognitive health disparities that disproportionately impact the Mexican American population can be addressed by improving access to educational and occupational opportunities in early and midlife. This study points to key areas of intervention within work and the home for the Mexican-origin population.
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Affiliation(s)
- Sunshine M Rote
- Kent School of Social Work, University of Louisville, Kentucky
| | - Jacqueline L Angel
- School of Public Affairs and Department of Sociology, The University of Texas at Austin
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Flores DV, Rote S, Angel J, Chen NW, Downer B, Markides K. Depressive symptoms in child caregivers of very old Mexican Americans. Aging Ment Health 2021; 25:61-67. [PMID: 32883095 PMCID: PMC7785680 DOI: 10.1080/13607863.2017.1423024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. METHODS This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. RESULTS Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. CONCLUSIONS In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.
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Affiliation(s)
- David V. Flores
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Sunshine Rote
- Kent School of Social Work, The University of Louisville,
Louisville, KY, USA
| | - Jacqueline Angel
- LBJ School of Public Affairs, The University of Texas,
Austin, TX, USA
| | - Nai-Wei Chen
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Division of Rehabilitation Sciences, The University of
Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
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Vu LH, Markides KS, Downer B. Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older. Gerontol Geriatr Med 2021; 7:23337214211002724. [PMID: 33796630 PMCID: PMC7983470 DOI: 10.1177/23337214211002724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/28/2022] Open
Abstract
Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from Wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. Logistic regression models were used to estimate the average marginal effect (range = -1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment (p < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14-0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.
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Affiliation(s)
- Lan H. Vu
- University of Texas Medical Branch, Galveston, USA
| | | | - Brian Downer
- University of Texas Medical Branch, Galveston, USA
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15
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Moon HE, Haley WE, Rote SM, Sears JS. Caregiver Well-Being and Burden: Variations by Race/Ethnicity and Care Recipient Nativity Status. Innov Aging 2020; 4:igaa045. [PMID: 33241124 PMCID: PMC7679974 DOI: 10.1093/geroni/igaa045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others). RESEARCH DESIGN AND METHODS The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (N = 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver's outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts of the inclusion of caregiving factors (background factors, primary stressors, secondary stressors, and resources). RESULTS Regression analyses showed that only care burden significantly varied by care recipient nativity status after controlling for covariates. Caregivers of foreign-born care recipients reported a higher burden. However, when interactions of care recipient nativity status × caregiver race/ethnicity were introduced, non-Hispanic black and Hispanic caregivers of foreign-born care recipients were more likely to report better psychological well-being and self-rated health compared to their counterparts. Across caregiver groups, better caregiver-care recipient relationship quality and less caregiver chronic conditions were associated with less burden and better caregiver psychological well-being and self-rated health. DISCUSSION AND IMPLICATIONS Care recipient nativity status and caregiver race/ethnicity may have complex effects on caregiving experiences. Given the observed significant interaction effects for caregiver psychological well-being and self-rated health, cultural factors may affect the extent to which these caregivers appraise their caregiving. Future research should delve into the appropriate ways to assess care stress as well as resilience among each caregiver group. Our results indicate the need for research, education, and practice that assess cultural and within-group differences among caregivers and inform needed changes to structural barriers.
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Affiliation(s)
- Heehyul E Moon
- Kent School of Social Work, University of Louisville, Kentucky
| | - William E Haley
- School of Aging Studies, College of Behavioral and Community Science, University of South Florida, Tampa
| | - Sunshine M Rote
- Kent School of Social Work, University of Louisville, Kentucky
| | - Jeanelle S Sears
- Department of Human Services, Bowling Green State University, Ohio
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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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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: 15] [Impact Index Per Article: 3.0] [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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Rote SM, Moon H. Racial/Ethnic Differences in Caregiving Frequency: Does Immigrant Status Matter? J Gerontol B Psychol Sci Soc Sci 2019; 73:1088-1098. [PMID: 27573991 DOI: 10.1093/geronb/gbw106] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/02/2016] [Indexed: 01/11/2023] Open
Abstract
Objectives With growing diversity in the older adult and caregiver populations, the purpose of the current study is to describe the extent to which elder care frequency varies by race/ethnicity and immigrant/native status using national data from the United States. Method Using pooled data from the 2011-2014 American Time Use Surveys (ATUS; N = 7,855), we present multinomial logistic regressions of caregiving frequency by race/ethnicity and immigrant/native status and explore whether factors within the caregiving domain (duration of care, number of care recipients, and coresidence) attenuate any observed differences. Results Compared to non-Latino Whites, non-Latino Black, Mexican-origin, and other Latino caregivers engage in more frequent elder care activities, which is partially attributable to high levels of coresidence among these subpopulations. Although immigrant caregivers, in general, tend to engage in more time-intensive caregiving, for Mexican-origin and other Latino caregivers, U.S.-born caregivers report more frequent elder care provision. Discussion More time-intensive and demanding caregiving careers reported by racial/ethnic minority and immigrant caregivers further emphasize the need for culturally competent home- and community-based care options.
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Affiliation(s)
- Sunshine M Rote
- Raymond A. Kent School of Social Work, University of Louisville, Kentucky
| | - Heehyul Moon
- Raymond A. Kent School of Social Work, University of Louisville, Kentucky
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Sadarangani TR, Missaelides L, Yu G, Trinh-Shevrin C, Brody A. Racial Disparities in Nutritional Risk among Community-Dwelling Older Adults in Adult Day Health Care. J Nutr Gerontol Geriatr 2019; 38:345-360. [PMID: 31361195 DOI: 10.1080/21551197.2019.1647327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Information regarding nutritional risk among users of American adult day health centers (ADHCs), 60% of whom are racial minorities, is scant. This study examined nutritional risk and associated factors in a diverse sample ADHC users aged 50+ using secondary cross-sectional analysis of data collected between 2013 and 2017. Risk was assessed using the DETERMINE checklist, and results were stratified by race. The majority of the sample (N = 188) was at moderate (45.2%) or high (38.5%) nutritional risk, with statistically significant racial differences. Blacks were at greater risk than any other group: 65% had high nutritional risk; 76.5% ate <5 servings of fruits, vegetables, or milk daily; 21% ate <2 meals daily, 48.5% reported involuntary weight loss/gain, and 41.2% had tooth loss/mouth pain. Older adults in ADHCs are at elevated risk of malnutrition, disproportionately so amongst blacks. Both routine nutrition screening and population-specific approaches are needed to attenuate risk.
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Affiliation(s)
- Tina R Sadarangani
- Rory Meyers College of Nursing, New York University , New York , NY , USA
| | - Lydia Missaelides
- California Association for Adult Day Services , Sacramento , CA , USA
| | - Gary Yu
- Rory Meyers College of Nursing, New York University , New York , NY , USA
| | | | - Abraham Brody
- Rory Meyers College of Nursing, New York University , New York , NY , USA
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Chiriboga DA, Park NS, Gilbert K, Molinari VA, Barnes M. Cognitive and Functional Status of Persons Newly Enrolled at Dementia-Specific Adult Day Centers and Burden of Their Caregivers. Innov Aging 2019; 3:igz013. [PMID: 31263789 PMCID: PMC6592638 DOI: 10.1093/geroni/igz013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives Recognizing the important role that dementia-specific adult day centers have in maintaining persons with a neurocognitive disorder in their home, this article examines three critical indicators at the time when people first enroll in such a center: cognitive and functional impairment of the enrollee, and burden reported by their family caregivers. We also considered variations in these 3 indicators by race/ethnicity and by the relationship of caregiver to the new enrollee. Research Design and Methods We conducted a secondary analysis of data collected by a nonprofit organization operating 11 dementia-specific adult day centers located on the east coast of Florida. Nursing staff conducted intake interviews with enrollees and their caregivers, and assessed functional status within one month of admission. Instruments included the Zarit Burden Scale and components of the Minimum Data Set: the Brief Interview for Mental Status (BIMS) and 4 measures of functional status. Results On average the cognitive scores of newly enrollees were well-within the range indicated for severe impairment, and these levels did not differ by race/ethnicity. Burden reported by caregivers however differed significantly, with Latinx caregivers reporting the greatest burden and African American/Black caregivers reporting the least. Further, while daughters generally reported higher levels of burden than other family caregivers, Black daughters reported the least. Discussion and Implications Results suggest a need for greater dissemination efforts about adult day programs to the Latinx community, as well as attention to the disparate burden placed upon differing family relationships of caregivers to enrollees.
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Affiliation(s)
- David A Chiriboga
- Department of Child & Family Studies, University of South Florida, Tampa
| | - Nan S Park
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Karen Gilbert
- Alzheimer's Community Care, West Palm Beach, Florida
| | - Victor A Molinari
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Mary Barnes
- Alzheimer's Community Care, West Palm Beach, Florida
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Markides KS, Rote S. The Healthy Immigrant Effect and Aging in the United States and Other Western Countries. THE GERONTOLOGIST 2018; 59:205-214. [DOI: 10.1093/geront/gny136] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Kyriakos S Markides
- Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston
| | - Sunshine Rote
- Kent School of Social Work, University of Louisville, Kentucky
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22
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Das A. "Crossover" in Depressive Symptoms Among Older Couples: Are Previous Findings Artifactual? J Aging Health 2018; 32:3-13. [PMID: 30246591 DOI: 10.1177/0898264318800919] [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: 12/27/2022]
Abstract
Objective: This study examined effects of a partner's depressive symptoms on those of a focal respondent. Method: Data were from the 2008-through-2014 waves of the Health and Retirement Study. Linear growth modeling was used to distinguish within- from between-person variation, and genetic instrumental variables to take endogeneity into account. Results: A partner's 2008 depressive symptoms had no associations with within-person change in those of a respondent between 2010 and 2014. Corresponding linkages with their between-person variation in 2010 were positive and significant for both genders. Among women, these last estimates remained intact in genetic instrumental variable models restricted to white couples. Discussion: Results indicate that contrary to previous literature, late life relationships are not marked by "crossover" of depressive symptoms. Women's affect may, however, be influenced by such transmission in the relationship's history. Beyond depression, findings suggest current theories of dyadic health effects may partly rest on flawed evidence.
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Garcia MA, Saenz JL, Downer B, Chiu CT, Rote S, Wong R. Age of Migration Differentials in Life Expectancy With Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE. THE GERONTOLOGIST 2018; 58:894-903. [PMID: 28486598 PMCID: PMC6137351 DOI: 10.1093/geront/gnx062] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives To examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States. Research Design and Methods This study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life. Results Foreign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants. Discussion and Implications The relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age.
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Affiliation(s)
- Marc A Garcia
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Joseph L Saenz
- University of Southern California, Davis School of Gerontology, Los Angeles
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston
| | - Chi-Tsun Chiu
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Sunshine Rote
- University of Louisville, Kent School of Social Work, Kentucky
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, University of Texas Medical Branch, Galveston
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Caring for Aging Populations: Examining Compassion Fatigue and Satisfaction. JOURNAL OF ADULT DEVELOPMENT 2018. [DOI: 10.1007/s10804-018-9315-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Anthony KP, John Geldhof G, Mendez-Luck CA. Characterizing Caregiving Intensity Among Mexican-origin Women Caregivers. THE GERONTOLOGIST 2018; 57:1084-1092. [PMID: 27342442 DOI: 10.1093/geront/gnw090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/05/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Objective (physical) caregiving burden has not often been associated with subjective (emotional) burden among Mexican-origin women caregivers. Yet, many studies show that Latina caregivers suffer from negative psychological outcomes related to caregiving at a higher rate than non-Latino Whites. This study considered whether self-rated intensity of ADL/IADL support explained the relationship between number of care recipient illnesses and caregiver emotional drain among Mexican American women caregivers. Design and Methods Participants included Mexican-origin women caregivers (n = 132) in East Los Angeles, CA who completed a survey that asked culturally appropriate questions about their experiences caring for elderly relatives. Results Logistic regression models indicated that ADL/IADL supports ranked as difficult were also chosen as causing emotional drain. Mediation models revealed a significant indirect effect of number of care recipient illnesses on caregiver emotional drain for English-speaking caregivers but not for Spanish-speaking caregivers. These results indicate that Mexican-origin women caregivers do experience subjective burden associated with specific objective ADL/IADL supports and suggest that culturally relevant survey design can assist in better understanding the emotional drain among this population. Implications Cultural values should be considered when discussing aspects of care provision with Mexican-origin women caregivers in order to elicit an accurate description of their informal caregiving experiences that may contribute to caregiver burden.
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Affiliation(s)
- Katherine P Anthony
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - G John Geldhof
- College of Public Health and Human Sciences, Oregon State University, Corvallis
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Collins DM, Downer B, Kumar A, Krishnan S, Li CY, Markides KS, Karmarkar AM. Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients. Prev Chronic Dis 2018; 15:E51. [PMID: 29729133 PMCID: PMC5951156 DOI: 10.5888/pcd15.170358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Older Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations. METHODS We analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3). RESULTS Care recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34-2.94), self-care limitations (OR = 2.53; 95% CI, 1.70-3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28-3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26-2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05-5.24) than those with just arthritis and hypertension. CONCLUSION MCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.
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Affiliation(s)
- Diane M Collins
- University of Texas Medical Branch, Department of Occupational Therapy, 301 University Blvd, 3.916 School of Health Professions, Galveston, TX 77555-1142.
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Amit Kumar
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas
| | - Kyriakos S Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Amol M Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
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Caceres BA, Bub L, Negrete MI, Rodríguez LG, Squires AP. Healthcare professionals' perceptions of neglect of older people in Mexico: A qualitative secondary analysis. Int J Older People Nurs 2018; 13:10.1111/opn.12168. [PMID: 28913937 PMCID: PMC8697719 DOI: 10.1111/opn.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 08/11/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe healthcare professionals' perceptions of neglect of older people in Mexico. BACKGROUND Mistreatment of older people, particularly neglect, has emerged as a significant public health concern worldwide. However, few studies have been conducted to examine neglect of older people in low- and middle-income countries. Most research has focused on estimating the prevalence of neglect in older populations with little emphasis on the perceptions of healthcare professionals and their role in addressing neglect of older people. DESIGN Qualitative secondary analysis. METHODS The parent study consisted of nine focus groups conducted with healthcare professionals at five public hospitals in Mexico. The purpose of the parent study was to perform a needs assessment to determine the feasibility of adapting the Nurses Improving Care for Healthsystem Elders programme to Mexico. A qualitative secondary analysis with directed content analysis approach was used to extract data related to neglect of older people. RESULTS A total of 89 participants representing healthcare professionals from several disciplines were interviewed. Three themes emerged: (i) The main point is not here; (ii) We feel hopeless; and (iii) We need preparation. Participants reported distress and hopelessness related to neglect of older people. Lack of community-based resources was noted as contributing to neglect. Increased education regarding care of older people for both caregivers and healthcare professionals and greater interdisciplinary collaboration were identified as potential solutions to combat neglect. CONCLUSIONS Community-based services and resource allocation need to be re-evaluated to improve the care of older Mexicans. Interdisciplinary models of care should be developed to address concerns related to neglect of older people. IMPLICATIONS FOR PRACTICE Neglect negatively impacts healthcare professionals' ability to adequately care for older patients. There is a need to invest in community-based services and models of care to address these concerns.
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Affiliation(s)
- Billy A. Caceres
- Columbia University School of Nursing, New York, NY, USA
- NYU Rory Meyers College of Nursing, New York, NY, USA
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Badana ANS, Marino V, Haley WE. Racial Differences in Caregiving: Variation by Relationship Type and Dementia Care Status. J Aging Health 2017; 31:925-946. [DOI: 10.1177/0898264317743611] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Victoria Marino
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - William E. Haley
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Lee K, Martin P, Poon LW. Predictors of caregiving burden: impact of subjective health, negative affect, and loneliness of octogenarians and centenarians. Aging Ment Health 2017; 21:1214-1221. [PMID: 27438060 DOI: 10.1080/13607863.2016.1206512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study aimed (1) to determine whether octogenarian and centenarian care recipients' self-report on physical, social, and emotional status are different from caregivers' reports, (2) to assess associations between octogenarian and centenarian care recipients' poor physical, social, and emotional status and caregiver burden, and (3) to determine which report, the care recipients' self-report or caregivers' report, about the participants' physical and emotional status predicted more accurately levels of caregiver burden. METHOD Self-ratings and caregiver informant ratings were obtained from 309 participants of the Georgia Centenarian Study. Care recipients' health, negative affect, and loneliness were reported by both the caregivers and care recipients for the analyses. Differences between care recipients' and caregivers' reports were assessed by t-test. Blockwise multiple regression analysis was computed to assess predictors of caregiver burden. RESULTS Caregivers' reports on the three measures were significantly higher than self-reports. Caregivers' negative affect and loneliness, not physical health, reported by caregivers predicted higher caregiver burden. Care recipients' reports did not predict caregiver burden. CONCLUSION Caregivers perceived care recipients' social and emotional status more negatively, and caregivers' negative perceptions on care recipients' well-being status were an important predictor of caregiver burden.
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Affiliation(s)
- Kyuho Lee
- a Department of Human Development and Family Studies , Iowa State University , Ames , IA , USA
| | - Peter Martin
- a Department of Human Development and Family Studies , Iowa State University , Ames , IA , USA
| | - Leonard W Poon
- b Institute of Gerontology, University of Georgia , Athens , GA , USA
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Cantu PA, Angel JL. Demography of Living Arrangements Among Oldest-Old Mexican Americans: Evidence From the Hispanic Epidemiologic Study of the Elderly. J Aging Health 2017; 29:1015-1038. [PMID: 30231830 PMCID: PMC6380186 DOI: 10.1177/0898264317727790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In this article, we examine the demographics of living arrangements and household headship status among Mexican-origin individuals aged 85+ years. METHOD Data come from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) caregiver and respondent surveys. RESULTS Finances of the elderly individual and their caregiver inform living arrangement decisions. Physical and cognitive disability differentiate among living arrangements: The most mentally and physically impaired are most likely to live with others and less likely to be the head of the household. DISCUSSION Motivations for living with others are clearly more complex than simple filial piety considerations might hold. Extended living arrangements provide concrete financial and instrumental benefits for both elderly parents and their adult child caregiver. Future research should address the question of the capacity of the Mexican American family to provide care for elderly parents in the face of major demographic and social changes.
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Affiliation(s)
- Phillip A. Cantu
- Population Research Center and Department of Sociology and 2 LBJ School of Public Affairs and Department of Sociology, The University of Texas at Austin
| | - Jacqueline L. Angel
- LBJ School of Public Affairs and Department of Sociology, University of Texas at Austin
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Rote SM, Angel JL, Markides K. Neighborhood Context, Dementia Severity, and Mexican American Caregiver Well-Being. J Aging Health 2017; 29:1039-1055. [PMID: 28553825 PMCID: PMC10676002 DOI: 10.1177/0898264317707141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The current study extends research on Latino caregiving to describe the role of neighborhood-level factors and dementia severity for caregiver well-being. METHOD Data are drawn from the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE 2010/2011, N = 343). We present regression analyses that describe the relationship between dementia severity in the older care recipient and neighborhood-level structural factors for caregiver mental health. RESULTS Mexican Americans providing care in neighborhoods characterized by a higher percent Latino report fewer depressive symptoms and greater life satisfaction. Percent Latino and percent Spanish speaking residing in the neighborhood are especially protective of caregiver depressive symptoms when care recipients display more severe dementia-related neuropsychiatric symptoms. DISCUSSION Neighborhood characteristics play an important role in the Latino caregiver well-being processes. Targeting neighborhoods, especially in regard to culturally competent dementia care education and services, should be the focus of intervention strategies for Mexican-origin caregivers.
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Meyer OL, Liu X, Nguyen TN, Hinton L, Tancredi D. Psychological Distress of Ethnically Diverse Adult Caregivers in the California Health Interview Survey. J Immigr Minor Health 2017; 20:784-791. [PMID: 28748300 DOI: 10.1007/s10903-017-0634-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined factors associated with psychological distress for culturally diverse family caregivers using a population-based sample. Data were analyzed from the 6634 caregivers of adults (i.e. elderly as well as non-elderly) who self-reported as non-Hispanic White, Mexican, Chinese, or Vietnamese in the 2009 California Health Interview Survey. Simple and multiple regression analyses were conducted to assess the potential influence of race/ethnicity, caregiving context, and social contextual variables on psychological distress. Analyses that included moderators showed that while more education was associated with less distress for White caregivers, it was associated with more distress for Vietnamese and Chinese caregivers. Identifying the caregiving and contextual variables associated with psychological distress is critical for tailoring interventions towards those who need the most help-in this case, possibly less educated White caregivers and more educated Asian American caregivers.
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Affiliation(s)
- Oanh L Meyer
- Department of Neurology, University of California, Davis, School of Medicine, 4860 Y Street, Sacramento, CA, 95817, USA.
| | - Xiaoyan Liu
- University of California, Davis, Biostatistics, Davis, CA, USA
| | - Thuc-Nhi Nguyen
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Daniel Tancredi
- Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento, CA, USA
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Abstract
This article contains a review of literature published from 2010 to 2016 on family caregiving in oncology. An analysis of 810 citations resulted in 50 randomized trials. These trials describe the need to prepare family caregivers for the complex role they play in cancer care. Several studies have demonstrated improved quality of life for family caregivers and improved emotional support from interventions. Several studies addressed communication and relational intimacy, which are key concerns. An additional focus of these trials was in the area of caregiving tasks and ways to diminish the burden of caregiving and preparedness for this role. Further research is needed in this area given the shift to outpatient care and as family caregivers become the primary providers of care. Future research should include expanding tested models of family caregiver support in clinical practice and in diverse populations. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:318-325. © 2017 American Cancer Society.
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Affiliation(s)
- Betty Ferrell
- Director, Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
| | - Elaine Wittenberg
- Associate Professor, Division of Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
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Mendez-Luck CA, Walker KO, Luck J. Preventive Services Use Among African American and Latino Adult Caregivers in South Los Angeles. Med Care 2016; 54:1098-1104. [PMID: 27414461 PMCID: PMC5110364 DOI: 10.1097/mlr.0000000000000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of informal caregiving is significant and well-documented, yet the evidence is mixed as to whether being a caregiver presents an additional barrier to receiving recommended preventive care. OBJECTIVES To determine whether (1) caregivers compared with noncaregivers were less likely to receive preventive health services; and (2) higher intensity caregivers were less likely to receive preventive health services than lower intensity caregivers. RESEARCH DESIGN, SUBJECTS, AND MEASURES Data were from a telephone survey of Latino and African American adults 50 years or older in South Los Angeles (n=702). Outcomes were flu vaccination, pneumococcal vaccination, and colorectal cancer screening. Logistic regression models adjusted for predisposing, enabling, and need factors according to the Andersen Model of Access to Health Care for Low-income Populations. RESULTS Caregiver type (eg, adult child, nonrelated) was associated with varying odds of receiving a preventive service. Caregivers had lower odds than noncaregivers of receiving preventive services although odds of receiving a flu vaccination improved slightly for caregivers of persons with memory loss compared with other caregivers. More weekly caregiving hours was associated with higher odds of receiving flu vaccination (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1) or colorectal cancer screening (adjusted odds ratios, 1.1; 95% confidence interval=1.0, 1.1). Caregivers and noncaregivers age 65 and older or with chronic conditions were more likely to receive vaccinations. CONCLUSIONS Preventive service use was influenced by characteristics of the caregiving situation. An opportunity may exist to leverage care recipients' ongoing contact with health care providers to increase caregivers' own access to preventive services.
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Affiliation(s)
| | - Kara Odom Walker
- Program Officer, Patient Centered Outcomes Research Institute (During the time of this work, the affiliation was with the Department of Family and Community Medicine, University of California, San Francisco)
| | - Jeff Luck
- College of Public Health and Human Sciences, Oregon State University
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Evans BC, Coon DW. The "Reckoning Point" as a Marker for Formal Palliative and End-of-Life Care in Mexican American Families. JOURNAL OF FAMILY NURSING 2016; 22:606-630. [PMID: 27903942 DOI: 10.1177/1074840716677994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the "point of reckoning" in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver. Ninety-three of 116 caregivers recognized and spontaneously reported a "reckoning point" that initiated the caregiving trajectory, while eight cited "gradual decline" into caregiving for elders in their homes. This "reckoning point," which marks the assumption of this role, may afford a fertile opportunity for referral to community resources or initiation of formal PEOLC, thereby improving the quality of life for these older individuals and their families.
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