1
|
Miyawaki CE, McClellan A, Russell D, Bouldin ED. Comparing Unmet Service Needs Between Rural and Urban Family Caregivers of People Living With Alzheimer's Disease and Related Dementias: A Multisite Study. THE GERONTOLOGIST 2024; 64:gnae083. [PMID: 38946163 PMCID: PMC11308181 DOI: 10.1093/geront/gnae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The scarcity of resources and available caregiving services in rural areas in the United States has been well documented. However, less research has compared unmet service needs between caregivers of people with Alzheimer's disease and related dementias (ADRD) in rural versus urban areas. RESEARCH DESIGN AND METHODS Using semistructured interviews guided by theories of health service use and dependent care, we interviewed 20 family caregivers residing in rural areas of Western North Carolina and 18 caregivers within the urban setting of Houston, Texas, and compared their unmet service needs and contextual factors that facilitate their service use. RESULTS Thematic analyses revealed similar unmet service needs among rural and urban caregivers; however, the ways they approached and solved their challenges differed. Caregivers in rural areas wished for more information and caregiver support whereas urban caregivers looked for information they needed until they found the answers. Rural caregivers expressed guilt about using services because they felt they were limited and zero-sum whereas urban caregivers shared available resources so that other caregivers could use them as well. Unmet service needs for urban caregivers included more racially and ethnically specific services for people with ADRD in their ethnic-specific languages and foods while rural caregivers' cultural needs were not racially and ethnically specific but for more place-specific services. DISCUSSION AND IMPLICATIONS Recommendations for rural caregivers included utilizing online and virtual opportunities and expanding their reach across the United States. For urban caregivers, increasing culturally tailored service options would likely increase access and use.
Collapse
Affiliation(s)
| | - Angela McClellan
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Erin D Bouldin
- Health Services Research & Development, Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
2
|
Mulati N, Aung MN, Moolphate S, Aung TNN, Koyanagi Y, Supakankunti S, Yuasa M. Disparity in the Burden of Caring for Older Persons between Families Living in Housing Estates and Traditional Communities in Thailand. Eur J Investig Health Psychol Educ 2024; 14:1514-1526. [PMID: 38921066 PMCID: PMC11202914 DOI: 10.3390/ejihpe14060100] [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: 04/27/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Thailand's rapid population aging and reliance on family-based long-term care requires research into disparities in family caregiver burden. Since the type of residence matters to the caregiving outcome, this research aimed to examine the difference in caregiver burden between residents of private housing estates and traditional village communities. This cross-sectional study was conducted with 1276 family caregivers of community-dwelling Thai older adults, in Chiang Mai province, Thailand. The caregiver burden was examined using the Caregiver Burden Inventory (CBI), and the care recipients' dependency status was examined using Barthel's Activity of Daily Living (ADL). Descriptive analysis, multivariate analysis of variance test, and multiple logistic regression analysis were performed. Family caregivers living in a traditional village community were 1.607 times more likely to experience emotional burden (adj. OR 1.607, 95% CI: 1.049, 2.462) and 2.743 times more likely to experience overall caregiver burden (adj. OR: 1.163, 95% CI: 1.163, 6.471) compared to those in the private housing estate group. Our findings showed significant differences in caregiver burden based on residential area, contributing with insights to evidence-based policies, interventions, and programs to minimize disparities and promote family caregivers' health and well-being.
Collapse
Affiliation(s)
- Nadila Mulati
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (N.M.); (M.Y.)
| | - Myo Nyein Aung
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (N.M.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
- Advanced Research Institute for Health Sciences, Juntendo University, Tokyo 113-8421, Japan
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai 50300, Thailand;
| | - Thin Nyein Nyein Aung
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Yuka Koyanagi
- Faculty of Health Sciences, Tokyo Ariake University of Medical and Health Sciences, Tokyo 135-0063, Japan;
| | - Siripen Supakankunti
- Centre of Excellence for Health Economics, Faculty of Economics, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Motoyuki Yuasa
- Department of Global Health Research, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (N.M.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan
| |
Collapse
|
3
|
Yu K, Jiang H, Liu M, Wu S, Jordan-Marsh M, Chi I. Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App. Can J Aging 2024:1-8. [PMID: 38757195 DOI: 10.1017/s0714980824000187] [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: 05/18/2024] Open
Abstract
BACKGROUND Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials. OBJECTIVE This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs. METHODS Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases. FINDINGS Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens. DISCUSSION The co-design process appears to be beneficial in having participants voice both barriers and preferences.
Collapse
Affiliation(s)
- Kexin Yu
- NIA-Layton Aging and Alzheimer's Disease Center, and Oregon Center for Aging & Technology, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
| | - Haojun Jiang
- Tourism and Social Administration College, Nanjing Xiaozhuang University, Nanjing, China
| | - Mandong Liu
- Research Institute of Social Development, Southwestern University of Finance and Economics, Sichuan, China
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Maryalice Jordan-Marsh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
4
|
Bratches RWR, Freundlich NZ, Odom JN, O'Malley AJ, Barr PJ. Communicating visit information to family caregivers: How does method matter? A national survey. Palliat Support Care 2024:1-8. [PMID: 38654707 DOI: 10.1017/s1478951524000427] [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: 04/26/2024]
Abstract
OBJECTIVES The clinic visit is a critical point of contact for family caregivers. However, only 37% of family caregivers are able to accompany patients to visits. When they cannot attend, caregivers receive visit information to assist with their caregiving. However, little is known about how method of receiving information from clinic visits is associated with important caregiver outcomes. This study sought to determine whether mode of receiving clinic visit information (speaking with the patient, attending the visit, or using an after-visit summary [AVS]) was associated with changes in caregiver burden, caregiver preparedness, and the positive aspects of caregiving. METHODS Cross-sectional web-based survey of a national sample of adult family caregivers. Multiple linear regression models determined associations between communication modes and caregivers' burden, preparedness, and positive aspects of caregiving, adjusting for sociodemographic covariates. RESULTS Respondents (N = 340) were mostly male (58%), White (59%), ranged from 18 to 85 years old, and supported patients with conditions including diabetes, dementia, and cancer. Speaking with patients was associated with increases in positive aspects of caregiving (95% CI = 2.01, 5.42) and an AVS was associated with increases in positive aspects of caregiving (95% CI = 0.4, 3.56) and preparedness for caregiving (95% CI = 0.61, 3.15). Using any method of receiving information from visits was associated with the greatest increase in preparedness, compared to not receiving visit information. We did not observe an association between method of communication and caregiver burden. SIGNIFICANCE OF RESULTS Method of communicating visit information is associated with improvements in caregiver preparedness and the positive aspects of caregiving, though caregiver burden may be unaffected by information exchange. Given the limitations of current communication methods, future work should explore directionality of the associations we found and identify visit communication strategies with caregivers that optimize caregiver and patient outcomes.
Collapse
Affiliation(s)
- Reed W R Bratches
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, USA
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noah Z Freundlich
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A James O'Malley
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, USA
| | - Paul J Barr
- Center for Technology and Behavioral Health, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
5
|
Garcia CN, Duran MC, Ramirez M. Refining Cultural Adaptations of a Behavioral Intervention for Latino Caregivers of People Living With Dementia: Qualitative Interview Study in Washington State. JMIR Aging 2024; 7:e53671. [PMID: 38206663 PMCID: PMC10811572 DOI: 10.2196/53671] [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: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND In the United States, Latino caregivers of individuals with dementia face unique challenges and an elevated risk of adverse health outcomes. Despite the increasing prevalence of Alzheimer disease and related dementias among Latino adults, few evidence-based interventions are tailored to their cultural context. To address this gap, we examined the cultural adaptations required for the STAR caregivers (STAR-C) virtual intervention, an evidence-based intervention that educates family caregivers to manage behavioral and psychological symptoms of dementia. While STAR-C has shown effectiveness, neither the original in-person nor the virtual intervention considered the distinct experiences of Latino caregivers, who often bring culturally significant values into caregiving interactions. OBJECTIVE This study's objective was to test and refine the preliminary cultural adaptations of the STAR-C web-based training modules for Latino caregivers of people living with dementia. METHODS Through qualitative interviews with 15 Latino caregivers in Washington State, we identified key adaptations to enhance the cultural relevance of the web-based training modules. RESULTS The interviews highlighted 4 main themes for adaptation: the delivery of the STAR-C web-based training modules, comprehensive dementia education, simplified problem-solving strategies, and prioritizing caregiver well-being. CONCLUSIONS This study's findings informed the development of culturally adapted STAR-C web-based training modules that aim to provide tailored support to Latino caregivers. While further research is needed to assess the efficacy of these adaptations, our work contributes to bridging the gap in dementia caregiving for Latino families, potentially reducing health disparities and enhancing health care services for this population.
Collapse
Affiliation(s)
- Celeste N Garcia
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Miriana C Duran
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Magaly Ramirez
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| |
Collapse
|
6
|
Pornprasit P, Utoomprurkporn N, Areekit P, Manum P, Thanutammakul S, Parmar B, Adamson J, Bamiou D. Attitudes towards hearing difficulties, health-seeking behaviour, and hearing aid use among older adults in Thailand. Front Digit Health 2024; 5:1075502. [PMID: 38269091 PMCID: PMC10806058 DOI: 10.3389/fdgth.2023.1075502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction This qualitative study explores older adults' attitudes towards hearing difficulties, health-seeking behaviour and hearing aid use in Samutprakarn, Thailand. Method Three focus groups (n=25), with adults aged 60-88 years, were conducted within a residential complex for older adults. Qualitative data analysis, employing a phenomenological approach was completed. Results Four themes are presented: (1) Perception of hearing difficulties, (2) Experience of receiving care, (3) Attitudes towards wearing hearing aids, and (4) Raising awareness of hearing difficulties in older adults. Findings indicate that Thai older adults may not be aware or accepting of their hearing difficulties, due to the stigma associated hearing loss, older age, and disability. The consequential impact of these unacknowledged issues manifest in communication challenges and the adoption of avoidance behaviours across diverse situational contexts. Conclusion This study enhances our understanding of how Thai older adults perceive hearing problems and ear care. Findings underscore the potential pivotal role of familial and social networks in mitigating barriers associated with hearing difficulties among older adults in Thailand. These insights can raise awareness and inform effective management for older adults and their families. Additionally, the findings could guide healthcare providers, researchers, and policy makers, fostering improved care for this demographic.
Collapse
Affiliation(s)
| | | | - Poonsub Areekit
- Faculty of Psychology, Chulalongkorn University, Bangkok, Thailand
| | - Pornnapat Manum
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Bhavisha Parmar
- Sound Lab, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Faculty of Brain Science, UCL Ear Institute, University College London, London, United Kingdom
| | - Joy Adamson
- Department of Health Science, University of York, York, United Kingdom
| | - Doris Bamiou
- Faculty of Brain Science, UCL Ear Institute, University College London, London, United Kingdom
- NIHR Biomedical Research Centre Hearing and Deafness, London, United Kingdom
| |
Collapse
|
7
|
Carson A. A Pressure Release Valve: South Korean Long-Term Care Policy as Supplemental to Family Elder Care. J Aging Soc Policy 2023; 35:756-779. [PMID: 36242768 DOI: 10.1080/08959420.2022.2133318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
South Korea's National Long-term Care Insurance (NLTCI) has received international acclaim for its universal continuum-of-care model. Based on 25 qualitative interviews with family caregivers, this research explores the relationship between NLTCI policies and experiences of family caregiving for older people. Caregivers who share care responsibilities or are supported by other family are coping well with minor to moderate policy recommendations. Lone caregivers without support from other family are struggling and express desire for expanded services. These findings highlight a need for more consideration of the influence of family dynamics on informal caregiver burdens. Despite many strengths, NLTCI policy functions as a pressure release valve, supplementing family care for seniors - not replacing it - with minimal gender equity contributions.
Collapse
Affiliation(s)
- Alexa Carson
- PhD Candidate, Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Lee J, Sohn YH, Chung SJ, Kim SH, Suh Y, Park J, Kim Y. Validity and Reliability of the Korean Version of the Parkinson's Disease Questionnaire-Carer. J Clin Neurol 2023; 19:547-557. [PMID: 37488956 PMCID: PMC10622727 DOI: 10.3988/jcn.2022.0390] [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: 10/10/2022] [Revised: 01/12/2023] [Accepted: 04/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND PURPOSE The importance of the quality of life (QOL) of carers has been increasingly recognized as it has a wide range of effects on the psychological, emotional, and social outcomes of patients with Parkinson's disease (PD). Understanding their QOL is important as it reflects their unique characteristics; however, there have been few studies on this in Korea. This study aimed to translate and validate the Korean version of the Parkinson's Disease Questionnaire-Carer (PDQ-Carer). METHODS This was a methodological study that included a translation process and a cross-sectional investigation. The Korean version of the scale was developed using back translation, semantic adjustment, and pretests. The final version was self-administered by 125 Korean family carers. Cronbach's alpha values were used to assess the internal consistency of the PDQ-Carer. Exploratory and confirmatory factor analyses were used to validate the translated scale. RESULTS Exploratory factor analysis identified four factors that accounted for 64.51% of the variance. A modified model using modification indices was found to fit the data well in the confirmatory factor analysis. That factor analysis supported the structure of the original four factors with relocation of several items that reflected Korean culture. Cronbach's alpha values were 0.96 for the total scale, 0.93 for personal and social activities, 0.89 for strain, 0.85 for anxiety and depression, and 0.85 for self-care. CONCLUSIONS This study verified that the Korean version of the PDQ-Carer can be used to acquire important information about the multidimensional aspects of the QOL of Korean carers for patients with PD.
Collapse
Affiliation(s)
- JuHee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei Evidence Based Nursing Centre of Korea: a Joanna Briggs Institute of Excellence, College of Nursing, Yonsei University, Seoul, Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Sung Hae Kim
- Department of Nursing, Tongmyong University, Busan, Korea
| | - Yujin Suh
- College of Nursing, Health Science & Human Ecology, Dong-Eui University, Busan, Korea
| | - Jungah Park
- College of Nursing, CHA University, Pocheon, Korea
| | - Yielin Kim
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Korea.
| |
Collapse
|
9
|
Arbel I, Cameron JI, Trentham B, Dawson DR. A Narrative Inquiry Into the Lived Experiences of the Oldest-Old Caregivers and How These Are Shaped by Age and Aging. THE GERONTOLOGIST 2023; 63:1385-1394. [PMID: 36516466 DOI: 10.1093/geront/gnac185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Oldest-old (80+) spousal caregivers of people with dementia are a fast-growing, highly vulnerable, and poorly understood population. As oldest-old individuals, these caregivers have a high likelihood of experiencing aging-related changes (e.g., frailty and multimorbidity) that result in unique caregiving experiences and support needs. Specialized interventions, sensitive to caregivers' age- and aging-related experiences and needs, may be required to provide adequate support to this group. To date, this group has received limited attention in the literature. Thus, the purpose of this study was to elucidate how age and aging shape the experiences of oldest-old spousal caregivers of people with dementia. RESEARCH DESIGN AND METHODS We used a narrative gerontology approach, with 2-3 semistructured interviews with 11 caregivers ages 80-89 (25 interviews in total). We analyzed narrative data thematically. RESULTS We identified 4 main themes representing caregivers' perceptions of age or aging: aging as decline, aging as life experience, doings in older age, and older age as perceived by others. Our results illustrate a breadth of age- and aging-related caregiving experiences stemming from each perception. DISCUSSION AND IMPLICATIONS This study provides insight into the particular experiences of oldest-old spousal caregivers of people with dementia and provides a foundation for critical future research that will continue to explore the experiences of this unique and fast-growing caregiving group. A more nuanced understanding of this caregiving subgroup is needed to develop age-sensitive health and social care services to meet their needs and, ultimately, improve their well-being and that of their spouses.
Collapse
Affiliation(s)
- Ifah Arbel
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Barry Trentham
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Deirdre R Dawson
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Joo J, Choi S, Gallo JJ, Han H, Kim S, Xu J, Yeom S. Intersection of multiple factors shape Korean American caregiver experience in dementia caregiving. Aging Ment Health 2023; 27:1975-1982. [PMID: 37278694 DOI: 10.1080/13607863.2023.2219625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/24/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Studies have shown that cultural norms such as filial responsibility and familism operate in the Korean American caregiving context. The purpose of our study is to understand the practice of Korean American caregivers who provide care to a family member living with dementia and their dementia care support needs. MATERIALS AND METHODS We conducted 2 focus groups and individual semi-structured interviews with a total of 20 Korean American caregivers. We used inductive thematic analysis to guide coding and generation of themes. RESULTS Three themes were identified; 1) intersectionality in the Korean American caregiver experience, 2) complex family dynamics, and 3) dementia care barriers and caregiver support needs. Within the dyadic relationship and the family, cultural identity, generational, acculturational, and language factors shaped the caregiver experience. The need to navigate bicultural norms could lead to tensions but also provide opportunity for caregivers to consider self-care and use external supports to decrease the work of caregiving. Family was the unit of caregiving and caregiving was divided among family members based on acculturation and language fluency. Caregivers desired both medical information combined with knowledge that experienced lay support could provide. Support that reflects their cultural context was valued. DISCUSSION Findings suggest the importance of understanding the diversity of response to strong elder care norms among Korean American caregivers and the intersection of multiple factors that influence their caregiving experience. Integrating acculturation and generational assessments may be useful as a way to tailor interventions to optimize engagement in dementia care interventions.
Collapse
Affiliation(s)
- Jinhui Joo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Choi
- College of Medicine, Inha University, Incheon, Republic of Korea
| | - Joseph J Gallo
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Haera Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Seojin Kim
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Jiayun Xu
- School of Nursing, Purdue University, Baltimore, MD, USA
| | - Sangeun Yeom
- School of Arts and Sciences, Johns Hopkins University, West Lafayette, IN, USA
| |
Collapse
|
11
|
Hynek K, Gotehus A, Methi F, Nes RB, Skirbekk V, Hansen T. Caregiving + Migrant Background = Double Jeopardy? Associations between Caregiving and Physical and Psychological Health According to Migrant Backgrounds in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105800. [PMID: 37239528 DOI: 10.3390/ijerph20105800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Informal caregiving can have detrimental consequences for physical and psychological health, but the impacts are highly heterogenous. A largely ignored question is whether these impacts differ with migrant backgrounds, and whether caregiving and a migrant background combine to create double jeopardy. We explored these questions using large-scale data that allows stratification by sex, regional background, and types (inside vs. outside of household) of caregivers. We used cross-sectional 2021 data collected from two Norwegian counties as part of the Norwegian Counties Public Health Survey (N = 133,705, RR = 43%, age 18+). The outcomes include subjective health, mental health, and subjective well-being. The findings show that both caregiving, especially in-household caregiving, and a migrant background relate to lower physical-psychological health. In bivariate analysis, non-Western caregivers, women particularly, reported poorer mental health and subjective well-being (but not physical health) than other caregiver groups. After controlling for background characteristics, however, no interaction exists between caregiver status and migrant background status. Although the evidence does not suggest double jeopardy for migrant caregivers, caution is warranted due to the likely underrepresentation of the most vulnerable caregivers of migrant backgrounds. Continued surveillance of caregiver burden and distress among people of migrant backgrounds is critical to develop successful preventive and supportive intervention strategies for this group, yet this aim hinges on a more inclusive representation of minorities in future surveys.
Collapse
Affiliation(s)
- Kamila Hynek
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Aslaug Gotehus
- Work Research Institute (AFI), Oslo Metropolitan University, 0130 Oslo, Norway
| | - Fredrik Methi
- Department of Health Services Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - Ragnhild Bang Nes
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Promenta Research Center, University of Oslo, 0373 Oslo, Norway
- Department of Philosophy, Classics, History of Arts and Ideas, University of Oslo, 0213 Oslo, Norway
| | - Vegard Skirbekk
- Center for Fertility and Health, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Department of Psychology, University of Oslo, 0373 Oslo, Norway
| | - Thomas Hansen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, 0213 Oslo, Norway
- Promenta Research Center, University of Oslo, 0373 Oslo, Norway
- Norwegian Social Research (NOVA), Oslo Metropolitan University, 0130 Oslo, Norway
| |
Collapse
|
12
|
Miyawaki CE, Bouldin ED, Taylor CA, McGuire LC, Markides KS. Characteristics of Asian American Family Caregivers of Older Adults Compared to Caregivers of Other Racial/Ethnic Groups: Behavioral Risk Factor Surveillance System 2015-2020. J Appl Gerontol 2023; 42:1101-1107. [PMID: 36540000 PMCID: PMC10408680 DOI: 10.1177/07334648221146257] [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: 12/24/2022] Open
Abstract
Asian Americans (AAs) are the fastest-growing racial/ethnic minority group in the United States. While otherwise highly heterogeneous, AAs overall value filial piety and eldercare. This study compared the health and caregiving experiences of AA caregivers of older adults to AA non-caregivers and caregivers of older adults across racial/ethnic groups. We used 2015-2020 Behavioral Risk Factor Surveillance System data for 315 AA caregivers and 3822 AA non-caregivers, plus 395 American Indian/Alaska Native, 1883 Black, 1292 Hispanic, and 20,321 non-Hispanic White caregivers. Among AAs, 4.3% were caregivers, a lower proportion than in other racial/ethnic groups. Most AA caregivers were female (59%), married (71%), in excellent/very good/good health (76%), and with at least one chronic health condition (66%). Other than relationship to care recipients, caregivers' experiences were similar across racial/ethnic groups: most cared for <20 hours/week and provided household and personal care. Efforts to support AA caregivers should be attentive to cultural practices.
Collapse
Affiliation(s)
| | - Erin D. Bouldin
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Alzheimer’s Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher A. Taylor
- Alzheimer’s Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa C. McGuire
- Alzheimer’s Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kyriakos S. Markides
- School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
13
|
Lee SE, Hong M, Casado BL. Alzheimer's disease (AD) knowledge in Korean Americans: identifying knowledge gaps and misconceptions and examining predictors of AD knowledge. ETHNICITY & HEALTH 2023; 28:431-445. [PMID: 35229696 DOI: 10.1080/13557858.2022.2045907] [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] [Indexed: 05/05/2023]
Abstract
OBJECTIVES This study examined Alzheimer's disease (AD) knowledge and its predictors among Korean Americans (KAs). DESIGN Convenience sampling was used to recruit KAs in the Greater Washington metropolitan area. A total of 268 KAs participated in the study and completed a cross-sectional survey in 2014. Using the Alzheimer's Disease Knowledge Scale (ADKS), overall and domain knowledge was assessed. Multiple regression analyses were conducted for overall and domain knowledge with predictors including exposure to AD, social engagement, sources and frequency of health-related information, stigmatic beliefs (pity, antipathy, and social distance), English proficiency, and education. RESULTS KAs reported a 59% accuracy in the overall AD knowledge. At the domain level, KAs were most knowledgeable about assessment and diagnosis and least knowledgeable about caregiving. Our regression analyses showed that having a college degree or higher is associated with a greater overall AD knowledge. Three domain models of life impact, risk factors, and caregiving turned out to be significant: Having a college degree or higher is a predictor of greater knowledge in all three domains. Having more pity stigmatic beliefs is related to greater knowledge in both life impact and caregiving domains while having less pity stigmatic beliefs is associated with more risk factor knowledge; having less social distance stigmatic beliefs is associated with greater life impact knowledge; and having less antipathy stigmatic beliefs is related to better caregiving knowledge. CONCLUSION Our findings revealed areas of misconceptions and knowledge gaps in KAs which need to be addressed in educational interventions. Different knowledge status across the domains demonstrates a multi-dimensional nature of AD knowledge. Multivariate findings confirmed the robust role of education in overall and domain AD knowledge. The effect of different AD stigmatic beliefs on certain AD knowledge domains suggests ways of how stigma change can be efficient for the purpose of increasing AD domain knowledge in KAs.
Collapse
Affiliation(s)
- Sang E Lee
- School of Social Work, San Jose State University, San Jose, CA, USA
| | - Michin Hong
- School of Social Work, Indiana University, Indianapolis, IN, USA
| | | |
Collapse
|
14
|
Hong Y, Xu W, Zhao L. The impact of grandchild care on depressive symptoms of grandparents in China: The mediating effects of generational support from children. Front Public Health 2023; 11:1043969. [PMID: 37020818 PMCID: PMC10067760 DOI: 10.3389/fpubh.2023.1043969] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/02/2023] [Indexed: 04/07/2023] Open
Abstract
Objectives Despite extensive studies about the direct effect of grandchild care on caregiver depression in China, understanding of its internal influencing mechanism has been limited. After controlling for socioeconomic factors, this study investigated whether the experience of caring for grandchildren had a long-term impact on the depression levels of grandparents, either directly or indirectly through generational support from adult children. Methods The subjects of this study were a total of 9,219 adults over 45 who participated in the China Health and Retirement Longitudinal Surveys in 2015 and 2018. We adopted a lag-behind variable to examine the impact of grandchild care on depressive symptoms of grandparents. The proposed mediation model was analyzed using bootstrap modeling, and the KHB method was conducted further to examine differences in the effects of generational support. Results The experience of caring for grandchildren had a significant negative correlation with the depression level of Chinese grandparents. Moreover, children's support significantly mediated the impact of parenting experience on grandparents' depression. Significantly, instrumental support mediated the effect to the greatest extent, while emotional support from children contributed the least. The intermediary effect has urban-rural heterogeneity. Conclusion These findings indicated that grandchild care significantly inhibited the depression level of Chinese grandparents through increased intergenerational support from adult children. The implications of the study's findings were discussed.
Collapse
Affiliation(s)
| | - Wei Xu
- School of Sociology, Wuhan University, Wuhan, China
| | - Lijuan Zhao
- School of Sociology, Wuhan University, Wuhan, China
| |
Collapse
|
15
|
Lwi SJ, Ford BQ, Levenson RW. Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers. Clin Gerontol 2023; 46:207-222. [PMID: 36309843 PMCID: PMC9928887 DOI: 10.1080/07317115.2022.2137448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia. METHODS We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72). RESULTS Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia. CONCLUSIONS These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers. CLINICAL IMPLICATIONS Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.
Collapse
Affiliation(s)
- Sandy J Lwi
- VA Northern California Health Care System, Martinez, California, USA
| | - Brett Q Ford
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Robert W Levenson
- Department of Psychology, University of California, Berkeley, California, USA
| |
Collapse
|
16
|
Ansari-Thomas Z. Care Needs and Arrangements of Aging Immigrants in the United States. J Aging Health 2023; 35:191-208. [PMID: 35972426 DOI: 10.1177/08982643221120701] [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: 02/03/2023]
Abstract
OBJECTIVES To examine the need for and arrangements pertaining to personal care assistance among individuals 65 and older, and how life stage at migration impacts nativity differences in aging-related care. METHODS Using data from the Survey of Income and Program Participation (2001, 2004, and 2008), I examine the odds of needing care assistance, who provides care assistance, and the duration of time care assistance is needed, comparing U.S.-born individuals to migrants who arrived before age 50 ("earlier-life migrants") and those who arrived after age 50 ("later-life migrants"). RESULTS While earlier-life migrants showed similar patterns to U.S.-born, later-life migrants showed higher care needs, were more likely to receive care from an adult child, and were particularly likely to need care for longer durations compared to U.S.-born. DISCUSSION Aging later-life migrants have strikingly distinct care needs and arrangements, with implications for individual and family well-being, especially considering their barriers to public support.
Collapse
Affiliation(s)
- Zohra Ansari-Thomas
- Population Studies Center and Department of Sociology, 142839University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
17
|
Shrestha S, Arora S, Hunter A, Debesay J. Changing dynamics of caregiving: a meta-ethnography study of informal caregivers' experiences with older immigrant family members in Europe. BMC Health Serv Res 2023; 23:43. [PMID: 36650497 PMCID: PMC9847080 DOI: 10.1186/s12913-023-09023-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The population of Europe is ageing and becoming more ethnically diverse due to migration. Finding suitable long-term caring arrangements for older immigrants in Europe has been one of healthcare policymakers' concerns in the last decade. However, relatively few older people with an immigrant background live in long-term care facilities, and many prefer to be cared for by their family members. Little is known about immigrant family caregivers' experiences of caring for older family members and the support they need while providing care. This study aims to synthesize the qualitative literature exploring the experiences of individuals caring for older family members with immigrant backgrounds from Africa, Asia and South America living in Europe. METHODS We searched the electronic databases Medline Ovid, Embase Ovid, PsycInfo Ovid, SocIndex EBSCOhost, CINAHL EBSCOhost, Scopus, Social Care Online, ASSIA ProQuest, and Google Scholar for original, peer reviewed research articles, published in English from 2011 to 2022. The seven-step interpretive methodology in meta-ethnography developed by Noblit and Hare (1988) was followed for qualitative synthesis. RESULTS After assessing 4155 studies for eligibility criteria, 11 peer-reviewed articles were included in this review. The qualitative synthesis of these included articles resulted in four main themes: strong care norms for parents, the moral dilemma of continuing care, uneven care sharing, and the use of formal care services. CONCLUSIONS Caregiving dynamics are changing, both in terms of motivations and approaches to caregiving. Furthermore, there are gender disparities in the distribution of caregiving duties, particularly with women carrying the more significant burden of care. The care burden is further exacerbated by the lack of culturally sensitive formal services complementing the care needs of the ageing immigrants and their family caregivers. Therefore, those searching for alternatives to informal care should be met with appropriate health and care services in terms of language, culture, religion, and lifestyle, delivered in a non-judgmental way.
Collapse
Affiliation(s)
- Sunita Shrestha
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Sanjana Arora
- Centre for Intercultural Communication, VID Specialized Univeristy, Stavanger, Norway
| | - Alistair Hunter
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, UK
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
18
|
Hamiduzzaman M, De Bellis A, Abigail W, Harrington A, Fletcher A. "When I suffer from fever, I eat mangos." Determinants of health-seeking beliefs and behaviors of rural older women in Sylhet, Bangladesh. J Women Aging 2023; 35:4-21. [PMID: 34724877 DOI: 10.1080/08952841.2021.1996195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Poverty, poor living conditions, religious values and norms, lack of education, and gender discrimination influence the beliefs and behaviors of rural older women in many low-income countries. This paper aims to report the socio-ecological determinants of health-seeking beliefs and behaviors of rural older women in North-eastern Bangladesh and how these behaviors impact their recognition within the setting. It involved semi-structured interviews with 25 older women and 11 healthcare professionals. The findings revealed various determinants at the personal level (awareness of illness, mistrust toward medical treatment, self-treatment, and religious values and norms), the interpersonal level (isolation in family and communication with clinicians), community level (community perception of aging, neighboring and community organizations), and in the sphere of human rights (care affordability, social safety-net coverage and national policy). Four core determinants (poverty, education, gender and religiosity) were intertwined in shaping beliefs and behaviors.
Collapse
Affiliation(s)
- Mohammad Hamiduzzaman
- College of Health, Medicine & Wellbeing, The University of Newcastle, Taree, New South Wales, 2430, Australia
| | - Anita De Bellis
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Wendy Abigail
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Ann Harrington
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia.,Public and Contextual Theology Research Centre, Australian Centre for Christianity & Culture, Charles Sturt University, Barton, Australia
| | - Amber Fletcher
- Department of Sociology & Social Studies, University of Regina, Regina, Saskatchewan, Canada
| |
Collapse
|
19
|
Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants. J Cross Cult Gerontol 2022; 37:407-426. [PMID: 36469229 DOI: 10.1007/s10823-022-09465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Bangladesh has the third largest population of poor older adults in the world and 73% of them live in rural areas. Disparity in the country's health services is evident that creates a substantial pressure, especially on rural elderly women who live in a compromised socio-cultural atmosphere. This is true that we know about rural elderly women's self-reported health and service use barriers, but no studies captured the views of health staff. This study presents a qualitative exploration of the views held by rural health staff whose role is to provide care to local elderly women. We conducted 11 interviews with clinicians, pharmacists and public health assistants in Sylhet district, Bangladesh. A critical thematic discourse analysis, using the critical social constructs of Habermas and Honneth, of the data informed the women's inadequate healthcare access and associated barriers that were complex and overlapping but had explicit institutional, subjective and material consequences. Five major themes emerged including: unequal distribution of health services; marginalization in patient-staff relationships; living with poverty; social relegation; and mistrust of clinical treatment. Rural areas were viewed with inequitably distributed health services and traditionally a large proportion of elderly women living in poverty who lacked social support and demonstrated a mistrust towards healthcare system. No recognition of the women and power differences were underpinned by economic factors and cultural societal values. The findings suggest a need for health policy solutions and education of healthcare staff and elderly women regarding accessing healthcare.
Collapse
|
20
|
Lee E. Perceptions of caregiving for people living with dementia and help-seeking patterns among prospective Korean caregivers in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4885-e4893. [PMID: 35785502 DOI: 10.1111/hsc.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/27/2022] [Accepted: 06/18/2022] [Indexed: 06/15/2023]
Abstract
Due to cultural influences, people from some ethnic minority groups expect to provide caregiving for their family members who suffer from illness. Little is known about the expectations about caregiving and the help-seeking process among the Korean population in Canada. Thus, the purpose of this study is to examine perceptions of caregiving for people living with dementia and help-seeking patterns among prospective Korean caregivers who anticipate becoming primary caregivers of their older relatives with dementia. An exploratory qualitative study was conducted in Montreal, Canada. In-depth semi-structured interviews were conducted with nine prospective Korean caregivers. The interviews were analysed using a qualitative thematic analysis. This study found four emerging themes: (1) the importance of family care; (2) the ability to find resources outside of the family; (3) the roles of Korean churches as a support system and; (4) the perceptions of service providers and health care settings. The findings of this study suggest that linguistic support services enable family caregivers to access more health and social services. Resources may be more easily accessed by Korean communities when provided through churches.
Collapse
Affiliation(s)
- Eunyoung Lee
- Department of Social Welfare, Dongguk University, Seoul, South Korea
| |
Collapse
|
21
|
Nguyen T, Levkoff S, Nguyen H. 'He is just getting old, you know': the role of cultural and health beliefs in shaping the help-seeking process of family members caring for persons with dementia in Vietnam. ETHNICITY & HEALTH 2022; 27:1630-1651. [PMID: 33951992 DOI: 10.1080/13557858.2021.1922612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aims to examine the help-seeking process of family caregivers for persons with dementia (PWD) in Vietnam, and how health and cultural beliefs shape this process. DESIGN Twenty family caregivers of PWD at a geriatric hospital in Northern Vietnam were recruited. A total of 30 face-to-face, semi-structured interviews, including 10 follow-up interviews, were conducted. Structural coding was used first to guide data analysis through four structural codes consistent with the four stages of the help-seeking model: (1) disease and symptom experience; (2) explanatory models for symptom appraisal; (3) decision to seek help; and (4) contact with the sources of help. Then thematic coding was used for more detailed and data-driven initial codes to emerge from the data. RESULTS Cultural and health beliefs, particularly collectivist values, such as familism and filial piety, shaped each stage of Vietnamese family caregivers' help-seeking process. Caregivers experienced different PWD's symptoms and adopted a mixed explanatory model combining biomedical and folk beliefs to explain the causes of dementia. They highly valued independence, autonomy, devotion to their family, and self-sacrifice, making these values the driving force underlying their self-reliance regime in caregiving. Help-seeking was often delayed until caregivers considered the situation to be beyond their own capacity to manage independently. The family was always the primary informal source of support for caregivers, with additional help sought from friends, neighbors, and religious facilities. Health professionals, if available, were also an important formal source for medical advice. CONCLUSIONS The results highlight the importance of culture and health beliefs in shaping caregivers' help-seeking process, and advocate the needs of service development targeting not only Vietnamese family caregivers for PWD, but also caregivers sharing similar collectivist culture in different areas. Interventions and services that are consistent with their values of self-sacrifice, devotion to family, autonomy, and self-reliance are much needed.
Collapse
Affiliation(s)
- Trang Nguyen
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- University of Social Sciences and Humanities, Vietnam National University, Hanoi, Vietnam
| | - Sue Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Huong Nguyen
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
22
|
The Implementation of Palliative Home Care in Southeast Asian Countries: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221113858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Asia where family caregiving is part of the culture, palliative home care becomes the most suitable service to keep patients close to their family and to reduce costs. There is a wide variety of palliative home care services due to different cultures and levels of involvement of the family. This review aims to explore the implementation of palliative home care in East and Southeast Asian countries. The articles reviewed in this study were obtained from 3 electronic databases: EbscoHost, PubMed, and Scopus. Journal articles that discussed palliative home care for patients with cancer in East and Southeast Asia countries were included. Review papers were excluded. Seven studies were used in the current review. In general, there are 6 services provided for palliative home care in this region, which are daily activity living care, planning and preparation for palliative home care, education and counseling, patients’ follow-up, symptom management, and direct care for family. Most of the programs involve family caregivers during the treatment. The palliative home care team consists of at least a doctor and a nurse. Symptom management is the most common service and direct care for family is the least offered palliative home care service in this region. Alleviating symptoms is one of the targets in palliative care, therefore involving family in symptom management for palliative home care is fundamental. Although caregiving is part of the culture, family members need to be supported to maintain their quality of life.
Collapse
|
23
|
Miyawaki CE, Liu M, Markides KS. Association between caregivers' characteristics and older care recipients' well-being among Vietnamese immigrant families in the United States. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2214-2224. [PMID: 34882808 PMCID: PMC9177710 DOI: 10.1002/jcop.22768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 06/01/2023]
Abstract
AIMS We examined the association between caregivers' psychological status and their older family members' (care recipients) mental health in the Vietnamese American community (N = 58 dyads). METHODS Logistic regression models were used. RESULTS Caregivers and care recipients were on average 53 and 75 years old, immigrated at ages 32 and 51, and had 10 and 6 years of formal education, respectively. Approximately two-thirds of caregivers provided care for 20+ h/week for 7 years with the majority of care recipients reporting fair or poor health. Care recipients' physical and cognitive health had a significant association with their depressive symptoms. However, care recipients acting as burdened caregivers' "company" helped themselves and felt less depressed (OR = 0.89, 95% CI: 0.80, 0.99). CONCLUSION Leveraging the tradition of Vietnamese multigeneration households, we should promote being a good company to each other that will help the caregiver-care recipient dyad, as well as their family unit when planning future interventions.
Collapse
Affiliation(s)
| | - Minhui Liu
- Department of Community Care, Xiangya School of Nursing Central South University, Changsha, China
| | - Kyriakos S. Markides
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
24
|
Xue M, Chen X, Zhao H, Zhao Y, Li J, Chen W. Understanding the experiences of older caregivers of patients with lung cancer during palliative chemotherapy in China: a qualitative study. Support Care Cancer 2022; 30:8011-8018. [PMID: 35764692 DOI: 10.1007/s00520-022-07247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Although there has been an increase in research on caregivers of patients with cancer, there has been little focus on the specific experiences of older caregivers of patients with lung cancer and the effect of their cultural backgrounds on their experiences. This study explored the caregiver experience among the ageing population in China. METHODS Older caregivers of patients with lung cancer undergoing palliative chemotherapy were recruited. Data were collected using a qualitative descriptive design involving semi-structured interviews, which were recorded, transcribed verbatim and analysed qualitatively using inductive content analysis. RESULTS Eighteen caregivers aged 61-81 years completed the interviews. The following four themes were identified: physical difficulty, living with ambivalence, perception of role and role-related behaviour changes. These themes enabled a greater understanding of role-related behaviours in older caregivers and their challenges in addressing biological and psychosocial challenges related to older age. CONCLUSION The present study highlighted the vulnerability and perceived challenges of the role of older caregivers. These findings help lay the foundation for interventions to improve the care provided to caregivers and their health outcomes, especially caregivers with chronic conditions.
Collapse
Affiliation(s)
- Min Xue
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Jinan, Shandong, 250021, People's Republic of China
| | - Xiaoyun Chen
- Shandong Women's University, 2399 Daxue Road, Jinan, Shandong, 250300, People's Republic of China
| | - Haiyan Zhao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Jinan, Shandong, 250021, People's Republic of China
| | - Yumei Zhao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Jinan, Shandong, 250021, People's Republic of China
| | - Jing Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Jinan, Shandong, 250021, People's Republic of China
| | - Weijuan Chen
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, Jingwuweiqi Road, Jinan, Shandong, 250021, People's Republic of China.
| |
Collapse
|
25
|
Huang YH, Nagao CA, Santos KMB, Werchowsky MI. Impact of Culture, Spirituality, and Mental Health Attitudes on Intergenerational Asian-American Caregivers: A Pilot Study. Am J Occup Ther 2022; 76:23198. [PMID: 35143608 DOI: 10.5014/ajot.2022.046912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Asian-Americans are more likely than other ethnic groups to care for older family members and less likely to seek mental health services. The research on caregiver burden among Asian-American intergenerational caregivers is limited. OBJECTIVE To investigate how spirituality and mental health help-seeking attitudes correlate with and predict perceived feelings of caregiver burden among Asian-American caregivers. Favorable mental health help-seeking attitudes were predicted to negatively correlate with caregiver burden, and spirituality was predicted to negatively correlate with and negatively predict caregiver burden. DESIGN Quantitative survey research. SETTING Community mental health. PARTICIPANTS One hundred one participants were recruited using the following inclusion criteria: Asian-Americans who currently or previously provided care to an Asian family member at least one generation older than the caregiver for at least 1 mo and in the past 3 yr. Outcomes and Measures: Items from the Burden Scale for Family Caregivers, Spirituality Scale, Expressions of Spirituality Inventory-Revised, Mental Help Seeking Attitudes Scale, and Self-Stigma of Seeking Psychological Help measured caregiver burden, spirituality, and mental health help-seeking attitudes. RESULTS A statistically significant negative correlation was found between caregiver burden and spirituality and between caregiver burden and mental health help-seeking attitudes. Spirituality and number of domains of care were statistically significant predictors of caregiver burden. CONCLUSIONS AND RELEVANCE Spirituality was found to negatively predict caregiver burden among Asian-American intergenerational caregivers. Mental health help-seeking attitudes were negatively correlated with caregiver burden. Occupational therapy practitioners have the opportunity to integrate spirituality and culturally sensitive mental health promotion into their services to Asian-Americans. What This Article Adds: Evidence that spirituality is a negative predictor of caregiver burden for Asian-American intergenerational caregivers offers a unique opportunity for occupational therapy practitioners to offer alternative methods of mental health promotion with this population. Understanding that spirituality and mental health help-seeking attitudes are culturally mediated allows practitioners to be informed about a dynamic in Asian-American culture.
Collapse
Affiliation(s)
- Yan-Hua Huang
- Yan-hua Huang, PhD, OTR/L, is Professor, Department of Occupational Therapy, College of Health, Human Services and Nursing, California State University Dominguez Hills, Carson;
| | - Ciara A Nagao
- Ciara A. Nagao, MS, OTR/L, is Occupational Therapist, Orange, CA. At the time of the study, Nagao was Master's Student, California State University Dominguez Hills, Carson
| | - Kelsey Michelle B Santos
- Kelsey Michelle B. Santos, MS, OTR/L, is Occupational Therapist, Orange County, CA. At the time of the study, Santos was Master's Student, California State University Dominguez Hills, Carson
| | - Madison I Werchowsky
- Madison I. Werchowsky MS, OTR/L, is Occupational Therapist, Los Angeles, CA. At the time of the study, Werchowsky was Master's Student, California State University Dominguez Hills, Carson
| |
Collapse
|
26
|
Kaewwilai L, Duggleby W, O'Rourke HM, Santos Salas A. Coping strategies and quality of life among Thai family carers of community-dwelling persons living with dementia: A cross-sectional study. J Adv Nurs 2022; 78:2785-2798. [PMID: 35150154 DOI: 10.1111/jan.15185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/16/2021] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
AIMS To examine the association between coping strategies and quality of life (QOL) among Thai family carers of persons living with dementia. DESIGN A descriptive correlational quantitative design. METHODS Data were collected between January 2021 and April 2021. A multi-pronged approach for recruitment was used. Participants completed measures assessing carer demographic characteristics, coping styles, QOL, perceived stress and perceived social support. Hierarchical multiple regression analysis was used to determine the association between types of coping strategies used and QOL scores, adjusting for carer characteristics and carers' stress and social support. RESULTS There were 86 participants (mean age 52.84 years), and the majority were female (87.2%). After adjusting for covariates, hierarchical multiple regression revealed that only positive emotion-focused coping demonstrated a statistically significant association with total QOL scores. Problem-focused coping and negative emotion-focused coping were not significantly associated with total QOL scores of Thai family carers of persons living with dementia. CONCLUSION Positive emotion-focused coping was associated with improved QOL scores. This finding supports the use of positive emotion-focused coping in Thai family carers of persons living with dementia, which potentially could improve the QOL of this population. IMPACT It is essential to differentiate between positive and negative emotion-focused coping to generate valid estimates of the association between coping and QOL. Nurses should encourage carers to use positive emotion-focused coping strategies as these strategies were found to be helpful in enhancing carers' QOL.
Collapse
Affiliation(s)
- Lalita Kaewwilai
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah M O'Rourke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Santos Salas
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
27
|
Pham Q, El-Dassouki N, Lohani R, Jebanesan A, Young K. The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic. J Med Internet Res 2022; 24:e29876. [PMID: 34994707 PMCID: PMC8783290 DOI: 10.2196/29876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/18/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada's aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada's diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart.
Collapse
Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Noor El-Dassouki
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Aravinth Jebanesan
- Global Health Office, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Karen Young
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
28
|
Zhao D, Zhou Z, Shen C, Ibrahim S, Zhao Y, Cao D, Lai S. Gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren. BMC Public Health 2021; 21:1838. [PMID: 34635088 PMCID: PMC8507248 DOI: 10.1186/s12889-021-11886-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 09/29/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Caring for grandchildren is regarded as one of the principle roles of middle- and old-aged adults, especially among rural Chinese grandparents. This study aims to examine the gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren, based on the gender differences in grandparental role engagement and the theories of role strain and role enhancement. METHODS A total of 4833 rural citizens with one or more grandchildren were selected from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015. Grandchild care was measured by continuous variable (duration) and categorical variable (no care, low intensity, moderate intensity, high intensity). Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CES-D). We used coarsened exact matching (CEM) to balance the covariates of caregivers and non-caregivers. Following CEM, 1975 non-caregivers and 2212 caregivers were identified (N = 4187). Multilevel linear regression was employed to examine the gender differences in depressive symptoms. We also tested for the moderating role of gender on the association between grandchild care and depressive symptoms. RESULTS Grandmothers were more likely to provide grandchild care (54.42% vs 51.43%) at high intensity (61.46% vs 51.01%), with longer duration (39.24 h vs 33.15 h) than that given by grandfathers. Grandmothers suffered more from depressive symptoms than grandfathers, and such gap increased when grandparents were involved in high-intensity care. Grandmothers providing grandchild care, particularly at moderate intensity, were associated with fewer depressive symptoms (Coef. = - 0.087, 95%CI: - 0.163, - 0.010; Coef. = - 0.291, 95%CI: - 0.435, - 0.147), compared with non-caregivers. Grandmothers giving moderate intensity of grandchild care were also associated with fewer depressive symptoms (Coef. = - 0.171, 95% CI: - 0.313, - 0.029), compared with those with low-intensity care. However, such associations were not significant among grandfathers. CONCLUSIONS Our findings highlight the gender differences in depressive symptoms of rural Chinese grandparents caring for grandchildren. Grandparents should be encouraged to engage in grandchild care, but at moderate intensity. The health status of middle- and old-aged adults, particularly females, should be monitored closely. Humanistic care, preventive care and curative treatment strategies focusing on such populations should be developed and refined.
Collapse
Affiliation(s)
- Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Sahardid Ibrahim
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Dan Cao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| |
Collapse
|
29
|
Nguyen TT. "I am not a good enough caregiver, and it is my fault": The complex self-concept of Vietnamese female caregivers in dementia care. DEMENTIA 2021; 20:2340-2361. [PMID: 33595340 DOI: 10.1177/1471301221994359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Vietnam, the majority of dementia caregivers are women. They play multiple social roles, confronting role conflicts, and caregiving burdens with insufficient social supports. Dementia caregiving alters their self-concepts, or who and how good they think they are. This secondary analysis study aims to explore self-concepts of Vietnamese female caregivers of people with dementia. In total, data of 21 face-to-face, semi-structured interviews, including six follow-up interviews, conducted with 13 Vietnamese female caregivers of people with dementia, were drawn from a larger study for analysis following the thematic coding procedure. Results showed that the self-concepts of female caregivers in dementia care were complex, contextualized, and manifested in different aspects. First, the guided self and the performed self emerged from the data as the key themes consistently shared by female caregivers. Their guided self was the self that their social norms and cultural traditions told them about who they should be, while their performed self was the self they demonstrated to the outside world. The mismatch between these two types of self (self-discrepancy) caused distress among caregivers. Second, caregivers' self-concept was the combination of the three key types of the self: the moral self (a filial daughter or a responsible wife); the feminine self (a patient and graceful women); and the worthy self (a devoted and helpful caregiver). Understanding Vietnamese female caregivers' self-concepts, self-discrepancy, and its impacts on their well-being can be used to inform the development of interventions and social services for this underserved group.
Collapse
Affiliation(s)
- Trang T Nguyen
- 5783Tulane University, New Orleans, LA, USA; Vietnam National University, Hanoi, Vietnam
| |
Collapse
|
30
|
Miyawaki CE, Bouldin ED, Taylor CA, McGuire LC. Baby Boomers Who Provide Informal Care for People Living with Dementia in the Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9694. [PMID: 34574619 PMCID: PMC8467135 DOI: 10.3390/ijerph18189694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
One in four Baby Boomers fills the informal caregiver role in the United States. The objectives of this study were to estimate the prevalence of Baby Boomers who are informal caregivers for people living with dementia and compare their physical and mental health status to caregivers for persons with conditions other than dementia using 2015-2018 Behavioral Risk Factor Surveillance System data (N = 10,602). We identified caregiving status (assisting a family member/friend with a long-term illness or disability in the past month, managing personal care, and not caring for a child/grandchild) and whether the care recipient's major health condition was dementia. We calculated weighted estimates and used chi-square tests and log-binomial regression for comparisons of selected characteristics. Among Baby Boomer caregivers, 15.4% were caring for someone with dementia. Dementia caregivers were more likely to be female, caring for a parent/parent-in-law, and providing care longer than caregivers for persons without dementia. After adjusting for sociodemographic and caregiving characteristics, the prevalence of fair/poor health, frequent mental distress, and chronic conditions were similar across types of caregivers. Although no differences in caregiver's physical and mental health by care recipient's dementia status were found, we should underscore the importance of maintaining Baby Boomer caregivers' health and well-being.
Collapse
Affiliation(s)
- Christina E. Miyawaki
- Graduate College of Social Work, University of Houston, 3511 Cullen Boulevard, Room 110HA, Houston, TX 77204-4013, USA
| | - Erin D. Bouldin
- Department of Health & Exercise Science, Appalachian State University, 1179 State Farm Rd, Suite 432, P.O. Box 32071, Boone, NC 28608, USA;
- Alzheimer’s Disease & Healthy Aging Program, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA; (C.A.T.); (L.C.M.)
| | - Christopher A. Taylor
- Alzheimer’s Disease & Healthy Aging Program, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA; (C.A.T.); (L.C.M.)
| | - Lisa C. McGuire
- Alzheimer’s Disease & Healthy Aging Program, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA; (C.A.T.); (L.C.M.)
| |
Collapse
|
31
|
Hamiduzzaman M, Torres S, Fletcher A, Islam MR, Siddiquee NA, Greenhill J. Aging, care and dependency in multimorbidity: how do relationships affect older Bangladeshi women's use of homecare and health services? J Women Aging 2021; 34:731-744. [PMID: 34255615 DOI: 10.1080/08952841.2021.1951115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Gender issues can create major barriers to healthcare utilization for older women with multimorbidity, especially in developing countries like Bangladesh. Elderly rural women in Bangladesh, are the poorest of the poor, and the women with multimorbidity live in a regulated family atmosphere. This study explored the relationship dimensions of older women with multimorbidity in homecare and their utilization of health services. To gain a deeper understanding of these complex issues, a qualitative case study was conducted. Semi-structured, in-depth interviews were conducted with 11 health staff and 22 older women with multimorbidity, living in three residential communities of the Sylhet District, Bangladesh. Our analysis used critical thematic discourse, a technique developed from Axel Honneth's recognition-and-misrecognition theory. Seven relationship dimensions have been identified, and grouped under three major themes: intimate affairs [marital marginalization and parent-children-in law dynamics]; alienation in community relationships [patriarchal sibling relationships, neighborhood challenges, and gender inequality in interactions]; and legal disconnections [ignorance of rights and missed communication]. Our findings revealed a lack of understanding of the women's multimorbid care needs and patriarchal marginalization in family. This lack of understanding together with poor peer-supports in healthcare is perpetuated by misrecognition of needs from service providers, resulting in a lack of quality and poor utilization of homecare and health services. Understanding the high needs of multimorbidity and complexities of older women's relationships can assist in policy decisions. This study deepens our understanding of the ways gender inequality intersects with cultural devaluation to reduce the well-being of older women in developing countries.
Collapse
Affiliation(s)
- Mohammad Hamiduzzaman
- College of Health, Medicine & Wellbeing, The University of Newcastle, New South Wales, Australia
| | - Stacy Torres
- Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Amber Fletcher
- Department of Sociology & Social Studies, University of Regina, Saskatchewan, Canada
| | - M Rezaul Islam
- Institute of Social Welfare & Research, University of Dhaka, Dhaka, Bangladesh
| | - Noore Alam Siddiquee
- College of Business, Government & Law, Flinders University, South Australia, Australia
| | - Jennene Greenhill
- Faculty of Health and Medical Sciences, UWA Medical School, University of Western Australia, Perth, Australia
| |
Collapse
|
32
|
Tomita S, Kuga T, Osugi Y, Kobayashi D. Factors associated with the accomplishment of home death among patients receiving physician-led home healthcare. Geriatr Gerontol Int 2021; 21:525-531. [PMID: 33904229 DOI: 10.1111/ggi.14173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate unique factors associated with home death in older Asian individuals who received physician-led home healthcare. METHODS We carried out a case-control study at a single hospital in Japan from February 2018 to December 2019. We included patients who had started receiving physician-led home healthcare and died at home as cases, and those receiving the same type of care but died in the hospital as controls. Multivariable logistic regression was used to evaluate factors associated with home death. RESULTS A total of 152 patients (mean age 70.3 years [SD 11.2 years]; 86 [56.6%] men) were included, of whom 89 (58.6%) died at home and 63 (41.4%) died in the hospital. Comparing the two groups, the presence of family psychological problems related to care was significantly more common in the hospital death group (home death 49.4%; hospital death 32.3%, P = 0.036). Home death was related to patients aged >85 years compared with patients aged <75 years (adjusted odds ratio 6.47, 95% CI 1.52-27.48) and patients who were in the highest quartile of the number of symptoms (adjusted odds ratio 5.45, 95% CI 1.15-25.95) compared with the lowest. Family members' willingness for the patient to die at home was associated with home death (adjusted odds ratio 7.47, 95% CI 2.13-26.19). CONCLUSIONS Older age and multiple symptoms were related to accomplishing home death. Patient preference was not associated with the place of death, but family member preference was. These results might reflect family concepts particular to Asia. Geriatr Gerontol Int 2021; 21: 525-531.
Collapse
Affiliation(s)
- Shiori Tomita
- General Internal Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Takao Kuga
- General Medicine, Toyota Regional Medical Center, Toyota, Japan
| | - Yasuhiro Osugi
- Community Based Medicine, Fujita Health University, Toyoake, Japan
| | - Daiki Kobayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| |
Collapse
|
33
|
Huyen BT, Van Anh PT, Duong LD, The THN, Guo P, Van Thuc P, Khue LN, Krakauer EL, Harding R. Quality of life among advanced cancer patients in Vietnam: a multicenter cross-sectional study. Support Care Cancer 2021; 29:4791-4798. [PMID: 33537888 PMCID: PMC8236448 DOI: 10.1007/s00520-021-06012-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
Purpose Cancer is a leading cause of death in Vietnam. To maximize quality of life (QOL) at the end of life, valid and clinically useful instruments are needed to assess palliative care needs and the effectiveness of palliative care interventions. Methods We aimed to (i) determine psychometric properties of the Vietnamese version of the WHO abbreviated quality of life scale (WHOQOL-BREFVN) among advanced cancer patients, (ii) measure HR-QOL, and (iii) identify predictors of HR-QOL. We collected demographic, clinical, and HR-QOL data from stage III/IV adult cancer patients at two major Vietnamese cancer centers. We determined the internal consistency (Cronbach’s alpha), construct validity (confirmatory factor analysis (CFA)), and discriminant validity (known-groups comparison) of the Vietnamese instrument. HR-QOL was analyzed descriptively. Multinomial logistic regressions identified predictors of HR-QOL. Results A total of 825 patients participated. Missing data were completely at random (MCAR) (chi-square = 14.270, df = 14, p = 0.430). Cronbach’s alpha for all items was 0.904. CFA loadings of physical, psychological, social relationship, and environment domains onto HR-QOL were 0.81, 0.82, 0.34, and 0.75, respectively. Prediction of scores differed significantly by functional status (Wilks’ lambda = 0.784, chi-square = 197.546, df = 4, p < 0.01, correct prediction = 74.6%). HR-QOL was reported as very bad/bad by n = 188 patients (22.8%) and general health as very bad/bad by n = 430 (52.1%). Multinomial logistic regression (likelihood ratio test: chi-square = 35.494, df = 24, p = 0.061, correct prediction = 62.2%) and the Pearson correlations revealed worse HR-QOL was associated with inpatient status, high ECOG score, and having dependent children. Conclusion The Vietnamese version of the WHOQOL-BREF has excellent internal consistency reliability and sound construct and discriminant validity in advanced cancer patients. Advanced cancer inpatients, those with dependent children, and those with poorer physical function appear to have the greatest palliative care needs.
Collapse
Affiliation(s)
- Bui Thanh Huyen
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,City Children's Hospital, Ho Chi Minh City, Vietnam
| | - Pham Thi Van Anh
- Department of Infectious Diseases, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Le Dai Duong
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Geriatrics and Palliative Care, University Medical Center, Ho Chi Minh City, Vietnam
| | - Than Ha Ngoc The
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Geriatrics and Palliative Care, University Medical Center, Ho Chi Minh City, Vietnam
| | - Ping Guo
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Pham Van Thuc
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Luong Ngoc Khue
- Administration of Medical Services, Ministry of Health, Hanoi, Vietnam
| | - Eric L Krakauer
- Department of Palliative Care, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, USA
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK.
| |
Collapse
|
34
|
Hamiduzzaman M, De Bellis A, Abigail W, Kalaitzidis E, Harrington A. The World Is Not Mine - Barriers to Healthcare Access for Bangladeshi Rural Elderly Women. J Cross Cult Gerontol 2021; 36:69-89. [PMID: 33449242 DOI: 10.1007/s10823-020-09420-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as 'socially determined'. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, 'emancipation' of Habermas and 'recognition' of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women's healthcare access. The concept of 'social determinants of healthcare access' is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of 'The World is Not Mine'. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.
Collapse
Affiliation(s)
- Mohammad Hamiduzzaman
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia. .,College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, GPO BOX 852, Renmark, South Australia, 5341, Australia.
| | - Anita De Bellis
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Wendy Abigail
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Evdokia Kalaitzidis
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Ann Harrington
- College of Nursing & Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
35
|
Liu HY, Hsu WC, Shyu YIL, Wang YN, Huang TH, Lin YE, Huang CH. Finding a balance in family caregiving for people with dementia: A correlational longitudinal study. J Adv Nurs 2021; 77:2278-2292. [PMID: 33434343 DOI: 10.1111/jan.14747] [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: 08/01/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
AIMS The "Finding a Balance Point" framework was used to explore the caregiving process over time for family caregivers of people with dementia in Taiwan. This study aimed to: (a) identify Taiwanese caregivers' different balance trajectories; (b) explore predictors of trajectory group membership; and (c) examine associations of different balance trajectories with caregiving outcomes. DESIGN A correlational longitudinal design was used. METHODS Data were collected from 200 family caregivers' self-completed questionnaires and they were followed over 2 years (June 2015-May 2017). Discrete balance trajectories were identified by group-based trajectory modelling. Predictors of trajectory group membership were identified from potential predictors of caregiving characteristics and caregiving factors using multivariate logistic regression. Associations of trajectory groups with caregiving outcomes (depressive symptoms and health-related quality of life) were explored using the generalized estimating equation. RESULTS Balance trajectories best fit a two-group trajectory model (poor and good). Caregivers with a poor sense of balance between competing needs were more likely to have more depressive symptoms (b = 11.71, 95% CI [9.04, 14.38], p < .001), worse physical health (b = -6.22, 95% CI [-8.71, -3.74], p < .001), and worse mental health (b = -11.1, 95% CI [-13.58, -8.63], p < .001) than caregivers with a good sense of balance. Caregivers experiencing lower role strain (b = -1.45, SE = 0.48, p = .003) or higher predictability (b = 2.83, SE = 0.76, p < .001) were more likely to belong to the good-balance group. CONCLUSIONS Caregivers with poor balance between competing needs are more likely to have worse caregiving outcomes. Role strain and predictability significantly predicted balance trajectory groups. Family caregivers with lower caregiving task difficulty and/or better knowledge of the care receiver were more likely to be in the good balance trajectory group. IMPACT Our findings support the framework, "Finding a Balance Point," and clarify the family caregiving process for people with dementia. This framework could be used to tailor interventions for home care nurses to improve family caregivers' caregiving outcomes.
Collapse
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Wen-Chuin Hsu
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).,Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Yu-Nu Wang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.)
| | - Tzu-Hsin Huang
- Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Yueh-E Lin
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).,Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
| | - Chun-Hsia Huang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| |
Collapse
|
36
|
Liu M, Jiang T, Yu K, Wu S, Jordan-Marsh M, Chi I. Care Me Too, a Mobile App for Engaging Chinese Immigrant Caregivers in Self-Care: Qualitative Usability Study. JMIR Form Res 2020; 4:e20325. [PMID: 33263552 PMCID: PMC7744258 DOI: 10.2196/20325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/05/2020] [Accepted: 11/20/2020] [Indexed: 01/17/2023] Open
Abstract
Background Caregiving and self-care are challenging for Chinese immigrants in the United States due to limited accessible support and resources. Few interventions exist to assist Chinese immigrant caregivers in better performing self-care. To address this gap in the literature, our team developed the Care Me Too app to engage Chinese immigrant caregivers in self-care and conducted a user experience test to assess its usability and acceptability. Objective This paper aims to report the results of the app’s usability and acceptability testing with Chinese immigrant caregivers and to solicit participants’ feedback of the app design and functions. Methods A total of 22 Mandarin-speaking Chinese caregivers participated in the study, which consisted of 2 parts: the in-lab testing and the 1-week at-home testing. In-depth face-to-face interviews and follow-up phone interviews were used to assess user experience of the app’s usability and acceptability and to solicit feedback for app design and functions. Directed content analysis was used to analyze the qualitative data. Results Among the 22 participants, the average age was 60.5 (SD 8.1) years, ranging from 46 to 80 years; 17 (77%) participants were women and 14 (64%) had an associate degree or higher. Participants reported uniformly positive ratings of the usability and acceptability of the app and provided detailed suggestions for app improvement. We generated guidelines for mobile health (mHealth) app designs targeting immigrant caregivers, including weighing flexibility versus majority preferences, increasing text sizes, using colors effectively, providing engaging and playful visual designs and functions, simplifying navigation, simplifying the log-in process, improving access to and the content on the help document, designing functions to cater to the population’s context, and ensuring offline access. Conclusions The main contribution of this study is the improved understanding of Chinese caregivers’ user experiences with a language-appropriate mHealth app for a population that lacks accessible caregiving and self-care resources and support. It is recommended that future researchers and app designers consider the proposed guidelines when developing mHealth apps for their population to enhance user experience and harness mHealth’s value.
Collapse
Affiliation(s)
- Mandong Liu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Edward R Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| | - Tongge Jiang
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Kexin Yu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Edward R Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Edward R Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States.,Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Maryalice Jordan-Marsh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States.,Edward R Roybal Institute on Aging, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
37
|
Ma KPK, Saw A. An international systematic review of dementia caregiving interventions for Chinese families. Int J Geriatr Psychiatry 2020; 35:1263-1284. [PMID: 32964577 DOI: 10.1002/gps.5400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/26/2020] [Accepted: 08/08/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Older Asians and Chinese are among the least studied populations in the dementia caregiving literature. This review seeks to critically synthesize the literature on intervention characteristics, components and tailoring strategies for dementia family caregivers in Chinese communities globally. METHODS Five electronic databases (PsychINFO, PubMed, CINAHL, ScienceDirect and Google Scholar) were searched for articles published between 1980 and July 2018. The protocol of this review was registered with PROSPERO (CRD42019132800). RESULTS Twenty-nine unique interventions across 39 papers met inclusion criteria. Results from descriptive and thematic syntheses revealed that most interventions were psychoeducational, CBT-based, multicomponent, structured, and less than a year in duration. Disease education, management of behavioral and psychological symptoms of dementia, stress coping techniques, and referral to community resources were frequently included in interventions. Community-, culture- and language-focused strategies were used to tailor interventions. The most common tailoring strategies were: (a) using community networks and media for outreach and recruitment; (b) making translations and language adaptations to the intervention materials; and (c) focusing on trust and therapeutic alliance. Most interventions produced desired outcomes, particularly reducing caregiver burden and increasing self-efficacy. CONCLUSIONS To our knowledge, this is the first review to date that systematically synthesized the characteristics and tailoring of dementia caregiving interventions for Chinese families globally. Current findings suggest that most interventions are effective, although many only superficially address Chinese culture. Future research should incorporate Chinese values and cross-cultural challenges into caregiving interventions for deep-level adaptations that could potentially be more effective to engage and support Chinese caregivers.
Collapse
Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Miyawaki CE, Bouldin ED, Taylor CA, McGuire LC. Baby Boomers as Caregivers: Results From the Behavioral Risk Factor Surveillance System in 44 States, the District of Columbia, and Puerto Rico, 2015-2017. Prev Chronic Dis 2020; 17:E80. [PMID: 32790608 PMCID: PMC7458106 DOI: 10.5888/pcd17.200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Baby boomers, people born from 1946 through 1964, represent a substantial portion of the US population. Generally, baby boomers have more chronic disease and disability than those in the previous generation. Frequently, they also provide informal care to others. The objective of our study was to estimate the prevalence of informal caregiving among baby boomers and compare the health of baby boomer caregivers and noncaregivers. METHODS Using data from the Behavioral Risk Factor Surveillance System (2015-2017) for 44 states, the District of Columbia, and Puerto Rico, we classified 109,268 baby boomers as caregivers or noncaregivers and compared their general health (poor or fair vs good, very good, or excellent), chronic health conditions, and frequent mental distress (FMD). FMD was defined as 14 days or more of poor mental health in the past month. We used log-binomial regression to calculate prevalence ratios, adjusted for age and sex (aPRs), and to separately estimate aPRs for fair or poor health and FMD or at least one chronic health condition. RESULTS One in 4 baby boomers (24.2%) were caregivers. In adjusted models, male caregivers had a higher prevalence of fair to poor health than noncaregivers (aPR = 1.17; 95% confidence interval [CI], 1.06-1.29; P = .001). More caregivers than noncaregivers had at least 1 chronic health condition (aPR = 1.10, 95% CI, 1.07-1.13; P < .001) and more often had FMD (aPR = 1.39; 95% CI, 1.26-1.53; P < .001). CONCLUSION Our study showed these caregivers had more chronic health conditions and more often had FMD than noncaregivers. The health of baby boomer caregivers is a public health priority, as these caregivers might need support to maintain their own physical and mental health.
Collapse
Affiliation(s)
- Christina E Miyawaki
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Room 110HA, Houston, TX 77204.
| | - Erin D Bouldin
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia.,Department of Health and Exercise Science, Appalachian State University, Boone, North Carolina
| | - Christopher A Taylor
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C McGuire
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
40
|
Arora S, Rechel B, Bergland A, Straiton M, Debesay J. Female Pakistani carers' views on future formal and informal care for their older relatives in Norway. BMC Health Serv Res 2020; 20:603. [PMID: 32611337 PMCID: PMC7329493 DOI: 10.1186/s12913-020-05468-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/25/2020] [Indexed: 02/05/2023] Open
Abstract
Background The aging of Pakistani immigrants in Norway raises questions related to their increased need for care and help from relatives, as well as those concerning what future formal and informal care and healthcare accessibility for older immigrants may look like. The hidden nature of family caregiving means that the circumstances of carers, their views and their dilemmas related to future care are largely invisible. In this study, we explored female Pakistani carers’ views of future care and healthcare accessibility for their older relatives in Norway. Methods Our data included interviews with family carers between the ages of 23 and 40 years old, living in Oslo, Norway. We recruited ten family carers, out of which eight were daughters and two were daughters-in-law. Interviews were conducted by the first author in Urdu or English and were recorded and transcribed verbatim. Results Our findings revealed several factors that influenced participants’ perceptions about formal and informal caregiving, which can be organised into the following themes: 1) caring for family in Norway as in Pakistan, 2) worries about being ‘dropped off’ at a care home, 3) concerns about being cared for by outsiders, 4) questions about what other people might say and 5) adhering to society’s expectations of a ‘good’ carer. Conclusion Family carers’ traditional views of filial piety do not entirely determine the use of or access to healthcare services of their older relatives. There is a need to develop culturally sensitive healthcare systems so that immigrant families and their carers have more options in choosing care in old age, which in turn will ease their families’ care burden. Healthcare professionals and policymakers should not assume that immigrant families will take care of their own older members but should instead secure adequate support for older immigrants and their family carers.
Collapse
Affiliation(s)
- Sanjana Arora
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, N-0130, Oslo, Norway.
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Astrid Bergland
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, N-0130, Oslo, Norway
| | - Melanie Straiton
- Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, 0213, Oslo, Norway
| | - Jonas Debesay
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, N-0130, Oslo, Norway
| |
Collapse
|
41
|
Beyond Just Giving Care: Exploring the Role of Culture in Chinese American Personal Care Aides' Work. J Cross Cult Gerontol 2020; 35:255-272. [PMID: 32583186 DOI: 10.1007/s10823-020-09404-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As the number of older Chinese Americans with immigration background increases, there is a growing need for Chinese American personal care aides (CA-PCAs) to assist them with aging at home by providing culturally congruent and linguistically competent service. However, little is known about how culture factors into the caregiving process and influences CA-PCAs' well-being. In this study, two focus groups were conducted with ten immigrant CA-PCAs and conventional content analysis was used to analyze the qualitative data. Seven cultural themes were identified, including guanxi (relationship), renqing (favor), mianzi/lian (face), hierarchy and authority, communication, harmony, and elder respect. By drawing attention to the idiosyncratic cultural landscape and entailed challenges faced by underrepresented CA-PCAs, the investigators corroborate the importance of cultural sensitivity for working with ethnic minority non-familial caregivers. The findings shed light on cultural factors that can be targeted by culturally sensitive direct practices, programs, and policies.
Collapse
|
42
|
Neuropsychiatric symptoms in Parkinson's disease: association with caregiver distress and disease severity. Int Psychogeriatr 2020; 32:733-739. [PMID: 31647049 DOI: 10.1017/s1041610219001510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The condition of caregivers is important to the quality of care received by people with Parkinson's disease (PD), especially at the late disease stages. This study addresses the distress placed on caregivers by participants' neuropsychiatric symptoms at different stages of PD in Taiwan. METHODS This prospective study enrolled 108 people with PD. All participants were examined with the Unified Parkinson's Disease Rating Scale (UPDRS), Neuropsychiatric Inventory (NPI), Mini-Mental State Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), and Clinical Dementia Rating (CDR) scale. Caregiver distress was measured using the Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D). Statistical analysis was used to explore the PD-related factors that contribute to caregiver distress. RESULTS The mean follow-up interval in the 108 PD participants were 24.0 ± 10.2 months with no participant lost to follow-up due to death. NPI-distress (the sum of NPI caregiver distress scale across the 12 domains of the NPI) was positively correlated with NPI-sum (the total score across the 12 domains of the NPI) (r = 0.787, p < 0.001), CDR (r = 0.403, p < 0.001), UPRDS (r = 0.276, p = 0.004), and disease duration (r = 0.246, p = 0.002), but negatively correlated with CASI (r = -0.237, p = 0.043) and MMSE (r = -0.281, p < 0.001). Multiple linear regression analysis showed that only NPI-sum and disease duration were independently correlated with NPI-distress. CONCLUSION The disease duration and NPI-sum are independent predictors of caregiver distress in Taiwanese populations with PD. Early detection and reduction of neuropsychiatric symptoms in people with PD can help decrease caregiver distress.
Collapse
|
43
|
Miyawaki CE, Chen NW, Meyer OL, Tran MT, Markides KS. Vietnamese Adult-Child and Spousal Caregivers of Older Adults in Houston, Texas: Results from the Vietnamese Aging and Care Survey (VACS). JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:5-18. [PMID: 31900089 PMCID: PMC9564481 DOI: 10.1080/01634372.2019.1707735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 06/01/2023]
Abstract
Vietnamese are the largest Asian ethnic group in Houston, Texas; however, research on this population is scarce. To address this dearth of knowledge, we developed the Vietnamese Aging and Care Survey. The objective of the study was to explore the sociodemographic and health characteristics of Vietnamese adults aged 65 years and older (n = 132) and their family caregivers (n = 64). Adult-child caregivers (n = 41) were aged between 21 and 65 years old. The majority were married, working, female, and in good to excellent health. Spousal caregivers (n = 23) were between 57 and 82 years old, retired, female, and in fair to good health. Adult children received more caregiving-related help from others compared to spousal caregivers; however, they felt more caregiver burden, had more perceived stress, and were in challenging relationships with care recipients. Differences in life stages of adult-child versus spousal caregivers may contribute to these results. Implications are discussed.
Collapse
Affiliation(s)
| | - Nai-Wei Chen
- Beaumont Health, Beaumont Research Institute, Royal Oak, Michigan, USA
| | - Oanh L. Meyer
- University of California, Davis, Sacramento, California, USA
| | - Mindy Thy Tran
- College of Natural Sciences and Mathematics, University of Houston, Houston, Texas, USA
| | | |
Collapse
|
44
|
Greenwood N, Smith R. Motivations for being informal carers of people living with dementia: a systematic review of qualitative literature. BMC Geriatr 2019; 19:169. [PMID: 31208351 PMCID: PMC6580594 DOI: 10.1186/s12877-019-1185-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Informal, often family carers play a vital role in supporting people living with dementia in the community. With ageing populations, the part played by these carers is increasing making it important that we understand what motivates them to take on the role. This systematic review aimed to identify and synthesise qualitative literature describing what motivates people to care for someone with dementia. Methods The review followed the Centre for Reviews and Dissemination (CRD) guidelines. Six electronic databases were searched from their first records until August 2018. Synthesis was narrative. Results Twenty-six studies fitting the inclusion criteria were identified. Carers described multiple, inter-related motives for caring for someone with dementia. Caring was generally described as a reflection of long-standing family relationships between carers and the care recipients, whether by blood or marriage. Commonly offered motivations included love, reciprocity, filial piety, duty and obligation. Conclusions Perhaps the most striking finding was the similarity in these motivations irrespective of gender or relationship with the care recipient. Family relationship and shared history underlay most motivations. Future research should include more longitudinal studies incorporating within study comparisons between different demographic groups to give greater confidence in identifying similarities and differences between demographic groups.
Collapse
Affiliation(s)
- Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK.
| | - Raymond Smith
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 0RE, UK
| |
Collapse
|
45
|
Haya MAN, Ichikawa S, Wakabayashi H, Takemura Y. Family Caregivers' Perspectives for the Effect of Social Support on their Care Burden and Quality of Life: A Mixed-Method Study in Rural and Sub-Urban Central Japan. TOHOKU J EXP MED 2019; 247:197-207. [PMID: 30890666 DOI: 10.1620/tjem.247.197] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Japan has adopted community-based integrated long-term care, which has shifted the burden of care from institutions to the home. However, family caregivers have received less attention compared with care recipients. Many family caregivers are also older adults, and it is important that caregivers receive appropriate support to alleviate the burden of care. In rural and sub-urban area with limited resources compared to urban area, it is necessary to know which support to be prioritized. Therefore, this study aimed to understand family caregivers' perceptions of social support, the type and source of support which were considered important, and how it affected their caregiving burden and quality of life (QOL). We conducted a convergent mixed-method study with 174 primary family caregivers of older adults receiving home care in rural and suburb area of Central Japan. The mixed-method approach enabled qualitative data to complement quantitative results. Strong family support and higher education had positive effects on QOL, while higher caregiving burden and longer duration of care had negative effects on QOL. Provision of tangible support from family and healthcare professionals was central in reducing caregiving burden and improving caregivers' QOL. Support from distant relatives or neighbors, which was deemed inappropriate by caregivers, had a negative effect on caregivers' emotional status. In conclusion, family caregivers perceived support positively, but the effects depended on who provided support. While tangible support from close family and professionals was perceived positively, support from neighbors or distant relatives should consider caregivers' needs and condition to avoid a negative impact.
Collapse
Affiliation(s)
- Marinda Asiah Nuril Haya
- Department of Family Medicine, Mie University Graduate School of Medicine.,Department of Community Medicine, Faculty of Medicine Universitas Indonesia
| | - Shuhei Ichikawa
- Department of Community Medicine Nabari, Mie University School of Medicine
| | - Hideki Wakabayashi
- Department of Community Medicine Kameyama, Mie University School of Medicine
| | - Yousuke Takemura
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University School of Medicine
| |
Collapse
|
46
|
Pang RC, Lee DT. Finding positives in caregiving: The unique experiences of Chinese spousal caregivers of persons with young-onset dementia. DEMENTIA 2017; 18:1615-1628. [PMID: 28831816 DOI: 10.1177/1471301217724026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The experience of taking care of spouses with young-onset dementia has been identified as unique and merits considerations. However, current knowledge about this area in Chinese spousal caregivers is scarce. A qualitative descriptive study was therefore conducted to explore the experience of spousal caregivers of persons with young-onset dementia in Hong Kong. A total of six spousal caregivers of persons diagnosed with dementia before the age of 65 participated in this study. Three major categories were identified: coming to terms with an unexpected diagnosis; multiple unanticipated and ‘early’ losses and finding positives and meaning. This study has highlighted the influence of sociocultural values on the spousal caregiving experience in young-onset dementia caregiving. The findings also have significant implications for the development of interventions to facilitate the spousal caregivers to accept and sustain their caregiving role.
Collapse
Affiliation(s)
- Rebecca Ck Pang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Diana Tf Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
47
|
Liu HY, Yang CT, Wang YN, Hsu WC, Huang TH, Lin YE, Liu CY, Shyu YIL. Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross-sectional study. J Adv Nurs 2017; 73:2962-2972. [DOI: 10.1111/jan.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Hsin-Yun Liu
- Healthy Aging Research Center; Chang Gung University; Taoyuan Taiwan
| | - Ching-Tzu Yang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Nu Wang
- Department of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Wen-Chuin Hsu
- Dementia Center; Department of Neurology; Chang Gung Memorial Hospital; Taoyuan Taiwan
- School of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Tzu-Hsin Huang
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Yueh-E Lin
- Department of Nursing; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Chin-Yi Liu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yea-Ing L. Shyu
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Traumatological Division; Department of Orthopedics; Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Nursing; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| |
Collapse
|
48
|
Miyawaki CE. Association of Filial Responsibility, Ethnicity, and Acculturation Among Japanese American Family Caregivers of Older Adults. J Appl Gerontol 2017; 36:296-319. [PMID: 25883044 PMCID: PMC4608849 DOI: 10.1177/0733464815581484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Challenges of filial caregiving practices by 1st-generation immigrants due to differences in caregiving values between their home and host countries are well documented. This study explored the filial responsibility of later generation Japanese American caregivers of older adults. Acculturation and filial responsibility were measured using the Suinn-Lew Asian Self Identity Acculturation scale and Filial Values Index, respectively. A qualitative interview guide was developed using Gordon's assimilation theory, and 21 caregivers ( M age = 68 years, 86% female, seven in each generation) were interviewed. Despite the 3rd-generation caregivers' high acculturation level, their filial responsibility scores remained high. Qualitative interviews also revealed later generation caregivers' strong filial responsibility and continued caregiving involvement. Unexpectedly, caregivers' own future expectancy of care included placement in mainstream residential facilities rather than ethnic-specific settings. Findings point to the need to develop caregiver services that consider later generation caregivers' culture and level of assimilation.
Collapse
|
49
|
Tang F, Xu L, Chi I, Dong X. Psychological Well-Being of Older Chinese-American Grandparents Caring for Grandchildren. J Am Geriatr Soc 2016; 64:2356-2361. [PMID: 27641829 DOI: 10.1111/jgs.14455] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The rapid increase in grandparents caring for grandchildren has received growing attention, but little research has focused on Chinese-American grandparents and their caregiving experiences. Drawing on cross-sectional data from the Population Study of Chinese Elderly-a community-engaged, epidemiological study of Chinese-American adults aged 60 and older, the relationships between caregiving experiences and psychological well-being were examined. Of 2,365 older adults who answered the question about grandparent caregiving, 818 (35%) were designated as caregivers, spending an average of 12 hours a week on childcare. About one in five caregivers reported caregiving burden, pressure, or negative health effect of caregiving. Caregivers had better psychological well-being than noncaregivers, with significantly lower levels of depressive symptoms, anxiety, stress, and loneliness. For caregivers, higher levels of caregiving burden, pressure from adult children, and perceived negative effect were related to greater rates of psychological distress. With a strong cultural expectation of family care, grandparent caregiving is generally associated with positive psychological well-being, but it can also be stressful, especially when older adults feel pressured to provide childcare or that doing so is a burden. The study implies that cultural values and life transitions may shape grandparent caregiving experiences and well-being, indicating the importance of respecting cultural differences in family caregiving. Understanding positive and negative aspects of grandparent caregiving and the underlying mechanisms will help healthcare professionals identify caregivers at risk of psychological distress and provide proper interventions to attenuate negative outcomes while maximizing positive experiences for Chinese-American older adults.
Collapse
Affiliation(s)
- Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, Texas
| | - Iris Chi
- School of Social Work, University of Southern California, Los Angeles, California
| | - XinQi Dong
- Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
50
|
Werner P, Hess A. Examining courtesy stigma among foreign health care workers caring for persons with Alzheimer’s disease: A focus group study. Home Health Care Serv Q 2016; 35:69-85. [DOI: 10.1080/01621424.2016.1227011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|