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Lisabeth LD, Gallo LC, Prvu-Bettger J, Kwicklis M, Almendarez EM, Morgenstern LB. Outcomes Among Mexican American and Non-Hispanic White Informal Stroke Caregivers. Stroke 2024; 55:2003-2010. [PMID: 38966984 PMCID: PMC11262960 DOI: 10.1161/strokeaha.124.047035] [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: 02/28/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Informal home care is prevalent among Mexican American stroke survivors, but data on the impact on caregivers are not available. The aim was to assess ethnic differences in informal stroke caregiving and caregiver outcomes at 90 days poststroke. METHODS Informal caregivers were recruited from the population-based Brain Attack Surveillance in Corpus Christi Project (2019-2023), conducted in a bi-ethnic community in Texas. Caregivers of community-dwelling stroke survivors who were not cognitively impaired and not employed by a formal caregiving agency were interviewed. Interviews included sociodemographics, dyad characteristics, Modified Caregiver Strain Index (range 0-26, higher more positive), Positive Aspects of Caregiving scale (range, 5-45, higher more), Patient Health Questionnaire-8 (range, 0-30, higher worse), and PROMIS (Patient-Reported Outcomes Measurement Information System)-10 physical (range, 16.2-67.7, higher better) and mental health (range, 21.2-67.6, higher better) summary scores. Stroke survivor data was from interviews and medical records. Propensity score methods were used to balance caregiver and patient factors among Mexican American and Non-Hispanic White caregivers by fitting a model with ethnicity of caregiver as the outcome and predictors being caregiver sociodemographics, patient-caregiver dyad characteristics, and patient sociodemographics and functional disability. Propensity scores were included as a covariate in regression models, considering the association between ethnicity and outcomes. RESULTS Mexican American caregivers were younger, more likely female, and more likely a child of the stroke survivor than Non-Hispanic White caregivers. Mexican American caregiver ethnicity was associated with less caregiver strain (β, -1.87 [95% CI, -3.51 to -0.22]) and depressive symptoms (β, -2.02 [95% CI, -3.41 to -0.64]) and more favorable mental health (β, 4.90 [95% CI, 2.49-7.31]) and positive aspects of caregiving (β, 3.29 [95% CI, 1.35-5.23]) but not associated with physical health. CONCLUSIONS Understanding the mechanisms behind more favorable caregiver outcomes in Mexican American people may aid in the design of culturally sensitive interventions to improve both caregiver and stroke survivor outcomes, potentially across all race and ethnic groups.
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Affiliation(s)
- Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (L.D.L., M.K., L.B.M.)
- Stroke Program, University of Michigan Medical School, Ann Arbor (L.D.L., L.B.M.)
| | - Linda C Gallo
- Department of Psychology, College of Sciences, San Diego State University, CA (L.C.G.)
| | | | - Madeline Kwicklis
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (L.D.L., M.K., L.B.M.)
| | | | - Lewis B Morgenstern
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (L.D.L., M.K., L.B.M.)
- Stroke Program, University of Michigan Medical School, Ann Arbor (L.D.L., L.B.M.)
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Robinson-Lane SG, Leggett AN, Johnson FU, Leonard N, Carmichael AG, Oxford G, Miah T, Wright JJ, Blok AC, Iwashyna TJ, Gonzalez R. Caregiving in the COVID-19 pandemic: Family adaptations following an intensive care unit hospitalisation. J Clin Nurs 2024; 33:203-214. [PMID: 36262026 PMCID: PMC9874809 DOI: 10.1111/jocn.16560] [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: 07/16/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 01/29/2023]
Abstract
AIM AND OBJECTIVE To identify how family caregivers adapt to the caregiving role following a relative's COVID-19-related intensive care unit (ICU) hospitalisation. BACKGROUND Family caregiving is often associated with poor health amongst caregivers which may limit their capacity to effectively support patients. Though severe COVID-19 infection has necessitated increasing numbers of persons who require caregiver support, little is known about these caregivers, the persons they are caring for, or the strategies used to effectively adjust to the caregiving role. DESIGN A qualitative descriptive study design was adopted, and findings are reported using COREQ. METHODS A secondary analysis of transcripts from semi-structured interviews conducted with recently discharged ICU patients who had COVID-19 (n = 16) and their family caregivers (n = 16) was completed using thematic analysis. MAXQDA 2020 and Miro were used to organise data and complete coding. Analysis involved a structured process of open and closed coding to identify and confirm themes that elucidated adaptation to family caregiving. RESULTS Six themes highlight how family caregivers adapt to the caregiving role following an ICU COVID-19-related hospitalisation including (1) engaging the support of family and friends, (2) increased responsibilities to accommodate caregiving, (3) managing emotions, (4) managing infection control, (5) addressing patient independence and (6) engaging support services. These themes were found to be congruent with the Roy adaptation model. CONCLUSIONS Family caregiving is a stressful transition following a patient's acute hospitalisation. Effective adaptation requires flexibility and sufficient support, beginning with the care team who can adequately prepare the family for the anticipated challenges of recovery. RELEVANCE TO CLINICAL PRACTICE Clinical teams may improve post-hospitalisation care outcomes of patients by preparing families to effectively adjust to the caregiver role-particularly in identifying sufficient support resources. PATIENT OR PUBLIC CONTRIBUTION Participation of patients/caregivers in this study was limited to the data provided through participant interviews.
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Affiliation(s)
- Sheria G. Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Amanda N. Leggett
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Florence U. Johnson
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Natalie Leonard
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Alicia G. Carmichael
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Grace Oxford
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Tanbirul Miah
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Johnny J. Wright
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Amanda C. Blok
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Theodore J. Iwashyna
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Richard Gonzalez
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
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Dau H, Gottschlich A, Metz L, Pineda N, Pineda A, Alvarez CS, Bevliacqua K, Mendoza-Montano C, Ogilvie G, Rivera-Andrade A, Gharzouzi E, Meza R. The role of daughters in relation to their mother's cervical cancer diagnosis and treatment in Guatemala: a descriptive study. BMC Womens Health 2023; 23:142. [PMID: 36991461 PMCID: PMC10053719 DOI: 10.1186/s12905-023-02305-3] [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: 11/28/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE There is currently no information on how caregivers for women diagnosed with cervical cancer in Guatemala, particularly daughters, are affected by their supportive role. This study's objective was to describe the support role of caregivers in the country, with a focus on daughters with a mother diagnosed with cervical cancer. METHODS This analysis utilizes data from a cross-sectional study which aimed to understand pathways to cervical cancer care. Women seeking cervical cancer treatment at the Instituto de Cancerologia (INCAN) in Guatemala City, Guatemala and their companions were surveyed. Descriptive statistics were calculated. RESULTS One hundred forty-five women seeking treatment and 71 companions participated in the study. Patient's daughters were most frequently reported as the person who provided the most support (51%) and as the most reported to have encouraged the patient to seek care. Furthermore, daughters were noted as the person most reported to fulfill the major household and livelihood roles of the patient while they were seeking or receiving treatment (38.0%). Most daughters reported that they were missing housework (77%), childcare (63%), and income-earning activities (60%) to attend the appointment with their mothers. CONCLUSION Our study suggests that in Guatemala cervical cancer patient's daughters have a significant support role in their mother's cancer diagnosis. Furthermore, we found that while caring for their mothers, daughters in Guatemala are often unable to participate in their primary labor activities. This highlights the additional burden that cervical cancer has on women in Latin America.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Anna Gottschlich
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada.
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Lynn Metz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Natalia Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Andres Pineda
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Kristin Bevliacqua
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Mendoza-Montano
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | - Gina Ogilvie
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Room H203J - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Alvaro Rivera-Andrade
- Institute of Nutrition of Central America and Panama, Research Center for the Prevention of Chronic Diseases, Guatemala City, Guatemala
| | | | - Rafael Meza
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Morgenstern LB, Almendarez EM, Mehdipanah R, Kwicklis M, Case E, Smith MA, Lisabeth LD. Methods and early recruitment of the Brain Attack Surveillance in Corpus Christi-Post-acute Care (BASIC-PAC) Project. J Stroke Cerebrovasc Dis 2022; 31:106851. [PMID: 36335753 PMCID: PMC10024336 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106851] [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: 06/02/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Compared with non-Hispanic whites (NHWs), Mexican Americans (MAs) have worse stroke outcomes. We report here the methods, background literature, and initial recruitment of the Brain Attack Surveillance in Corpus Christi-Post Acute Care (BASIC-PAC) Project which aims to explore PAC in MAs and NHWs from multiple perspectives: patients, caregivers, and community. MATERIALS AND METHODS Rigorous active and passive stroke surveillance captures all strokes in Nueces County, Texas. Stroke patients are followed for 90 days to determine their care transitions and factors influencing their rehabilitation setting. Informal caregivers of the stroke patients are identified and interviewed at 90 days to determine aspects of their caregiving and caregiver outcomes. Available community resources are compared with stated needs among stroke patient and caregivers to determine unmet needs. RESULTS Between October, 2019 and October, 2021, among the 629 stroke patients eligible, 413 were MA, 227 were NHW. Of the 629, all of the six follow-up calls were completed by 355 of the MAs (87%) and 191 of the NHWs (87%). During this same time period, we attempted to approach 621 potential caregivers. Of these, 458 (73.8%) potential caregivers participated in interviews to determine caregiver eligibility, and 373 (81.4%) of these participating potential caregivers met the eligibility criteria. CONCLUSIONS BASIC-PAC has strong initial recruitment and is poised to provide valuable data on multiple aspects of PAC and how PAC differs by ethnicity and contributes to worse stroke outcomes in MAs. Based on the study findings, interventions can be developed that will improve stroke health equity.
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Affiliation(s)
- Lewis B Morgenstern
- Stroke Program, University of Michigan Medical School, Ann Arbor, United States; Department of Epidemiology, University of Michigan School of Public Health, United States.
| | - Elizabeth M Almendarez
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Roshanak Mehdipanah
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, United States
| | - Madeline Kwicklis
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Erin Case
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Melinda A Smith
- Department of Epidemiology, University of Michigan School of Public Health, United States
| | - Lynda D Lisabeth
- Stroke Program, University of Michigan Medical School, Ann Arbor, United States; Department of Epidemiology, University of Michigan School of Public Health, United States
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López-Ortega M, Aguila E. Non -Contributory Pensions, Functional Limitations, and Unpaid Family Care for Older Adults in Mexico. J Aging Health 2022; 34:1213-1227. [PMID: 35739077 DOI: 10.1177/08982643221110093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We explore the effects of non-contributory pensions on functional limitations and receipt of unpaid family care by gender and frequency of pension payment. Methods: We employ a difference-in-differences estimator to identify the causal effects of non-contributory pension programs disbursed monthly or every two months for adults 70 years and older in the state of Yucatan, Mexico. Results:The monthly payment program led to lower difficulties in functional limitations and less receipt of help from family or relatives for older men and women as compared to the bimonthly program. We found a larger decline on receipt of family care for older women than for men. Discussion:Our results suggest that more frequent pension payments may have greater health benefits for recipients. They also highlight the need for greater understanding of policies that prevent or delay functional limitations and that could indirectly alleviate unpaid caregiver burden.
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Affiliation(s)
- Mariana López-Ortega
- Research Department, National Institutes of Health, 233936National Institute of Geriatrics, Mexico City, Mexico
| | - Emma Aguila
- Research Department, National Institutes of Health, 233936National Institute of Geriatrics, Mexico City, Mexico
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Simpson ML, McAllum K, Oetzel J, Berryman K, Reddy R. Māori elders’ perspectives of end-of-life family care: whānau carers as knowledge holders, weavers, and navigators. Palliat Care Soc Pract 2022; 16:26323524221118590. [PMID: 36090127 PMCID: PMC9459446 DOI: 10.1177/26323524221118590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background: There is growing interest in palliative care within Indigenous communities,
and within Aotearoa New Zealand, of the significant role that Māori
(Indigenous people) families play in caring for older relatives. This study
explored the centrality of culture in how Māori extended families
(whānau) in Aotearoa New Zealand interpret and enact
family-based care roles within the Māori world (Te Ao
Māori). Methods: Applying Māori-centered and community-based participatory research
principles, we examined 17 interviews with older Māori who shared
experiences of palliative care for a partner or family member. The thematic
analysis used a cultural-discursive framework incorporating Māori principles
of wellbeing and values expressed within the care relationship. Results: The findings centered on three whānau roles in palliative
care: whānau as (1) Holders and protectors of Māori
knowledge; (2) Weavers of spiritual connection; and (3) Navigators in
different worlds. Conclusion: The study problematizes the notion of a single ‘primary caregiver’,
privileges whānau as an inter-woven relational, dynamic
care network, and encourages health professionals to recognize the cultural
embeddedness of dominant approaches to palliative care.
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Affiliation(s)
- Mary Louisa Simpson
- Waikato Management School, University of Waikato, PB 3105, Hamilton 3240, New Zealand
| | | | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | - Kay Berryman
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
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Torres JM, Mitchell UA, Sofrygin O, Rudolph KE, López-Ortega M, Sharif MZ, Wong R, Glymour MM. Associations between spousal caregiving and health among older adults in Mexico: A targeted estimation approach. Int J Geriatr Psychiatry 2021; 36:775-783. [PMID: 33258494 PMCID: PMC8407372 DOI: 10.1002/gps.5477] [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] [Received: 04/20/2020] [Accepted: 11/01/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate associations between spousal caregiving and mental and physical health among older adults in Mexico. METHODS Data come from the Mexican Health & Aging Study, a national population-based study of adults ≥50 years and their spouses (2001-2015). We compared outcomes for spousal caregivers to outcomes for those whose spouses had difficulty with at least one basic or instrumental activity of daily living (I/ADL) but were not providing care; the control group conventionally includes all married respondents regardless of spouse's need for care. We used targeted maximum likelihood estimation to evaluate the associations with past-week depressive symptoms, lower-body functional limitations, and chronic health conditions. RESULTS At baseline, 846 women and 629 men had a spouse with ≥1 I/ADL. Of these, 60.9% of women and 52.6% of men were spousal caregivers. Spousal caregiving was associated with more past-week depressive symptoms for men (Marginal Risk Difference (RD): 0.27, 95% confidence internal [CI]: 0.03, 0.51) and women (RD: 0.15, 95% CI: 0.07, 0.23). We could not draw conclusions about associations with lower-body functional limitations and chronic health conditions. On average, all respondents whose spouses had caregiving needs had poorer health than the overall sample. CONCLUSION We found evidence of an association between spousal caregiving and mental health among older Mexican adults with spouses who had need for care. However, our findings suggest that older adults who are both currently providing or at risk of providing spousal care may need targeted programs and policies to support health and long-term care needs.
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Affiliation(s)
| | | | - Oleg Sofrygin
- Division of Research, Oakland, CA, Kaiser Permanente
| | | | | | | | - Rebeca Wong
- Sealy Center on Aging, University of Texas – Medical Branch
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8
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Aguila E, López-Ortega M, Angst S. Do Income Supplemental Programs for Older Adults' Help Reduce Primary Caregiver Burden? Evidence from Mexico. J Cross Cult Gerontol 2020; 34:385-402. [PMID: 31165322 DOI: 10.1007/s10823-019-09374-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In countries such as Mexico without formal public long-term care policies, informal care becomes the main source of support for older adults. Alternative social programs, such as supplemental income programs, for older adults could alleviate caregiver burden, especially if supplemental income were to be used for paid care or to compensate non-paid family caregivers. This work is the first to analyze the effects of a supplemental income program for older adults on primary caregiver burden. To identify how such a program might affect caregiver burden, we analyze rich panel data on 433 adults 70 years and older in two communities, one receiving a supplemental income program and the other not, in Yucatan, Mexico. Data were collected in 2008 and 2009 among treatment and control groups before and 6 months after program introduction. We employ a difference-in-differences approach. In our sample, most care is provided by non-paid female caregivers. We find that individuals in both the treatment and control groups received fewer hours of care over time. The decrease was lower for older adults who received the supplemental income, but the difference with those who did not was not statistically significant. We also observe few changes on caregiving burden; even after program introduction, more than 98% of caregivers remained unpaid and the same primary caregiver remained. Altogether, our work suggests supplemental income programs have negligible effects on caregiving, making evident the urgent need for other strategies to support non-paid caregivers who bear most of the burden for old-age care in Mexico.
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Affiliation(s)
- Emma Aguila
- Sol Price School of Public Policy, University of Southern California, 650 Childs Way, RGL Hall 226, Los Angeles, CA, 90089, USA.
| | - Mariana López-Ortega
- Research Department, National Institute of Geriatrics, National Institutes of Health, Mexico City, Mexico
| | - Sean Angst
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
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9
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Palacios-Ceña D, León-Pérez E, Martínez-Piedrola RM, Cachón-Pérez JM, Parás-Bravo P, Velarde-García JF. Female Family Caregivers' Experiences During Nursing Home Admission: A Phenomenological Qualitative Study. J Gerontol Nurs 2019; 45:33-43. [PMID: 31135935 DOI: 10.3928/00989134-20190430-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/02/2019] [Indexed: 11/20/2022]
Abstract
The experience of nursing home (NH) admission has a significant impact on older adults and their relatives. The aim of the current study is to describe the life experiences of female family caregivers (N = 20) after long-stay NH admission of their relative. A qualitative phenomenological approach was followed with purposeful sampling. Data were collected over 18 months using unstructured interviews, letters, and diaries and were analyzed using systematic text condensation analysis. Three themes emerged: The Value of Experience: Deciding on Admission and Defending One's Criteria; Living on Two Sides of the Same Coin; and Maintaining Contact. Results provide insight into female caregivers' experiences of NH admission, which may improve relationships established between female family caregivers and NH staff and help inform the decision-making process. [Journal of Gerontological Nursing, 45(6), 33-43.].
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Fuentes D, Aranda MP. Disclosing psychiatric diagnosis to close others: a cultural framework based on older Latin@s participating in a depression trial in Los Angeles county. Aging Ment Health 2019; 23:1595-1603. [PMID: 30380332 PMCID: PMC6494726 DOI: 10.1080/13607863.2018.1506738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: The objective of this qualitative study is to explore disclosure of depression diagnosis to close others among older adult Latinas/Latinos (Latin@s) recruited from an urban health care system specializing in low-cost community health services in Los Angeles County. Method: Semi-structured in-depth interviews were conducted with 35 older Latinos who participated in an NIMH-funded randomized depression trial. Results: Psychiatric disclosure is a dynamic, multidimensional, and culturally ladened experience that entails weighing in on interrelated factors. This study presents a cultural framework of depression disclosure that highlights 15 facilitators and barriers which were organized into three intrinsic and relational domains: (a) individual emotional and support needs; (b) personal characteristics of the recipient of the disclosure; and (c) quality of the interpersonal interactions between the patient and recipient. Conclusion: Knowledge of Latin@ older adults' perspectives and experiences with depression disclosure can inform strategies to support older Latin@s facing the dilemma of disclosure.
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Affiliation(s)
- Dahlia Fuentes
- USC Edward R. Roybal Institute on Aging, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 S. Olive Street (Suite 1400), Los Angeles, CA 90015, Telephone: (619) 248-4737
| | - María P. Aranda
- USC Edward R. Roybal Institute on Aging, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 S. Olive Street (Suite 1400), Los Angeles, CA 90015, Telephone: (213) 740-0286
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11
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Trapp S, MacKenzie J, Gonzalez-Arredondo S, Rodriguez-Agudelo Y, Arango-Lasprilla JC. Mediating role of caregiver burden among family caregivers of patients with Parkinson's disease in Mexico. Int J Psychiatry Med 2019; 54:203-216. [PMID: 30278803 DOI: 10.1177/0091217418791460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study examined the mediating role of caregiver distress on family factors and caregiver life satisfaction among an understudied population of Parkinson's disease caregiver in Mexico. METHODS A cross-sectional design was used to examine psychosocial factors pertinent to caregiver of individuals with Parkinson's disease ( n = 95). Guided by a caregiver stress process model, relations among family factors (e.g., cohesion, flexibility, quality of functioning), gender, distress, and satisfaction with life among caregiver were examined. Mediation analyses were performed to test the role of caregiver distress on the associations between family factors, gender, and caregiver satisfaction with life. RESULTS Mediation models demonstrated that caregiver distress fully mediated the relation between quality of family functioning and caregiver satisfaction with life and partially mediated the association between family flexibility and caregiver satisfaction with life. Caregiver gender did not emerge as a significant covariate, and null results were found in the model examining family cohesion as a predictor. CONCLUSION These results underscore the critical role of caregiver distress and family factors on features of caregiver well-being, notably satisfaction with life. This evidence also offers cross cultural evidence for the caregiver stress process model, which has primarily been observed in Western samples. Accordingly, the need to build and disseminate empirically supported family-based treatments that emphasize caregiver distress is warranted.
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Affiliation(s)
- Stephen Trapp
- 1 Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Justin MacKenzie
- 1 Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT, USA
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12
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Yahirun JJ, Arenas E. Offspring Migration and Parents' Emotional and Psychological Well-being in Mexico. JOURNAL OF MARRIAGE AND THE FAMILY 2018; 80:975-991. [PMID: 30369634 PMCID: PMC6201307 DOI: 10.1111/jomf.12479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/30/2018] [Indexed: 05/17/2023]
Abstract
In Mexico, offspring migration disrupts familial norms of coresidence and geographic proximity. This paper examines how offspring migration, both domestically and to the United States, affects the emotional and psychological well-being of parents who remain in the place of origin. Using nationally-representative longitudinal data from the Mexican Family Life Survey (N=4,718), we found limited evidence that parents whose offspring emigrated to the United States experience worse outcomes than parents of offspring who do not migrate. Although we found that offspring U.S. migration was not associated with changes in parents' overall depressive syndrome, a child's U.S. migration increased the likelihood of experiencing loneliness, and lead to a lower likelihood of recovery from parental sadness over time. Children's domestic migration did not affect parental well-being. These findings add to a growing body of literature that should be considered when assessing the broader impact of migration on family members who remain behind.
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Affiliation(s)
- Jenjira J Yahirun
- Center on the Family, University of Hawai'i at Mānoa. Miller Hall 103, 2515 Campus Road, Honolulu, HI 96822
| | - Erika Arenas
- Centro de Análisis y Bienestar Social, A.C and Department of Sociology, University of California, Santa Barbara. Social Studies and Media Science Bldg. 3123, Santa Barbara, CA 93106
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13
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Roberge EM, Benedek DM, Marx CE, Rasmusson AM, Lang AJ. Analysis of Recruitment Strategies: Enrolling Veterans With PTSD Into a Clinical Trial. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Erika M. Roberge
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, and Veterans Affairs Medical Center, Washington, D.C
| | - David M. Benedek
- Department of Psychiatry, Uniformed Services University of the Health Sciences
| | - Christine E. Marx
- Duke University Medical Center, Durham, North Carolina, and Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina
| | - Ann M. Rasmusson
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts, and Boston University School of Medicine
| | - Ariel J. Lang
- Department of Psychiatry, University of California San Diego, and Veterans Affairs San Diego Healthcare System Center of Excellence for Stress and Mental Health, San Diego, California
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Yahirun JJ, Sheehan CM, Hayward MD. Adult children's education and changes to parents' physical health in Mexico. Soc Sci Med 2017; 181:93-101. [PMID: 28384483 PMCID: PMC5600815 DOI: 10.1016/j.socscimed.2017.03.034] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 03/11/2017] [Accepted: 03/17/2017] [Indexed: 11/25/2022]
Abstract
The well-being of older adults is frequently tied to support from their adult children. Here, we assess whether the education of adult offspring is associated with changes to older parents' short- and long-term health in Mexico, a rapidly aging context with historically limited institutional support for the elderly. Educational expansion over the past half century, however, provides older adults with greater resources to rely on via the education of their children. Using longitudinal data from the Mexican Health and Aging Study (2001-2012), we find that offspring education is not associated with short-term changes in parents' physical functioning, but is associated with increased parental longevity, net of children's financial status and transfers. In addition, we find that mothers' longevity is more sensitive to offspring education than fathers. Our findings add to a growing body of literature that urges policy-makers to consider the multi-generational advantages of expanding educational opportunities in Mexico.
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Affiliation(s)
- Jenjira J Yahirun
- Center on the Family, University of Hawai'i at Mānoa, Honolulu, HI, United States.
| | - Connor M Sheehan
- Population Research Center and Department of Sociology, University of Texas at Austin, TX, United States
| | - Mark D Hayward
- Population Research Center and Department of Sociology, University of Texas at Austin, TX, United States
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15
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Mudrazija S, López-Ortega M, Vega WA, Gutiérrez Robledo LM, Sribney W. Household Composition and Longitudinal Health Outcomes for Older Mexican Return Migrants. Res Aging 2016; 38:346-73. [PMID: 26966255 DOI: 10.1177/0164027515620241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mexican return migrant population is increasing, yet our knowledge about their lives after resettlement in Mexico remains fragmentary. Using 2001-2012 longitudinal data from the Mexican Health and Aging Study, we investigate difference in household composition for older migrants who returned from the United States compared to nonmigrants. Furthermore, we fit a Cox proportional hazards model to assess the relationship between household composition and health and functional trajectories of return migrants and nonmigrants. The results indicate that return migrants with long duration of U.S. stay have different household composition than nonmigrants or short-term migrants: On average, they have smaller household size, including fewer females who may be available to offer assistance to older adults. Presence of middle-age females in the household has positive effects on health and functional trajectories. We highlight implications of this research for policy makers in Mexico and the United States.
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Affiliation(s)
| | | | - William A Vega
- School of Social Work, Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
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16
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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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17
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The impact of education and health heterogeneity on Generational Support Ratios: a cross-national comparison between Mexico and Korea. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTPolicy makers are concerned about the socio-economic consequences of population ageing. Policies often rely on estimations of support ratios based solely on the population age structure. We estimate Generational Support Ratios (GSRs) considering health heterogeneity of the population age 60+ and education heterogeneity of their offspring. We explore the effect of a public policy that changes the education of a targeted sub-group of women when they are young on their health once they become older, taking into account changes in demographic processes (i.e.marriage, fertility, offspring's education). We used the model presented by Kyeet al.for the Korean context and examine the Mexican context. Our paper has three objectives. First, by applying this framework to the Mexican context we aim to find that improvements in women's education may mitigate the negative consequences of population ageing directly and indirectly through subsequent demographic behaviours that altogether affect GSRs. Second, by making a cross-national comparison between Korea and Mexico, we aim to quantify how policies of educational expansion have different impacts in contexts in which the population age 60+ have universal access to health care compared to contexts in which access to health care is selective. Third, by comparing cross-nationally we aim to show how differences in family processes across countries alter the pathways through which improvements in education affect GSRs.
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18
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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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20
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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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21
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Amin I, Ingman S. Eldercare in the transnational setting: insights from Bangladeshi transnational families in the United States. J Cross Cult Gerontol 2015; 29:315-28. [PMID: 24879537 DOI: 10.1007/s10823-014-9236-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Little is known about the emotional impact of caregiving for elderly parents on migrant child in the transnational setting. To address this gap in the literature, this study examines the stressors, mediators, and outcomes of eldercare in the transnational context. Data were collected from 21 Bangladeshi immigrant men and women living in the United States who had living parents in Bangladesh over 60 years old. Despite the geographic distance, the migrants provide care to their parents such as emotional support, financial assistance, and arranging for care. While the health status of the care recipients contributed to primary objective stressors, none of the transnational caregivers' narratives reflected the presence of any subjective stressors such as role overload, role captivity, and relational deprivation. Distance and depending on others for hands-on caregiving resulted in feelings of loss of control over the caregiving process. Caregivers experienced a range of emotions from guilt, excessive worrying, and distress over the unpredictability and uncertainty of their circumstances. Kin networks, communicative technologies, and a cultural norm of filial piety contributed to mediating stress. The findings underscore the importance of supportive institutional policies such as visa and travel policies, employment leave, and counseling services for caregivers who provide care for their elderly parents transnationally.
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Affiliation(s)
- Iftekhar Amin
- Department of Counseling and Human Services, University of North Texas at Dallas, 7300 Houston School Road, Dallas, TX, 75241, USA,
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22
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López-Ortega M, García-Peña C, Granados-García V, García-González JJ, Pérez-Zepeda MU. Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study. BMC Health Serv Res 2013; 13:51. [PMID: 23391286 PMCID: PMC3610123 DOI: 10.1186/1472-6963-13-51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/31/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs. METHODS A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures. RESULTS A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to the caregivers of elderly hospitalized in the geriatric unit. The final model showed that type of service and satisfaction had the largest coefficients (-0.68 and 0.662 respectively, p<0.001). CONCLUSIONS This study allowed us to identify associated factors of economic burden in elderly hospitalized in acute care units. It opens as well, an issue that should not be overlooked in framing public policies regarding elderly health care.
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Affiliation(s)
- Mariana López-Ortega
- Instituto Nacional de Geriatría, Periférico Sur 2767, Colonia San Jerónimo Lídice, Delegación Magdalena Contreras, México D.F, Mexico
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23
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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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Abstract
INTRODUCTION: Developing countries in Latin America (LA) are experiencing rapid aging as a result of advances in medical interventions. This rapid aging has not occurred with comparable improvements in standards of living. Chronic conditions are becoming highly prevalent while exposure to infectious communicable diseases is very common. This unique situation where communicable and non-communicable diseases coexist in the presence of low socioeconomic status place countries in LA in a unique epidemiological situation. Mexico presents a very good example where the impact of this situation on health warrants further analysis. METHODS: We use data from the Mexican National Health and Nutrition Survey (ENSANut 2006), a cross-sectional study representative of all urban and rural areas of Mexico. A total of 5,605 adults older than 60 years of age with valid values for Body Mass Index and Hemoglobin were analyzed. We first included a descriptive analysis of the coexistence of anemia and obesity by age, gender and characteristics of the living environment. We reported the weighted percentages for each covariate by each of four nutritional condition categories (obese and anemic, only-obese, only-anemic, not obese and not anemic). We used multinomial logit regressions to determine the association of socioeconomic characteristics, health status and the living environment with the presence of the three nutritional condition categories. RESULTS: In the ENSANut cohort 10.3% of older adults are anemic, 25.0% are obese and 2.6% are both anemic and obese. Approximately 62% has neither anemia nor obesity. Within the 38% that fall in the three nutritional condition categories, the co-existence of obesity & anemia appears to be associated with metropolitan area residence, living alone, being male, having relatively high wealth, and reporting two or more chronic health conditions. Analyzing the effect of the covariates to distinguish between outcome categories, living environment, age, gender, wealth, and smoking show a significant effect when comparing across the three nutritional categories. CONCLUSIONS: Older Mexican adults with both obesity & anemia have a different profile compared to that of adults with only one of the conditions. Future studies need to do a careful clinical evaluation of this group and design clinical interventions to avoid complications. Additionally, social support initiatives that target specific groups of older adults according to their health and social needs must be established.
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Mendez-Luck CA, Trejo L, Miranda J, Jimenez E, Quiter ES, Mangione CM. Recruitment strategies and costs associated with community-based research in a Mexican-origin population. THE GERONTOLOGIST 2011; 51 Suppl 1:S94-105. [PMID: 21565824 DOI: 10.1093/geront/gnq076] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE We describe the recruitment strategies and personnel and materials costs associated with two community-based research studies in a Mexican-origin population. We also highlight the role that academic-community partnerships played in the outreach and recruitment process for our studies. We reviewed study documents using case study methodology to categorize recruitment methods, examine community partnerships, and calculate study costs. RESULTS We employed several recruitment methods to identify and solicit 154 female caregivers for participation in qualitative interviews and quantitative surveys. Recruitment approaches included using flyers and word of mouth, attending health fairs, and partnering with nonprofit community-based organizations (CBOs) to sponsor targeted recruitment events. Face-to-face contact with community residents and partnerships with CBOs were most effective in enrolling caregivers into the studies. Almost 70% of participants attended a recruitment event sponsored or supported by CBOs. The least effective recruitment strategy was the use of flyers, which resulted in only 7 completed interviews or questionnaires. Time and costs related to carrying out the research varied by study, where personal interviews cost more on a per-participant basis ($1,081) than the questionnaires ($298). However, almost the same amount of time was spent in the community for both studies. IMPLICATIONS Partnerships with CBOs were critical for reaching the target enrollment for our studies. The relationship between the University of California-Los Angeles (UCLA) Resource Center for Minority Aging Research/Center for Health Improvement for Minority Elderly and the Department of Aging provided the infrastructure for maintaining connections with academic-community partnerships. Nevertheless, building partnerships required time, effort, and resources for both researchers and local organizations.
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Affiliation(s)
- Carolyn A Mendez-Luck
- Department of Community Health Sciences, School of Public Health, University of California Los Angeles. 90095, USA.
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