The role of religion and ethnicity in the help seeking of family caregivers of elders with Alzheimer's disease and related disorders

Stages of help seeking during illness have been identified as follows: disease experience, symptom attribution, decision to seek care, and contact with care providers. These stages have not been evaluated amongst family caregivers of elders affected with Alzheimer's disease and related disorders (ADRD). Since minority families typically care for ADRD elders at home, it seems important to understand the help seeking of minority family caregivers in particular, and the role of religious/ethnic factors. Thematic analyses were conducted on in-depth interviews from 10 caregivers from 4 groups (total n = 40): African-American, Chinese-American, Puerto Rican, and Irish-American. Aside from the disease experience stage, where religious/ethnic themes were negligible, between-group differences existed in these themes at other stages. For example, themes of extended family support emerged around decision making, with much between-group variation. At the contact with providers stage themes of contacting religious or ethnic service organizations were present, again with between-group variation. Chinese-American and Puerto Rican narratives contained themes of language barriers to care, and a lack of culturally-competent services. Both Irish-American and African-American narratives showed themes of alienation from religious groups on the one hand, and using prayer to cope on the other. Narratives from all groups contained themes of religious and/or ethnic imperatives for providing care. Overall, findings reveal that religious/ethnic factors may both aid and impede the help seeking of caregivers.

Working with culture: a qualitative analysis of barriers to the recruitment of Chinese-American family caregivers for dementia research

The National Institutes of Health is making efforts to increase the representation of minority elders in aging research. While it is often noted that cultural barriers may make the recruitment of minority elders into research more difficult, relatively little empirical exists to support this claim. The purpose of this study was to identify sociocultural barriers to recruitment that emerged during a four-year study of dementia caregiving among Chinese families in the Boston area. More specifically, this paper examines how culturally shaped conceptions of health, aging, and dementia impacted the recruitment process. This paper is based on a qualitative analysis of interviews with 23 Chinese families and extensive fieldnotes generated by project ethnographers and interviewers. The following themes emerged in this analysis: 1) dementia-related changes were construed as a normal part of the aging process rather than a disease, making it more difficult to identify dementia-affected elders and to recruit families, 2) research participation was viewed as potentially harmful because it can lead to excessive worry 3) Alzheimer's disease carries a social stigma among Chinese, leading families to shun formal diagnosis and research participation, and 4) practitioners viewed research as an intrusion offering no direct benefit to participants.

Constructing Alzheimer's: narratives of lost identities, confusion and loneliness in old age

This paper is a qualitative study based on retrospective, unstructured, qualitative interviews with Mrs. Jones and other African-American, Chinese-American, Irish-American and Latino family caregivers in the Boston area. A narrative approach is used to show how family caregivers draw on their cultural and personal resources to create stories about the nature and meaning of illness and to ask how ethnic identity may influence the kinds of stories family caregivers tell. Three different story types are identified and described, each with a distinctive configuration of illness meanings and overarching theme, or storyline: a subset of African-American, Irish-American, and Chinese-American caregivers told us stories about Alzheimer's as a disease that erodes the core identity of a loved one and deteriorates their minds; a subset of Chinese caregivers narrated stories that emphasized how families managed confusion and disabilities, changes ultimately construed as an expected part of growing old; a subset of Puerto Rican and Dominican families, while using the biomedical label of Alzheimer's disease or dementia, placed the elder's illness in stories about tragic losses, loneliness, and family responsibility. To construct their stories, caregivers drew upon both biomedical explanations and other cultural meanings of behavioral and cognitive changes in old age. Their stories challenge us to move beyond the sharp contrast between ethnic minority and non-ethnic minority views of dementia-related changes, to local clinics and hospitals as sites where biomedical knowledge is interpreted, communicated, discussed, and adapted to the perspectives and lived realities of families.

Take up the caregiver's burden: stories of care for urban African American elders with dementia

This pilot study uses an anthropological gaze to analyze transcripts of extended in-home interviews among a set of ten caregivers of African-American elders with dementia. How are race and ethnicity made to matter in the recognition of, the meaning-making around and the responses to dementing illness among a sample of African-American caregivers? The essay contrasts prevailing cultural representations of African-American caregiver burden with caregiver interview data. What we find is that current constructs which consistently demonstrate "lesser burden" among African-American caregivers compared with Whites may not adequately capture these caregivers' experiences. Interpretations of experiences, meanings of "burden" and the logic of symptoms in the illness narratives generated by these African-American caregivers of elders with dementia require attention to the embodiment of large scale sociopolitical and historical forces like residential, educational and occupational segregation, institutional racism, and economic exploitation over the life course.

Epidemiology of delirium: an overview of research issues and findings

This paper provides a review of research issues and findings on the epidemiology of delirium. Despite the fact that research on this important geriatric syndrome has been conducted for many decades, several methodological issues make it difficult to compare findings across studies. In this paper we first discuss broadly methodological issues related to diagnosis, case-finding, and populations studied. We next review data on the occurrence and consequences of the syndrome. A discussion of the design and preliminary results of the Commonwealth-Harvard Study of Delirium in Elderly Hospitalized Patients documents both how we responded to the methodological issues outlined and how these choices influenced our findings. We conclude with a discussion of the needs for further research on the epidemiology of delirium.

Review of research instruments and techniques used to detect delirium

Over the past several decades, numerous investigators have studied the syndrome of delirium. Researchers have relied on a number of different case finding methods to detect the syndrome. This paper provides an overview of instruments used in studies of delirium. We assess the validity and reliability of these instruments and compare the advantages and disadvantages of the different methods. We then present the rationale for the development of the Delirium Symptom Interview, an instrument constructed for use in the Commonwealth-Harvard Study of delirium in elderly hospitalized patients.

Clinical decision making in the care of the aged

This study examines the decision-making process of health care providers working with older patients. Data were obtained through telephone interviews from a random sample of 251 health care providers at three Veterans Administration medical centers. Responding to a hypothetical clinical vignette, the majority of providers chose to give the one remaining bed in an ICU to a younger versus an older patient. Individuals relied on the patient's expected quality of life as well as the medical risk to the patient as important factors in this decision. In another vignette, less than 15% of the sample strongly supported a life-prolonging intervention for an 85-year-old man whose obstructive pulmonary disease had taken a terminal course. Expected quality of life was the most important determinant of the decision not to intubate. Respondents of different professions consistently ranked DNR orders as the decision with which they were most comfortable and termination of life supports as the decision with which they were least comfortable. A discussion of the different medical, social, and institutional factors that influence decision making is provided.

An empirical test for phases of retirement: findings from the Normative Aging Study

Although gerontologists have shown considerable interest in describing possible phases of retirement, the temporal course of retirement experience remains largely unspecified. This study of 293 male retirees from the Normative Aging Study used cross-sectional data to compare levels of life satisfaction and lesiure activities across 6-month time intervals within the first 3 years after retirement. Regression models were used to test the hypothesis that men retired 0 to 6 months differed from men retired for longer periods. Findings showed that, compared with these recent retirees, men retired 13 to 18 months had lower levels of overall life satisfaction and self-perceived involvement in physical activities. Analyses of the constituents of life satisfaction showed greater optimism and future orientation among recent retirees and a comparative deficit at 13 to 18 months. These findings support an interpretation that the immediate postretirement period is marked by more enthusiasm and that some degree of temporary letdown or dysphoria is likely during the second year of retirement.

The three tier family support system in care of the elderly

Changes in work and social patterns have led to reexamination of the role of the three tier family in caring for the elderly. This paper examines current knowledge about the changing function of the three tier family, the benefits to the family and the elders, and the potential problems and costs of such arrangements. Recommendations are made regarding social policies and formal supports which will encourage and enhance positive function of multi-generational families.