Introduction: exploring the relationships among aging, ethnicity, and family dementia caregiving

Racial/Ethnic Differences in Caregiving Frequency: Does Immigrant Status Matter?

Objectives

With growing diversity in the older adult and caregiver populations, the purpose of the current study is to describe the extent to which elder care frequency varies by race/ethnicity and immigrant/native status using national data from the United States.

Method

Using pooled data from the 2011-2014 American Time Use Surveys (ATUS; N = 7,855), we present multinomial logistic regressions of caregiving frequency by race/ethnicity and immigrant/native status and explore whether factors within the caregiving domain (duration of care, number of care recipients, and coresidence) attenuate any observed differences.

Results

Compared to non-Latino Whites, non-Latino Black, Mexican-origin, and other Latino caregivers engage in more frequent elder care activities, which is partially attributable to high levels of coresidence among these subpopulations. Although immigrant caregivers, in general, tend to engage in more time-intensive caregiving, for Mexican-origin and other Latino caregivers, U.S.-born caregivers report more frequent elder care provision.

Discussion

More time-intensive and demanding caregiving careers reported by racial/ethnic minority and immigrant caregivers further emphasize the need for culturally competent home- and community-based care options.

Cross-cultural representations of dementia: an exploratory study

Background

An ageing global population will bring a significant increase in the prevalence of dementia, with the need for a collaborative international effort to combat this public health challenge being increasingly recognised. To be successful, this cooperation must be sensitive to the different cultural environments in which dementia is positioned, which shape the variety of clinical, political and social approaches to the condition worldwide. The aim of this project is to examine the social representations of dementia among people from three countries with different health care systems. More specifically, to investigate the internal structure of the social representations of dementia within the framework of the structural approach among British, American and Chinese lay-people.

Methods

A sample of 194 participants completed a free association task and a justification task in response to the stimulus word ‘dementia’. The data was subsequently analysed within the framework of the structural approach to social representations, using prototypical analysis.

Results

The American group’s unique elements were nearly exclusively concerned with physical and cognitive decline, and elements referring to care were focused on external support, namely nursing homes. In the Chinese group, there were several elements referring to behaviour, but a much greater emphasis on cognition than predicted by the literature. Elements concerning care were, as expected, focused on the family. In the British group, there was also a cognitive focus, but this was accompanied by elements which portrayed the experience of the condition from the perspective of those affected, and a reference to relative well-being in the context of care.

Conclusions

Social representation theory proved to be a viable method in gathering data on cross-cultural differences in how dementia is understood and approached. The current study demonstrated how the conceptualisation of the condition’s relationship with the cognitive, behavioural and affective dimensions might have an impact on the structure and form of care for those living with dementia in each culture.

"It's just part of life": African American daughters caring for parents with dementia

The purpose of this study was to gain a greater understanding of the experiences of African American daughters caring for parents with Alzheimer's disease or a related dementia (ADRD). In this secondary analysis of a subset (N = 12) of the sample from a previous study, daughters averaged 54 years of age and were caring for parents with moderate to severe ADRD. Results revealed two main categories: Caregiver Concerns and Caregiver Coping. Subcategories included challenging behaviors, social aspects, integration, and family culture and values. Findings offer insight into cultural factors relevant to practice along with research recommendations.

The Lived Experiences of Israeli Arab Moslems Who are Caring for a Relative with Cognitive Decline

The study examined the lived experience of caring for a relative with cognitive decline. The informants were 18 Arab, Moslem caregivers living in rural communities in Northern Israel who participated in personal interviews. The transcripts were analyzed using the hermeneutic phenomenological approach to the study of human behavior (van Manen, 1998). The results clarified how social location affects caregiving perceptions, decisions, and actions. The portrayed experiences were complex and involved the dimensions of life, including individuals, family-neighbors, and social-political environments. The holistic overview of the transcripts indicated the inseparable political and personal influences on perceptions of caregivers, a conflict of old and new social viewpoints, the absence of one main caregiver for the divided duties of several family members, and the lack of scientific information about the condition of the relative. Several motivations for caregiving were documented and examples of personal, interpersonal, and community resources were provided.

Ageing, dementia and society - an epistemological perspective

Recent data show that as populations age, the number of people affected by neurodegenerative dementia is growing at an epidemic pace in various regions of the world. This cross-cultural study examined the relationships among age, gender, ethnicity, religion, and education as well as the attitudes and perceptions related to ageing and dementia. A random sample of 980 participants was selected to represent the multicultural population of Singapore. Data were collected using standardised questionnaires through online portals and by conducting interviews. These data were ultimately analysed by comparing percentage responses and correlation coefficients and by conducting a multiple regression analysis. The results indicate that the perceptions and attitudes of individuals toward ageing and dementia differ among different age groups. Moreover, the level of education attained was significantly correlated with understanding dementia; regardless of education level, Christians had the most positive mindset toward dementia, although most religious individuals did not believe in divine healing. In this study, it was determined that attitudes and perceptions about ageing and dementia are influenced by multiple factors, such as education, age, and religion, and that it is imperative that younger generations develop coping strategies, including healthy lifestyles and social and/or religious communities to provide quality care to the elderly, in general, and to dementia patients, in particular.

Experiences and concerns of family caregivers providing support to people with dementia: A cross-cultural perspective

Abstract:

We examined experiences and concerns among caregivers of community-dwelling people with dementia from two ethnic groups. We conducted a thematic analysis of responses to the question, ‘What is your life like as a caregiver?’ in nine focus groups ( n = 75) with Filipino and non–Hispanic White caregivers. Constant comparison methods identified themes by ethnicity. Experiences and concerns expressed across groups were related to care recipient symptoms commonly associated with dementia, including severe memory loss and behavioral changes. Participants in both ethnic groups described strategies that help them cope, such as receiving help from family and friends, receiving respite support, and participating in support groups. Filipino caregivers more often emphasized positive aspects of caregiving, whereas Whites often expressed that others do not understand the daily experiences of caregiving. Filipinos more commonly described caregivers as a ‘good person’ or ‘saint’ and emphasized that caregiving made them stronger.

Concepts and understandings of dementia by 'gatekeepers' and minority ethnic 'service users'

In this article I outline research which seeks to explore the intersections of dementia, ethnicity and family care. My focus is how research that aims to focus on dementia care and ethnicity illuminates the experiences of members of minoritized ethnic groups in accessing statutory services. I reflect on how the intersections of racialized identities and western medical terminology make researching and providing services across racialized boundaries and health/illness a complex procedure. This commentary has direct implications for the care of people with dementia, their family members and for service development within health and social care fields.

Religious and Spiritual Dimensions of the Vietnamese Dementia Caregiving Experience

This paper focuses on the role of religion and spirituality in dementia caregiving among Vietnamese refugee families. In-depth qualitative interviews were conducted with nine Vietnamese caregivers of persons with dementia, then tape-recorded, transcribed, and analyzed for emergent themes. Caregivers related their spirituality/religion to three aspects of caregiving: (1) their own suffering, (2) their motivations for providing care, and (3) their understanding of the nature of the illness. Key terms or idioms were used to articulate spiritual/religious dimensions of the caregivers' experience, which included sacrifice, compassion, karma, blessings, grace and peace of mind. In their narratives, the caregivers often combined multiple strands of different religions and/or spiritualities: Animism, Buddhism, Taoism, Confucianism and Catholicism. Case studies are presented to illustrate the relationship between religion/spirituality and the domains of caregiving. These findings have relevance for psychotherapeutic interventions with ethnically diverse populations.

Reexamining the relationships among dementia, stigma, and aging in immigrant Chinese and Vietnamese family caregivers

Prior literature emphasizes that Asian Americans with dementia may be particularly vulnerable to the stigma of chronic and severe mental illness. However, there is a dearth of empirical research to support this claim. This study examines the relationship of stigma and dementia in 32 qualitative interviews with Chinese and Vietnamese family caregivers. Stigma was a common theme in the interviews (91%). Further analysis revealed two sources: the stigma of chronic and severe mental illness and a stigma reflecting negative stereotypes of aging or the aged. Chinese and Vietnamese cultural views of normal aging are not unitary but accommodate different trajectories of aging, some more and some less desired. When applied to persons with dementia, a "normalized" but negative trajectory of aging carried with it significant stigma that was distinct from but in addition to the stigma of chronic and severe mental illness. Older Chinese and Vietnamese with dementia are thus at risk of experiencing multiple stigmas that include but go beyond the stigma associated with chronic and severe mental illness.

Social Representations of Barriers to Care Early in the Careers of Caregivers of Persons With Alzheimer's Disease

The first signs of cognitive impairment in the elderly generally elicit much concern among family members. Reactions run from denial to the active search for information. Some families manage to set up relatively well-organized networks of informal support to help both caregivers and elderly relatives. However, little is known about the processes underlying the different pathways that families follow at the onset of Alzheimer-type dementia in elderly relatives. To gain a better understanding of barriers to care early in the caregiving career, from the first signs of illness to diagnosis, the authors conducted interviews with 52 caregivers recruited at two cognition clinics. Barriers to help resources were analyzed from the viewpoint of social representations. This approach allowed the consideration of a broad range of individual and group phenomena capable of fashioning caregivers' representations of this period. The results confirmed the importance of the symbolic dimension of experience in steering social practice.

Public opinion about Alzheimer disease among blacks, hispanics, and whites: results from a national survey

Recent research has documented notable differences in knowledge, awareness, and cultural beliefs about Alzheimer disease (AD) among groups defined by race and ethnicity. The present study was conducted to assess racial differences in knowledge and attitudes about AD among a national sample of adults. Data from 1,176 adults aged 35 years and over (48.6% White, 25.7% Black, and 25.8% Hispanic) obtained via telephone interview were used in this study. Although some notable group differences defined by race/ethnicity were observed, more similarities in patterns of response were discovered than expected. Black and Hispanic respondents were significantly more likely to believe that AD is a normal part of aging, but were more optimistic about future advances in research than White participants. Compared with White and Black respondents, Hispanics were more likely to report feeling well-prepared for handling a diagnosis of AD in a family member. Overall, the results suggest that misconceptions about AD remain among large segments of the population, that AD remains a source of significant concern, and that continued efforts are needed to educate the public about this disease.

Hard lives, God's help, and struggling through: caregiving in Arkansas Delta

The purpose of this ethnographic study was to describe the experience of African American adults providing in-home care for a family member with chronic confusion living in the Arkansas Delta. We conducted this study over fourteen months in two rural Delta counties using participant observation and in-depth interviews. The majority of caregivers were adult daughters. Nearly half attributed chronic confusion to a difficult life and emotional stress or "worry;" a third believed it to be a natural component of "old age." Caregivers tended to view their work as an expression of love and devotion that was accompanied by emotional stress and personal sacrifice. While just under half of the caregivers had no other family members willing or available to assist with the physical care of the elder, the majority were able to turn to family members for emotional support. Further they identified strong religious beliefs as the primary force that sustained them in the caregiving role. The centrality of spirituality, faith/religion was noted in nearly all aspects of life. Faith in God was seen as continuing to be an important aspect of the care recipients' lives as well. Recipients' spiritual needs were addressed by accompanying the care recipient to church services and reading Bible passages to them on a regular basis. Selective community services (i.e., adult day care, home health services) were used that supported efforts at maintaining the family caregiver role. Findings are discussed within the context of historical and sociopolitical factors of the geographic region.

Conceptions of dementia in a multiethnic sample of family caregivers

Understanding variability in conceptions of dementia in multiethnic populations is important to improve care and guide research. The objectives of this study were to describe caregiver conceptions of dementia using a previously developed typology and to examine the correlates of conceptions of dementia in a multiethnic sample. This is a cross-sectional study conducted in Boston and the San Francisco Bay area. Participants were a convenience sample of 92 family dementia caregivers from four ethnic/racial groups: African-American, Anglo European-American, Asian-American, and Latino. In-depth, qualitative interviews explored the caregivers' ideas about the nature and cause of dementia (i.e., explanatory models). Explanatory models of caregivers were categorized as biomedical, folk, or mixed (folk/biomedical). Quantitative analyses examined the association between ethnicity and other caregiver characteristics, and explanatory model type. Overall, 54% of caregivers, including 41% of Anglo European Americans, held explanatory models that combined folk and biomedical elements (i.e., mixed models). For example, many families attributed Alzheimer's disease and related dementias to psychosocial stress or normal aging. Ethnicity, lower education, and sex were associated with explanatory model type in bivariate analyses. In multiple logistic regression analysis, minority caregivers (P<.02) and those with less formal education (P<.02) were more likely to hold mixed or folk models of dementia. Although minority and nonminority caregivers often incorporated folk models into their understanding of dementia, this was more common in minority caregivers and those with less formal education. Further research on cross-ethnic differences in a larger, more-representative sample is needed.

Racial and ethnic differences in the relationship of caregiving stressors, resources, and sociodemographic variables to caregiver depression and perceived physical health

Racial and ethnic differences in the association of stressors, resources, and sociodemographic characteristics with depressive symptoms and perceived physical health were investigated. Data from 653 White non-Hispanic caregivers, 278 African American, and 218 Hispanic Alzheimer's caregivers (209 males, 940 females) who were assessed at the baseline data collection of the REACH study, a multisite trial of caregiver interventions, was obtained. Multiple sample analysis, which allows testing whether a pattern of relationships is invariant across different samples, was used. Results support the hypothesis that, despite significant differences in resources and stressors, the predictors of depression and health are relatively uniform across groups. Ethnic differences were found for the effect of age, income, gender, and care receiver's self-care impairments on caregiver depression. For perceived physical health, there were ethnic differences for the effect of income, gender, and type of caregiver relationships.

Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis

PURPOSE

We investigated ethnic differences in caregiver background variables, objective stressors, filial obligations beliefs, psychological and social resources, coping processes, and psychological and physical health.

DESIGN AND METHODS

We used a meta-analysis to integrate the results of 116 empirical studies.

RESULTS

Ethnic minority caregivers had a lower socioeconomic status, were younger, were less likely to be a spouse, and more likely to receive informal support. They provided more care than White caregivers and had stronger filial obligations beliefs than White caregivers. Asian-American caregivers, but not African-American and Hispanic caregivers, used less formal support than non-Hispanic White caregivers. Whereas African-American caregivers had lower levels of caregiver burden and depression than White caregivers, we found that Hispanic and Asian-American caregivers were more depressed than their White non-Hispanic peers. However, all groups of ethnic minority caregivers reported worse physical health than Whites. Observed ethnic differences in burden and depression were influenced by study characteristics, such as the type of illness of the care recipient and the representativeness of the sample.

IMPLICATIONS

The results suggest that more specific theories are needed to explain differential effects of ethnic minority groups of caregivers. Intervention needs vary, in part, between ethnic groups of caregivers.

Recruitment and retention of latino dementia family caregivers in intervention research: issues to face, lessons to learn

PURPOSE

This article reviews and critiques several issues of importance to those whose goal is to make intervention research with Latino caregivers more "user-friendly." Issues range from current demographic trends showing the ever-increasing number of Latino caregivers to discussion of cultural values that influence their help-seeking behavior.

DESIGN AND METHODS

This article presents a review of current published information on this topic. The gerontological literature was searched for the past decade for relevant material; in addition, the authors' own experience in this area is described.

RESULTS

Although limited information was found that derived from actual empirical studies, a number of articles describe potential barriers to research involvement and provide suggestions for making participation more attractive and culturally appropriate for Latinos.

IMPLICATIONS

Clinical researchers need to increase their sensitivity to such issues as cultural values and language preference and develop effective collaborations with the Latino community so that intervention research programs can be designed and implemented successfully with Latinos caring for cognitively impaired elderly family members at home.

The cultural influence of values, norms, meanings, and perceptions in understanding dementia in ethnic minorities

Issues of ethnicity and culture, as they relate to Alzheimer disease and related disorders, continue to be under-studied. This article highlights the limited findings regarding ways in which culture can influence caregiving to older persons suffering from dementia across different ethnic groups in the United States. Particular attention is given to how cultural values, norms, and beliefs shape the meanings different ethnic groups assign to dementia. Findings show that family caregiving processes and help seeking are influenced by the meanings family members assign. However, more research is needed in this area. Also, researchers and practitioners could benefit Alzheimer sufferers and their caregivers by incorporating cultural and social information about diverse groups into their future models of research and practice.

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.

Decision-making within the social course of dementia: accounts by Chinese-American caregivers

The goal of this retrospective pilot study was to provide a naturalistic description of the decision-making process regarding dementia, a chronic illness. The hypothesis was that in-depth descriptions by caregivers in a community setting would provide a more comprehensive and realistic representation of decision-making in the case of chronic illness than has been provided by most models. Data were gathered from in-depth, qualitative interviews with seven Chinese-American families living in the Boston area and caring for an elderly family member with dementia. These were supplemented with interviews with medical professionals and ethnography done in the community regarding the care of elders with dementia. Based on the findings, this paper proposes a dynamic, more comprehensive model for the social process of decision-making which is particularly applicable to clinical and life situations of decision-making in the case of chronic illness. The model describes: 1) the decision-maker constellation, including multiple family members, professionals and service systems; 2) relationships between decision-makers as "allies" or "competitors"; 3) variations in the nature of the decision-making process; and 4) the interaction of decision-making with larger social, economic and cultural forces. Decision-making in the case of dementia is placed within the conceptual framework of the "social course" of chronic illness.