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Khan N, Malingagio A, Briceño EM, Mehdipanah R, Lewandowski-Romps L, Heeringa SG, Garcia N, Levine DA, Langa KM, Gonzales XF, Morgenstern LB. A Community-Based Study of Cognitive Impairment Caregiving Outcomes Pre- and During the COVID-19 Pandemic. J Appl Gerontol 2024; 43:700-705. [PMID: 37991816 PMCID: PMC11052669 DOI: 10.1177/07334648231215155] [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: 11/23/2023] Open
Abstract
The impact of the COVID-19 pandemic on informal caregiving was examined in a Mexican American (MA) and Non-Hispanic White (NHW) population-based cohort. 395 participants age > 65 years were recruited via door-to-door and phone recruitment as part of the Brain Attack Surveillance in Corpus Christi-Cognitive (BASIC-C) project. Both recipients and caregivers answered questions regarding the recipient's health and the COVID-19 pandemic. 15% of caregivers saw their caregiving recipient less than before the pandemic and 18% saw their recipient more than before. 55% of caregivers reported a slight to severe impact of the pandemic on their caregiving, and 45% reported no impact. For most caregivers, their caregiving role did not change markedly during the pandemic. MA and NHW caregivers had similar survey responses.
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Affiliation(s)
- Noreen Khan
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | | | - Steven G Heeringa
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Nelda Garcia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Kenneth M Langa
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Lewis B Morgenstern
- University of Michigan Medical School, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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2
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King JJ, Badger TA, Segrin C, Thomson CA. Loneliness, Spirituality, and Health-Related Quality of Life in Hispanic English-Speaking Cancer Caregivers: A Qualitative Approach. JOURNAL OF RELIGION AND HEALTH 2024; 63:1433-1456. [PMID: 37665415 DOI: 10.1007/s10943-023-01880-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 09/05/2023]
Abstract
Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.
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Affiliation(s)
- Jennifer J King
- University of Arizona Cancer Center, University of Arizona, 1295 N. Martin Ave., Drachman Hall, A260, PO Box 245209, Tucson, AZ, 85719, USA.
| | - Terry A Badger
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Chris Segrin
- College of Social and Behavioral Sciences, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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3
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Martinez IL, Acosta Gonzalez E, Black L. Services for Latino Family Dementia Caregivers: Is the Workforce Prepared? J Appl Gerontol 2024:7334648241234982. [PMID: 38454617 DOI: 10.1177/07334648241234982] [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: 03/09/2024] Open
Abstract
The American healthcare system is ill-fitted to meet the needs of the growing population with Alzheimer's and Related Dementias (ADRD) and their caregivers, which disproportionately affects Latinos. This paper describes the caregiving process for Latino patients with ADRD from the perspective of caregivers and service providers to reveal service areas in need of improvement. Ten providers and 24 Latino caregivers were interviewed through the Miami-Dade County Aging Network. Interviews were analyzed using a grounded theory approach. Five themes emerged: lack of social service connectivity, case management challenges, unmet mental health needs, language barriers, and the need for alternative service models. Our analysis indicates insufficient training and the need to improve dementia competencies, support strategies, and understanding of cultural nuances among service providers. These findings can help inform the development of a required ADRD provider education curriculum that incorporates cultural competency training to improve the quality and effectiveness of care.
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Affiliation(s)
- Iveris L Martinez
- Center for Successful Aging, College of Health and Human Services, California State University Long Beach, Long Beach, CA, USA
| | | | - Leah Black
- Department of Health Sciences, College of Health and Human Services, California State University Long Beach, Long Beach, CA, USA
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Sharma S, Hale JM, Myrskylä M, Kulu H. Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016. Demography 2023; 60:1441-1468. [PMID: 37638648 DOI: 10.1215/00703370-10941414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.
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Affiliation(s)
- Shubhankar Sharma
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of St Andrews, St Andrews, Scotland
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Jo Mhairi Hale
- University of St Andrews, St Andrews, Scotland
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- University of Helsinki, Helsinki, Finland
- Max Planck-University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland, and Rostock, Germany
| | - Hill Kulu
- University of St Andrews, St Andrews, Scotland
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López-Anuarbe M, Shugrue N, Baker K, Robison J. Hispanic Caregivers of the Money Follows the Person Program in Connecticut: Satisfaction, Familism, and Burden. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2022. [DOI: 10.1177/07399863221109017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hispanic caregivers provide more assistance than the U.S. average, but underutilize support services and report low levels of program satisfaction. A possible exception is the Money Follows the Person (MFP) program. Using an ordered logit statistical approach, we studied program satisfaction of all Hispanic caregivers assisting Connecticut MFP participants from 2014 to 2019, examining the effects of caregiver familism, burden, and personal characteristics including self-reported health and perceived financial situation. Healthier caregivers with positive perceptions of MFP’s usefulness and lower subjective burden reported higher program satisfaction. In ordered logits for separate blocks, familism elements (finding caregiving worthwhile, feeling well-supported as a caregiver, and having a good relationship with the care recipient) were statistically significant and associated with higher satisfaction. Our exclusive focus on Hispanic caregivers highlights the role of familism in satisfaction, and demonstrates that programs with a supportive caregiver component can supplement familism ties and overcome barriers to service usage.
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Affiliation(s)
| | - Noreen Shugrue
- University of Connecticut Center on Aging, Farmington, USA
| | - Kristin Baker
- University of Connecticut Center on Aging, Farmington, USA
| | - Julie Robison
- University of Connecticut Center on Aging, Farmington, USA
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Tian Z, Xiong C, Wang Y, Tao H, Zhou S, Yan J. Association between familism and mental health in dementia caregivers: a systematic review and meta-analysis. Psychogeriatrics 2022; 22:469-477. [PMID: 35636744 DOI: 10.1111/psyg.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/20/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dementia caregivers suffer from mental health problems while caring for dementia patients. As a core value, familism has been linked to the mental health of dementia caregivers. This study aims to systematically review the familism of dementia caregivers and to examine the association between familism and mental health of anxiety, depression, and burden in empirical research studies. METHODS We conducted a systematic search in various databases like Medline, PubMed, and Embase databases from inception till April 2021. Fisher's z was calculated with correlation coefficient or regression coefficient values for three familism dimensions and mental health of anxiety, depression, and burden. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 2.0 software. RESULTS A total of seven studies with 1178 participants were eligible for the meta-analysis. For caregivers' anxiety, three of seven studies, with 358 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that dementia caregivers' familism was significantly related to anxiety. The pooled z-value was 0.148 (95% CI = 0.043-0.253). In addition, caregivers' familism significantly affected depression (z = 0.080; 95% CI = 0.003-0.156), as did familial obligation (z = 0.122; 95% CI = 0.034-0.211), but perceived family support was not associated with this (z = 0.051, 95% CI = -0.038-0.140). As for caregiver burden, there was no evidence that familism was significantly associated with it (z = -0.073; 95% CI = -0.297 to 0.151), including familial obligation and perceived family support (z = -0.087 and -0.089, respectively; 95% CI = -0.278 to 0.104 and -0.335 to 0.157, respectively). CONCLUSIONS An association between caregiver familism and anxiety/depression exists in dementia patients. More research is needed to explore the relationship between familism and burden.
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Affiliation(s)
- Zhiwu Tian
- Blood Purification Centre, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chuyan Xiong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yingmin Wang
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongmei Tao
- Blood Purification Centre, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Shuang Zhou
- Department of Nephrology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jun Yan
- School of Nursing, Sun Yat-sen University, Guangzhou, China
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7
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Cordova-Marks FM, Valencia C, Badger TA, Segrin C, Sikorskii A. Depression among Underserved Rural and Urban Caregivers of Latinas with Breast Cancer. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2022; 33:450-464. [PMID: 37082709 PMCID: PMC10112537 DOI: 10.1080/10911359.2022.2062516] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.
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Affiliation(s)
- Felina M Cordova-Marks
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85719
| | - Celina Valencia
- Family and Community Medicine, University of Arizona, Tucson
| | - Terry A Badger
- Professor and Chair, Community and Systems Health Science Division, Professor, Department of Psychiatry, University of Arizona College of Nursing
| | - Chris Segrin
- Department Head Steve and Nancy Lynn Professor of Communication, Department of Communication, University of Arizona, Tucson, AZ
| | - Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University
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Role of the Infusion Nurse: Caring for the Family/Lay Caregiver of Older Adults. JOURNAL OF INFUSION NURSING 2021; 43:255-261. [PMID: 32881812 DOI: 10.1097/nan.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Approximately 43 500 000 family caregivers provide unpaid care to an adult or child. Most caregivers provide care to older adults, most often parents. Caregivers are often ill-prepared to assist their loved ones, creating or increasing caregiving burden and/or risk of compassion fatigue, potentially leading to critical "caregiving tipping points." Identifying families who are experiencing increased burden or risk of compassion fatigue is a skill that nurses, including infusion nurses, who have unique entrée into the caregiving situation, should develop. The purpose of this article is to describe "impending" tipping points before they occur and to offer solutions for how nurses can help caregiving families identify them and access additional supportive services.
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9
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Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia. Matern Child Health J 2021; 25:929-937. [PMID: 33759042 DOI: 10.1007/s10995-021-03121-7] [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] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively influencing their health seeking behaviors related to prenatal care. METHODS Qualitative, descriptive methods were used including individual interviews and focus groups to obtain maximum understanding of the women's lives. The interviews and focus groups were conducted using a semi-structured interview guide based on various components of the study's conceptual framework. Content analytic strategies included rigorous and systematic processes to increase trustworthiness: training, supervision, audits, electronic technologies, and ongoing input of the research team. RESULTS Factors on all levels of the study's conceptual framework compound the effects of stressors and restrictions on the lives of urban, childbearing Puerto Rican woman. The intersectionality of issues for Puerto Rican women can either mitigate or heighten the pressure on their daily lives. CONCLUSIONS This initial research sets the groundwork for further studies, such as narrative analysis, to better understand how to build appropriate and relevant interventions. Uncovering the women's stories gives them the opportunity to be a critical part of cross-sector partnerships towards the development of sustainable interventions.
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10
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Flores DV, Rote S, Angel J, Chen NW, Downer B, Markides K. Depressive symptoms in child caregivers of very old Mexican Americans. Aging Ment Health 2021; 25:61-67. [PMID: 32883095 PMCID: PMC7785680 DOI: 10.1080/13607863.2017.1423024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. METHODS This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. RESULTS Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. CONCLUSIONS In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.
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Affiliation(s)
- David V. Flores
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Sunshine Rote
- Kent School of Social Work, The University of Louisville,
Louisville, KY, USA
| | - Jacqueline Angel
- LBJ School of Public Affairs, The University of Texas,
Austin, TX, USA
| | - Nai-Wei Chen
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
| | - Brian Downer
- Division of Rehabilitation Sciences, The University of
Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- Department of Preventive Medicine and Population Health,
The University of Texas Medical Branch, Galveston, TX, USA
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Chase JAD, Russell D, Kaplan DB, Bueno MV, Khiewchaum R, Feldman PH. “Doing the Right Thing”: Family Caregivers Managing Medical and Nursing Tasks in the Postacute Home Health Care Setting. J Appl Gerontol 2020; 40:1786-1795. [DOI: 10.1177/0733464820961259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Family caregivers often manage complex medical and nursing tasks (MNTs) for older adults transitioning from hospital to home. To explore caregivers’ experiences managing MNTs in the postacute home health care (HHC) setting, we interviewed by phone 20 caregivers of older adults who received HHC following a hospitalization. Interviews were recorded, transcribed, and analyzed using directed content analysis. Caregivers highlighted the technical complexity and emotional impact of performing MNTs, as well as social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources they leveraged to meet the older adults’ care needs. Caregivers also identified challenges coordinating care and services within HHC and the larger health care system. Caregiver engagement in the postacute HHC setting should incorporate tailored training and support, assessments of socioenvironmental context and resources, and facilitated navigation of the health care system. Future research should elucidate factors associated with successful collaborative relationships among HHC providers, older adults, and their caregivers in the postacute HHC setting.
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Affiliation(s)
| | | | | | | | | | - Penny H. Feldman
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, USA
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12
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Guo M, Kim S, Dong X. Sense of Filial Obligation and Caregiving Burdens Among Chinese Immigrants in the United States. J Am Geriatr Soc 2020; 67:S564-S570. [PMID: 31403202 DOI: 10.1111/jgs.15735] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/02/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Focusing on Chinese immigrants, this study examined (1) whether filial obligation, the core social norm in the Chinese culture, is related to caregiving burdens; and (2) whether level of acculturation of the caregivers moderates the above relationships. DESIGN Cross-sectional. SETTING Chicago, Illinois. PARTICIPANTS A purposive sample of 393 Chinese adult immigrants who were primary caregivers of parents aged 60 years or older. MEASURES Sense of filial obligation was captured by felt responsibility toward parents in six domains (respect, make happy, care, greet, obey, and provide financial support). Caregiving burdens were measured by the Caregiver Burden Inventory. Acculturation was measured by 12 questions about respondents' language preference in different settings and ethnicity of individuals they interact with. RESULTS A stronger sense of filial obligation was significantly associated with lower levels of developmental (β = -.15), emotional (β = -.18), social (β = -.20), and physical (β = -.10) burdens. For subjective burdens (developmental, social burdens), such a protective effect of filial obligation was stronger among caregivers with lower acculturation levels. For more objective burdens (time-dependent, physical burdens), stronger filial obligation was actually associated with greater burdens among caregivers with higher acculturation levels. CONCLUSION Programs focusing on celebrating the cultural heritage of immigrants and improving the relationship between the parents and children may be helpful to reduce caregiving burdens. Intervention programs that help Chinese immigrant caregivers to find the most appropriate way to balance traditional and new social norms are important to provide successful care to aging Chinese immigrants. J Am Geriatr Soc 67:S564-S570, 2019.
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Affiliation(s)
- Man Guo
- School of Social Work, University of Iowa, Iowa City, Iowa
| | - Sohyun Kim
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - XinQi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey
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13
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Rote S, Angel J, Hinton L. Characteristics and Consequences of Family Support in Latino Dementia Care. J Cross Cult Gerontol 2019; 34:337-354. [PMID: 31346891 PMCID: PMC6858530 DOI: 10.1007/s10823-019-09378-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions - including, when appropriate, employing tactics to mobilize family support.
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Affiliation(s)
- Sunshine Rote
- Kent School of Social Work, University of Louisville, Louisville, KY, USA.
| | - Jacqueline Angel
- Lyndon B. Johnson School of Public Affairs and Department of Sociology, The University of Texas at Austin, Austin, TX, USA
| | - Ladson Hinton
- Psychiatry and Behavioral Sciences, University of California- Davis, Davis, CA, USA
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14
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Maldonado L, Moriarty H. Engagement of Urban, Pregnant Puerto Rican Women in Health Disparities Research. J Obstet Gynecol Neonatal Nurs 2019; 48:683-692. [PMID: 31622572 DOI: 10.1016/j.jogn.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2019] [Indexed: 11/28/2022] Open
Abstract
Persistent challenges surround the recruitment of minority women from marginalized communities in health disparities research. These challenges include lack of the following: interest in research participation, trust, positive relationships between researchers and participants/community, and principal investigators from minority groups. The purpose of this article is to describe successful recruitment strategies used in health disparities research with pregnant Puerto Rican women and to suggest ways to ensure the future success of studies on health disparities. Suggested strategies include creating trust, facilitating active participation of stakeholders, and strengthening the research pipeline with undergraduate and graduate nursing students.
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15
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Crist JD, Liu J, Shea KD, Peterson RL, Martin-Plank L, Lacasse CL, May JT, Wyles CL, Williams DK, Slebodnik M, Heasley BJ, Phillips LR. "Tipping point" concept analysis in the family caregiving context. Nurs Forum 2019; 54:582-592. [PMID: 31373002 DOI: 10.1111/nuf.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Analyze the concept "tipping point" in the older adult family caregiving context to further knowledge about caregiving families, enhancing transdisciplinary theory, research, and practice. BACKGROUND While used commonly in some disciplines, how "tipping point" has been used in health care, generally, and in relation to caregiving families, specifically, is less clear. This project was conducted to offer conceptual clarity to tipping point. DESIGN Walker and Avant's framework. DATA SOURCE Searches of scholarly literature in PsycINFO, CINAHL, and PubMed using the search term "tipping point" in either title or abstract. REVIEW METHODS Definitions used were extracted; instances when the concept was implied but the actual term "tipping point" was not used and contexts where the term was used or implied were identified. RESULTS The composite definition of a caregiving tipping point is a seemingly abrupt, severe, and absolute change event involving either the older adult or caregiver(s), or both that indicates a breakdown in the status quo of the caregiving system. CONCLUSIONS Transdisciplinary research, care, and policy should treat caregiving families as complex systems, use longitudinal assessments, and include colloquial communication. Early detection of impending tipping points will provide family-centered decisional support and enhance families' quality of life and safety.
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Affiliation(s)
- Janice D Crist
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Jian Liu
- Department of Systems and Industrial Engineering, The University of Arizona, Tucson, Arizona
| | - Kim D Shea
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Rachel L Peterson
- College of Medicine, University of Arizona Center on Aging, The University of Arizona, Tucson, Arizona
| | - Lori Martin-Plank
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Cheryl L Lacasse
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Jennifer T May
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Christina L Wyles
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Deborah K Williams
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Maribeth Slebodnik
- Arizona Health Sciences Library, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Beverly J Heasley
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Linda R Phillips
- College of Medicine, University of Arizona Center on Aging, The University of Arizona, Tucson, Arizona
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Rote SM, Angel JL, Moon H, Markides K. Caregiving Across Diverse Populations: New Evidence From the National Study of Caregiving and Hispanic EPESE. Innov Aging 2019; 3:igz033. [PMID: 31517066 PMCID: PMC6733633 DOI: 10.1093/geroni/igz033] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The current study employs population-based data to determine the extent to which stress and coping factors are related to self-rated health and distress for informal caregivers (CGs) from the 3 largest racial/ethnic groups in the United States (non-Latino White, African American, and Mexican American). RESEARCH DESIGN AND METHODS Data on primary, informal CGs are obtained from the 2015 National Study of Caregiving (NSOC) (n = 667) and the 2016 Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE) CG supplement (n = 287). Logistic regression models of health are presented for all CGs and specifically for dementia CGs. RESULTS Caregiving intensity is related to health for non-Latino White CGs and African American dementia CGs. Support from family and friends is related to better self-rated health, but only for African American dementia CGs. While better relationship quality is related to better health for African American CGs and White dementia CGs, formal support utilization is related to worse CG health for Mexican American dementia CGs. DISCUSSION AND IMPLICATIONS Findings emphasize the importance of earlier detection and intervention with CGs at the beginning in the caregiving career, the interplay of formal and informal support, and appropriate ways to intervene with dementia CGs. Culturally tailored home- and community-based care options are needed to supplement the low levels of CG support, especially for the Mexican American population.
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Affiliation(s)
- Sunshine M Rote
- Kent School of Social Work, University of Louisville, Kentucky
| | - Jacqueline L Angel
- School of Public Affairs and Department of Sociology, The University of Texas at Austin, Galveston
| | - Heehyul Moon
- Kent School of Social Work, University of Louisville, Kentucky
| | - Kyriakos Markides
- Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston
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Molina Y, Henderson V, Ornelas IJ, Scheel JR, Bishop S, Doty SL, Patrick DL, Beresford SAA, Coronado GD. Understanding Complex Roles of Family for Latina Health: Evaluating Family Obligation Stress. FAMILY & COMMUNITY HEALTH 2019; 42:254-260. [PMID: 31403986 PMCID: PMC6693639 DOI: 10.1097/fch.0000000000000232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We developed a measure of family obligation stress and compared its relationship to health and unmet health care needs relative to social support among a sample of US-based Latinas. Data come from a randomized controlled trial within 4 clinics to increase mammography among Latinas (n = 539). The 1-factor measure had acceptable reliability and construct validity. Family obligation stress was associated with worse health and greater unmet health care needs. Family obligation stress varied by years in the United States and country of origin. Our measure of family obligation stress contributes new venues to family research among Latino populations.
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Affiliation(s)
- Yamilé Molina
- Community Health Sciences Division, School of Public Health, University of Illinois at Chicago (Dr Molina); University of Illinois Cancer Center, Chicago (Dr Henderson); Departments of Health Services (Drs Ornelas and Patrick) and Epidemiology (Dr Beresford), School of Public Health, University of Washington, Seattle; Department of Radiology, School of Medicine, University of Washington, Seattle (Dr Scheel); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (Ms Bishop); Health Education Program Coordinator, Sea Mar Community Health Centers, Seattle, Washington (Ms Doty); and Kaiser Permanente Research Center for Health Research, Portland, Oregon (Dr Coronado)
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Anthony KP, John Geldhof G, Mendez-Luck CA. Characterizing Caregiving Intensity Among Mexican-origin Women Caregivers. THE GERONTOLOGIST 2018; 57:1084-1092. [PMID: 27342442 DOI: 10.1093/geront/gnw090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/05/2016] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study Objective (physical) caregiving burden has not often been associated with subjective (emotional) burden among Mexican-origin women caregivers. Yet, many studies show that Latina caregivers suffer from negative psychological outcomes related to caregiving at a higher rate than non-Latino Whites. This study considered whether self-rated intensity of ADL/IADL support explained the relationship between number of care recipient illnesses and caregiver emotional drain among Mexican American women caregivers. Design and Methods Participants included Mexican-origin women caregivers (n = 132) in East Los Angeles, CA who completed a survey that asked culturally appropriate questions about their experiences caring for elderly relatives. Results Logistic regression models indicated that ADL/IADL supports ranked as difficult were also chosen as causing emotional drain. Mediation models revealed a significant indirect effect of number of care recipient illnesses on caregiver emotional drain for English-speaking caregivers but not for Spanish-speaking caregivers. These results indicate that Mexican-origin women caregivers do experience subjective burden associated with specific objective ADL/IADL supports and suggest that culturally relevant survey design can assist in better understanding the emotional drain among this population. Implications Cultural values should be considered when discussing aspects of care provision with Mexican-origin women caregivers in order to elicit an accurate description of their informal caregiving experiences that may contribute to caregiver burden.
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Affiliation(s)
- Katherine P Anthony
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - G John Geldhof
- College of Public Health and Human Sciences, Oregon State University, Corvallis
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Crist JD, Montgomery ML, Pasvogel A, Phillips LR, Ortiz-Dowling EM. The association among knowledge of and confidence in home health care services, acculturation, and family caregivers' relationships to older adults of Mexican descent. Geriatr Nurs 2018; 39:689-695. [PMID: 29880443 DOI: 10.1016/j.gerinurse.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/18/2018] [Indexed: 12/15/2022]
Abstract
The purposes of this study were to examine the relationships among knowledge of and confidence in health care services (HHCS), acculturation, characteristics of family caregivers of Mexican descent, and differences by caregivers' relationship (spouse or adult child). A sample of Mexican-descent older adults and their caregivers was recruited (n = 74 dyads) in Arizona. Each participant completed questionnaires on knowledge, confidence, and acculturation. There were moderate but significant associations among higher Anglo Orientation with Knowledge and with Confidence. Fear of HHCS was positively associated with higher Anglo Orientation and English Language Preference; and negatively associated with Mexican Orientation and Spanish Language Preference. For Spouse caregivers, Fear of HHCS was positively correlated with higher Anglo Orientation and English Language Preference; for Offspring caregivers, Fear of HHCS was negatively correlated with Mexican Orientation and Spanish Language Preference. Results support assessing caregiver cohort and socio-cultural context to decrease HHCS use disparities by Mexican-descent caregiving families.
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Affiliation(s)
- Janice D Crist
- College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721-0203.
| | | | - Alice Pasvogel
- College of Nursing, The University of Arizona, PO Box 210203, Tucson, AZ 85721-0203
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Crist JD, Pasvogel A, Szalacha LA, Finley BA. Depression in Family Caregivers of Mexican Descent: Exacerbated by Stress and Mitigated by Mutuality. Res Gerontol Nurs 2017; 10:106-113. [DOI: 10.3928/19404921-20170412-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/27/2017] [Indexed: 11/20/2022]
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Evans BC, Coon DW. The "Reckoning Point" as a Marker for Formal Palliative and End-of-Life Care in Mexican American Families. JOURNAL OF FAMILY NURSING 2016; 22:606-630. [PMID: 27903942 DOI: 10.1177/1074840716677994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Palliative and end-of-life care (PEOLC) in Mexican American (MA) caregiving families remains unexplored. Its onset was uncovered in our mixed methods, multisite, interdisciplinary, qualitative descriptive study of 116 caregivers, most of whom had provided long-term informal home care for chronically ill, disabled older family members. This subanalysis used Life Course Perspective to examine the "point of reckoning" in these families, where an older person is taken in for care, or care escalates until one recognizes oneself as the primary caregiver. Ninety-three of 116 caregivers recognized and spontaneously reported a "reckoning point" that initiated the caregiving trajectory, while eight cited "gradual decline" into caregiving for elders in their homes. This "reckoning point," which marks the assumption of this role, may afford a fertile opportunity for referral to community resources or initiation of formal PEOLC, thereby improving the quality of life for these older individuals and their families.
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Mendez-Luck CA, Amorim C, Anthony KP, Neal MB. Beliefs and expectations of family and nursing home care among Mexican-origin caregivers. J Women Aging 2016; 29:460-472. [PMID: 27749161 PMCID: PMC8438791 DOI: 10.1080/08952841.2016.1222758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined perceptions of family care, nursing homes, and expectations of future care among 85 Mexican-origin women caregivers, some who lived in Mexico City and some who lived in East Los Angeles, California (East LA). Attitudes of Mexican-born women-living in Mexico City and in East LA-were more similar to each other than those of U.S.-born women. Most caregivers reported a preference for family care and had negative views of institutional care. In addition, despite the negative views about nursing homes, some caregivers expressed a willingness to seek nursing-home care for themselves so as to avoid burdening their children in the future. Findings lend support to the persistence of Mexican cultural values in this sample of Mexican-origin caregiving women, regardless of where they were born.
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Affiliation(s)
- Carolyn A. Mendez-Luck
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Clarice Amorim
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Katherine P. Anthony
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Margaret B. Neal
- Institute on Aging, Portland State University, Portland, Oregon, USA
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Maldonado L. Latinas and Intergenerational Caregiving: An Integrative Review of the Literature. J Transcult Nurs 2016; 28:203-211. [PMID: 26711886 DOI: 10.1177/1043659615623329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Identifying gaps in the literature regarding Puerto Rican childbearing women and intergenerational caregiving will facilitate future nursing practice and research regarding the amelioration of poor maternal-fetal outcomes. METHOD A literature search using PubMed and CINAHL, sensitized by Bronfenbrenner's Ecological-Environmental Model on Latinas and intergenerational caregiving, generated 18 peer-reviewed research articles (2009-2014) for analysis. RESULTS Categories and themes included the following: Latinas are the primary caregivers within their families and communities; caregiving is described; however, none of the studies classified caregiving as intergenerational and none sought to understand the overall impact on Latinas simultaneously caring for other members of their caregiving networks. CONCLUSION Gaps in the literature need to be addressed to facilitate design of health care programs to address disparities and increase supports for childbearing Latinas involved in intergenerational caregiving who are at risk for higher incidences of challenging life experiences.
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Mendez-Luck CA, John Geldhof G, Anthony KP, Neil Steers W, Mangione CM, Hays RD. Orientation to the Caregiver Role Among Latinas of Mexican Origin. THE GERONTOLOGIST 2016; 56:e99-e108. [PMID: 27342443 DOI: 10.1093/geront/gnw087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/01/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY To develop the Caregiver Orientation Scale for Mexican-Origin Women and evaluate its psychometric properties. DESIGN AND METHODS We developed a questionnaire to measure domains of cultural orientation to the caregiver role based on formative research and on the Cultural Justifications for Caregiving Scale. We conducted a series of exploratory factor analyses (EFAs) on data collected from 163 caregivers. We estimated internal consistency reliability (Cronbach's coefficient alpha) and assessed construct validity by estimating correlations between all latent factors and self-rated health, interview language, and weekly hours of care. RESULTS EFAs suggested four factors representing familism, obligation, burden, and caregiving intensity that displayed good fit (χ2 (df = 63) = 70.52, p = .24; RMSEA = .03 [90% CI: 0.00, 0.06]; comparative fit index = .99). Multi-item scales representing the four domains had coefficient alphas ranging from .68 to .86. Obligation was positively associated with burden (.46, p < .001) and intensity (.34, p < .01), which were themselves positively correlated (.63, p < .001). Familism was positively associated with obligation (.25, p < .05) yet negatively associated with burden (-.35, p < .01) and intensity (-.22, p < .05). Weekly hours of care were positively associated with burden (.26, p < .01) and intensity (.18, p < .05), whereas self-rated health and burden (-.21, p < .05) and Spanish language and intensity (-.31, p < .001) were negatively correlated. IMPLICATIONS The study shows that Mexican-origin caregiver orientation is multidimensional and that caregivers may have conflicting motivations for caregiving.
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Affiliation(s)
| | - G John Geldhof
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Katherine P Anthony
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - W Neil Steers
- David Geffen School of Medicine, General Internal Medicine/Health Services Research and
| | - Carol M Mangione
- David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
| | - Ron D Hays
- David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles
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Mendez-Luck CA, Applewhite SR, Lara VE, Toyokawa N. The Concept of Familism in the Lived Experiences of Mexican-Origin Caregivers. JOURNAL OF MARRIAGE AND THE FAMILY 2016; 78:813-829. [PMID: 27594714 PMCID: PMC5007003 DOI: 10.1111/jomf.12300] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
This study qualitatively examined the experiences of Mexican-origin women caring for elderly family members in order to identify aspects of familism in their caregiving situations. Data were collected from onetime interviews with 44 caregivers living in the greater East Los Angeles area. Kinscripts guided the framing of familism in this study. Data were analyzed using a grounded theory approach. Caregivers' descriptions of the Mexican family reflected an idealized view of familism. Caregivers reported a lack of support from others and relying for support on fewer family members than were potentially available to them. Findings suggest that the construct of familism has evolved from its long-standing portrayals in the literature. More research is needed to reexamine familism as a theoretical perspective to explain how Mexican-origin families negotiate and construct elder care over the family life course.
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Caregiving Practice Patterns of Asian, Hispanic, and Non-Hispanic White American Family Caregivers of Older Adults Across Generations. J Cross Cult Gerontol 2016; 31:35-55. [DOI: 10.1007/s10823-016-9281-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Savage B, Foli KJ, Edwards NE, Abrahamson K. Familism and Health Care Provision to Hispanic Older Adults. J Gerontol Nurs 2016; 42:21-9; quiz 30-1. [DOI: 10.3928/00989134-20151124-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/27/2015] [Indexed: 11/20/2022]
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Mendez-Luck CA, Anthony KP. Marianismo and Caregiving Role Beliefs Among U.S.-Born and Immigrant Mexican Women. J Gerontol B Psychol Sci Soc Sci 2015; 71:926-35. [PMID: 26362602 DOI: 10.1093/geronb/gbv083] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/08/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We aimed to explore how women of Mexican-origin conceptualized caregiving as a construct in terms of cultural beliefs, social norms, role functioning, and familial obligations. We examined the personal experiences of U.S-born and immigrant Mexican female caregivers to identify how these 2 groups differed in their views of the caregiver role. METHODS We conducted 1-time in-depth interviews with 44 caregivers living in Southern California. Our study was guided by marianismo, a traditional role occupied by women in the Mexican family. We analyzed data from a grounded theory approach involving the constant comparative method to refine and categorize the data. RESULTS The majority of all caregivers had similar views about caregiving as an undertaking by choice, and almost all caregivers engaged in self-sacrificing actions to fulfill the marianismo role. Despite these similarities, U.S.-born and immigrant caregivers used different words to describe the same concepts or assigned different meanings to other key aspects of caregiving, suggesting that these 2 groups had different underlying motivations for caregiving and orientations to the role. DISCUSSION Our findings highlight the complexity of language and culture in underlying caregiving concepts, making the concepts challenging to operationalize and define in a heterogeneous sample of Latinos.
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Affiliation(s)
| | - Katherine P Anthony
- College of Public Health and Human Sciences, Oregon State University, Corvallis
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Crist JD, Pasvogel A, Hepworth JT, Koerner KM. The impact of a telenovela intervention on use of home health care services and Mexican American older adult and caregiver outcomes. Res Gerontol Nurs 2015; 8:62-76. [PMID: 25594360 DOI: 10.3928/19404921-20150105-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022]
Abstract
A two-group randomized controlled trial tested a telenovela intervention (i.e., a culturally congruent videotaped dramatization with guided dialogue) to increase Mexican American older adults' and family caregivers' awareness of and confidence in home health care services (HHCS), thereby increasing use of HHCS and improving older adult and caregiver outcomes. Both groups had significant increases in awareness of and confidence in HHCS. The intervention group used HHCS more than the control group (91.1% versus 71.2% of total visits authorized); however, this was not a statistically significant difference (p = 0.18). Use of HHCS was associated with increased older adult and caregiver mutuality (i.e., the quality of the older adult-caregiver relationship) and decreased caregiving burden and depression. The predictive role and measurement of awareness and ways to improve the intervention are discussed. Findings are especially important with today's focus on transitional care to keep older adults at home and prevent unnecessary readmissions.
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LATIN@ ELDERS: Securing Healthy Aging Inspite of Health and Mental Health Disparities. INTERNATIONAL PERSPECTIVES ON AGING 2014. [DOI: 10.1007/978-94-017-8594-5_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Herrera AP, George R, Angel JL, Markides K, Torres-Gil F. Variation in Older Americans Act caregiver service use, unmet hours of care, and independence among Hispanics, African Americans, and Whites. Home Health Care Serv Q 2013; 32:35-56. [PMID: 23438508 DOI: 10.1080/01621424.2012.755143] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Home- and community-based services (HCBS) are underused by minority seniors and their caregivers, despite greater rates of disability. We examined racial/ethnic variation among 1,749 Hispanics, African Americans, and Whites receiving Older Americans Act Title III caregiver services in 2009. In addition, we identified the volume of services used by caregivers, their unmet hours of respite care, and the relationship between service use and seniors' ability to live independently. Minority caregivers cared for seniors in urban areas who had higher rates of disability, poverty, and Medicaid coverage. Hispanics had the highest rate of unmet hours of care, while caregiver services were less likely to help African Americans remain at home. Minorities sought services through community agencies and were more educated than demographically similar national cohorts. Greater efforts to reach minority caregivers of less educated, disabled seniors in urban areas and through community agencies may reduce unmet needs and support independent living.
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Affiliation(s)
- Angelica P Herrera
- University of Maryland, Baltimore County, Health Administration and Policy Program, Department of Sociology and Anthropology/Center for Aging Studies, 252 Public Policy Building, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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Parveen S, Morrison V, Robinson CA. Ethnicity, familism and willingness to care: important influences on caregiver mood? Aging Ment Health 2013; 17:115-24. [PMID: 22934683 DOI: 10.1080/13607863.2012.717251] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Few studies have to date examined the effects of ethnicity on caregiver motivations, coping responses and mood. This theoretically informed study uses the socio-cultural model of stress and coping to explore these relationships amongst a White-British and British South-Asian caregiver sample. METHOD A total of 235 primary family caregivers were recruited for a cross-sectional questionnaire survey; of which 162 were White-British and 73 were British South-Asian. RESULTS British South-Asian caregivers differed from White-British caregivers on several variables within the stress-coping framework. British South-Asian caregivers were younger, had significantly higher levels of familism, used significantly more behavioural disengagement and religious coping and reported having significantly less support than White-British caregivers. White-British caregivers were more likely to make use of substances and humour as coping methods, and also in these caregivers, familism was significantly related to caregiver depression. Whilst levels of willingness to care did not differ between the two caregiver groups, opposing relationships were seen in the association between willingness to care and caregiver anxiety. Regression analyses found that self-blame explained a significant proportion of variance in South-Asian anxiety and depression, whereas depression amongst White-British caregivers was associated with high use of substances, low use of humour and low mean satisfaction with support. CONCLUSION These findings offer support to the socio-cultural model of stress and coping in that coping is associated with two outcomes (anxiety and depression), but motivational factors are also highlighted which have additional implications for the development of culturally specific interventions aimed at reducing caregiver distress.
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Affiliation(s)
- Sahdia Parveen
- School of Psychology, Bangor University, Bangor, North Wales, UK.
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Hurley C, Panagiotopoulos G, Tsianikas M, Newman L, Walker R. Access and acceptability of community-based services for older Greek migrants in Australia: user and provider perspectives. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:140-149. [PMID: 23009742 DOI: 10.1111/hsc.12000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In most developed nations, ageing migrants represent a growing proportion of the older population. Policies that emphasise care in the community depend on older migrants having access to formal services along with informal support, yet little is known about how older migrants experience community-based formal services. By examining the views of both Greek elders in Australia and those of formal service providers, this research fills an important gap in the literature around access to and acceptability of formal community-based services for older migrants. A research team including two Greek background researchers used existing social groups and a snowball sampling method to conduct face-to-face interviews and focus groups with seventy older Greeks in Adelaide, Australia. In addition, 22 community-based service providers were interviewed over the telephone. Results from users and providers showed that while many older Greeks experience service access issues, they also relied heavily on family for support and assistance at home. Reliance on family was both in preference to formal services or where formal services were used, to locate, negotiate and monitor such services. Common barriers identified by both groups included cost, transport and availability, but additional challenges were posed by language, literacy and cultural attitudes. Demographic changes including greater employment mobility and female workforce participation among adult children will have implications for both formal and informal care providers. Formal service providers need to ensure that services are promoted and delivered to take account of the important role of family in informal support while also addressing the access challenges posed by language and literacy. Research conducted by researchers from the same cultural background in the respondent's native language can further advance knowledge in this area.
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Affiliation(s)
- Catherine Hurley
- SA Community Health Research Unit, Faculty of Health Sciences, Flinders University, Adelaide, South Australia, Australia.
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Herrera AP, Mendez-Luck CA, Crist JD, Smith ML, Warre R, Ory MG, Markides K. Psychosocial and cognitive health differences by caregiver status among older Mexican Americans. Community Ment Health J 2013; 49:61-72. [PMID: 22311331 PMCID: PMC3491112 DOI: 10.1007/s10597-012-9494-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 01/18/2012] [Indexed: 10/14/2022]
Abstract
This study identifies the risk and protective factors associated with informal caregiving by older (≥70 years) Mexican Americans and profiles caregiving arrangements. Overall, a greater number of informal caregivers (n = 92) were married and female. They also had higher physical functioning and better cognition than non-caregivers (n = 1,888) but fewer visited a physician regularly. Informal caregivers also showed an increased risk of depressive symptoms. A third of caregivers spent more than 20 h/day caregiving and the majority (84%) of care recipients were family members. In order to support the efforts of this disproportionately burdened caregiver group, increased social support and healthcare services are needed.
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Affiliation(s)
- Angelica P Herrera
- Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, CA, USA.
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Comparison of the burdens of family caregivers and foreign paid caregivers of the individuals with dementia. Int Psychogeriatr 2012; 24:1953-61. [PMID: 23092597 DOI: 10.1017/s1041610212001354] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The caregiver burden on foreign paid caregivers (FPCs) is currently not well understood. This study identified predictors and differences in caregiver burden between FPCs and family caregivers who provided care for patients with dementia. METHODS We recruited 489 patients with dementia (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition) and used the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR) Scale to assess their neuropsychiatric behavioral problems and severity of dementia. All caregivers [FPCs (n = 42) and family caregivers with (n = 42) and without (n = 447) FPCs] completed three questionnaires: the Zarit Burden Interview (ZBI), the Center for Epidemiological Studies-Depression Scale (CES-D), and caregivers' knowledge of dementia (KD). To understand caregiver burden, we analyzed the correlations between ZBI and other variables and investigated the differences between family caregivers and FPCs. RESULTS NPI and CDR scores were higher among patients assisted by FPCs than among those whose families did not employ FPCs. Burdens were greater among family caregivers assisted by FPCs than among FPCs and family caregivers who were not assisted by FPCs. Family caregivers had greater knowledge of dementia than did FPCs. For family caregivers, CES-D scores (Spearman's r = 0.650; p < 0.01) and patients' NPI scores (Spearman's r = 0.471; p < 0.01) were correlated with caregiver burden. For FPCs, only CES-D scores (Spearman's r = 0.511; p < 0.01) were correlated with caregiver burden. A linear regression model showed that CES-D scores contributed most to caregiver burden in all groups [β = 0.560 (family caregivers without FPCs), 0.546 (family caregivers with FPCs), and 0.583 (FPCs); p < 0.005]. CONCLUSION Both family caregivers and FPCs need emotional support. Adequate treatment to reduce the neuropsychiatric symptoms of patients with dementia might reduce the burden on family caregivers.
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Keeping it in the family: when Mexican American older adults choose not to use home healthcare services. ACTA ACUST UNITED AC 2011; 29:282-90. [PMID: 21543918 DOI: 10.1097/nhh.0b013e3182173859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mexican American elders are more functionally impaired and chronically ill than Anglo elders, yet use home care services less. The purpose of this study was to describe the cultural norms that influence Mexican American elders and their caregivers not to use home care services. A secondary analysis using descriptive ethnography was conducted. Thematic analysis was used to analyze Mexican American elders' (N = 4) and family caregivers' (N = 3) individual interviews. The overall finding was the category, "We Take Care of our Own!" This finding represented how Mexican American families faced increasing needs of elders at home in the context of their cultural norm of familism. The cultural findings, "Taking Care of Our Own!" were similar to those by elders who had chosen to use home care services in a previous study. Recognizing the importance of this norm, which is central to the culture, may shape interdisciplinary interventions that support traditional Mexican American family values, yet bring skilled or supportive help into the home. Interventions to increase the use of home care services by Latino families can contribute solutions to the national agenda to reduce healthcare disparities.
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Evans BC, Belyea MJ, Ume E. Mexican-American Males Providing Personal Care for their Mothers. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2011; 33:234-260. [PMID: 21643486 DOI: 10.1177/0739986311398615] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We know little about Mexican-American (MA) family adaptation to critical events in the informal caregiving experience but, in these days of economic and social turmoil, sons must sometimes step up to provide personal care for their aging mothers. This article compares two empirically real cases of MA males who provided such care, in lieu of a female relative. The cases are selected from a federally-funded, descriptive, longitudinal, mixed methods study of 110 MA caregivers and their care recipients. In case-oriented research, investigators can generate propositions (connected sets of statements) that reflect their findings and conclusions, and can be tested against subsequent cases: Caregiving strain and burden in MA males may have more to do with physical and emotional costs than financial ones; MA males providing personal care for their mothers adopt a matter-of-fact approach as they act "against taboo"; and this approach is a new way to fulfill family obligations.
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Affiliation(s)
- Bronwynne C Evans
- Arizona State University College of Nursing and Health Innovation, 500 N. 3rd Street, Phoenix, Arizona 85004, Office Phone 602-496-0766, Fax 602-496-0886
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