Aged blacks' choices for an informal helper network

Taking Diversity Seriously: Within-Group Heterogeneity in African American Extended Family Support Networks

OBJECTIVE

This study examined the correlates of involvement in extended family social support networks among African Americans.

BACKGROUND

Previous literature has documented the importance of informal social support from extended family members for the African American population. Most research has investigated black-white differences in network involvement or has focused on impoverished African American families. Both approaches conceal important within-group variation in participation among the total African American population.

METHOD

This study relied on nationally representative data from the African American sub-sample of the National Survey of American Life (n=3,538). It employed ordinary least squares regression analysis to examine the sociodemographic and family factors that are associated with four key measures of involvement in extended family support networks: receiving and providing extended family support, frequency of family contact, and degree of subjective closeness.

RESULTS

African Americans routinely interacted with members of their family, displayed a high degree of family closeness, and exchanged support fairly frequently. Findings also revealed significant variation in network involvement by sociodemographic characteristics: women, younger adults, and Southerners were typically most involved; individuals who experienced greater material hardship, were previously incarcerated, or served in the military reported less involvement. Results also showed that family closeness and family contact were particularly salient factors shaping the extent to which network members engaged in support exchanges.

CONCLUSION

The magnitude of within-group heterogeneity in network involvement underscores the importance of considering issues of intragroup diversity in the developing literature on African American extended family networks.

Religious Involvement and Cognitive Functioning at the Intersection of Race/Ethnicity and Gender in Mid-Life and Older Adults

OBJECTIVES

To investigate the association between religious involvement and cognitive functioning at the intersections of race-ethnicity and gender among mid-life and older adults, and to determine if psychosocial factors help explain this relationship.

METHODS

The sample included 14,037 adults aged 50+ from the Health and Retirement Study (HRS). We utilized measures from the HRS 2010 and 2012 Core interviews and Leave Behind questionnaires and estimated our models using linear regression.

RESULTS

Compared to individuals who frequently attended religious services, infrequent religious service attendance was related to poorer cognitive functioning. Religiosity was inversely associated with cognitive functioning at baseline, but the relationship varied by race/gender subgroup. Greater religiosity was associated with better cognitive functioning among Black women, but lower cognitive functioning among White men and women. Psychosocial factors did little to explain the inverse association between religiosity and cognitive functioning.

DISCUSSION

Results suggest the association between religious involvement and cognitive functioning is varied and complex, and largely dependent on important social identities. The findings have important implications for investigating health-protective factors, like religious involvement, using an intersectional perspective.

Reciprocal Family, Friendship and Church Support Networks of African Americans: Findings from the National Survey of American Life

This study examined reciprocal support networks involving extended family, friends and church members among African Americans. Our analysis examined specific patterns of reciprocal support (i.e., received only, gave only, both gave and received, neither gave or received), as well as network characteristics (i.e., contact and subjective closeness) as correlates of reciprocal support. The analysis is based on the African American sub-sample of the National Survey of American Life (NSAL). Overall, our findings indicate that African Americans are very involved in reciprocal support networks with their extended family, friends and church members. Respondents were most extensively involved in reciprocal supports with extended family members, followed closely by friends and church networks. Network characteristics (i.e., contact and subjective closeness) were significantly and consistently associated with involvement with reciprocal support exchanges for all three networks. These and other findings are discussed in detail. This study complements previous work on the complementary roles of family, friend and congregational support networks, as well as studies of racial differences in informal support networks.

Current and Future Family Help with Long-Term Care Needs of the Elderly

An accurate perspective of the variation in current mixes of familial/public sector support for older individuals with health-related needs requires a careful assessment of the huge diversity -in the sociodemographic composition of the older population as well as in the availability and type of family caregiving resources. This analysis of a sample of individuals 60 years of age and older from the National Survey of Families and Households attempts to provide an in-depth assessment of the sociodemographic composition of the older population and variation in primary kin support for this population by determining (a) the proportions of various age/race/gender population segments of the elderly that have one or more potential primary kin caregivers; (b) the number and proportions of these population segments who are in need of family support due to health status; and (c) who within these population segments receives familial assistance and who does not, given a consideration of both the potential family support network and health status. The analysis also includes an illustrative exercise exploring the potential future impact on the level of unmet need from changes in female labor force participation rates and norms regarding both work and parent care.

African American Dementia Caregivers

Differences in ethno-cultural perspectives have been previously suggested as the source of variation among ethnic groups regarding their approaches to dementia family caregiving. This study explored the perceptions and experiences that African American caregivers of family members with dementia encountered on their journey toward obtaining a diagnosis of dementia for their loved ones. An overall theme of respect emerged from a focus group session with seven family caregivers. Reports of respecting older family members through `normalization', thereby delaying evaluation for dementia, then encountering a lack of respect from health care providers when one was finally sought, created a duality of respect vs disrespect. This tension constituted a subtle but profound form of caregiver stress that may be unique to African American caregivers, and one that has not been considered in standardized measures. Findings inform providers about important issues to consider when working with and studying dementia caregiving among African American families.

Spousal dementia caregiving in the context of late-life remarriage

Increasing numbers of older couples entering late-life remarriage will face dementia and spousal caregiving. This qualitative study, informed by grounded theory methods, is a first to explore spousal caregiving in the late-life remarried context. Interviews with nine late-life remarried wife caregivers identified complex intergenerational stepfamily dynamics that appear to amplify isolation and stress for this group of caregivers. Most women reported experiencing rejection of remarriage by adult children, minimal family involvement in caregiving, and intergenerational conflict regarding decision making. Nonetheless, caregivers described proactive, strategic approaches toward caregiving. This study examines the construct of boundary ambiguity as it relates to late-life remarriage and dementia caregiving, thus merging the unique challenges of caregiver and stepfamily dynamics. Findings are discussed in light of the potential risks highlighted for remarried couples facing chronic health issues. Future dementia research that accounts for diverse marital and family histories is suggested.

Social Support, Stress, and Psychological Distress among Older Black and White Adults

This analysis examines the relationship among sources of stress, sources of support, and psychological distress among black and white elderly living in the community. The data are drawn from an epidemiological survey conducted in 1984 and show that black and white elders are equally likely to have family and friends available. and to ask relatives for help when they have problems. Older black people, however, are more likely than their white counterparts to ask friends more frequently for help. Using regression models and adjusting for age, sex, education and marital status, the results provide qualified support for a buffering hypothesis. Asking family and friends for help does modify the relationship between financial concerns and psychological distress among older adults. Friends are an important resource for coping with financial concerns among older blacks, and relatives are an important resource for coping with financial concerns among older, low-income whites. Finally, there is no evidence for a buffering hypothesis of calling on family or friends for help among older. high-income whites. These findings illustrate the need to examine the buffering effects of specific sources of support in relation to specific sources of stress, and the need to examine how race and socioeconomic status shape these relationships.

Informal Home Care for Frail Black Elderly

Inadequate financial resources to cover the cost of long-term care services is common among chronically disabled elderly. For many elderly, particularly Blacks, family caregivers are the primary source of long-term care, including medical services and all types of informal assistance. Using national data from Mathematica Policy Researchers' National Long Term Care Demonstration Project, this article identifies descriptive and unique characteristics of informal caregivers to the frail Black elderly. The analysis indicates a fundamental role of nonimmediate family members in the care of Black elderly. The employment status, living arrangements, education, and marital status of the caregiver, as well as the disability level of the elderly care recipient are key factors that influence the number of hours of informal care provided. Extensive hours spent in providing informal care are associated with a reduction in leisure time and physical and emotional strain for caregivers. The article concludes with policy suggestions pertaining to the use of consistent definitions of family by policymakers and the population they desire to serve, equitable tax policy, and family leave policy.

Difference by Race in Long-Term Care Plans

The underrepresentation of African American elders in institutional care is attributed to their greater desire for family care compared to Whites. Data from in-home interviews with 604 African Americans and Whites aged 65 and older are used to explore whether differences by race in long-term care plans substantiate this claim. Contrary to expectations, African American elders were more likely than Whites to have made long-term care plans and to include institutional as well as family care in their plans. Multivariate findings were that African American elders with more education were more likely than others to have made long-term care plans and educational attainment predicted plans for institutional care. Findings suggest that long-term care decision making is likely idiosyncratic rather than the result of careful consideration of care options in light of impending long-term care needs.

Perceived Support, Help Seeking, and Adaptation to Stress among Older Black and White Women Living Alone

This research tested two models of stress buffering to examine how older women living alone adapted to the stresses in their daily lives. No support was found for the suppressor model, but some support for the moderator model of stress buffering. Both perceived support and enacted support moderated the effect of stressors for psychological distress. Confidants were an important source of support for these older women. Both the perception that a friend was available with whom they could discuss their problems and the frequency of confiding moderated the negative impact of stress for psychological distress. Although confidants were a significant source of support for both Black and White women, support from relatives and friends moderated the effect of stressors only for Black women. Black women experienced greater economic hardship and more functional limitations than White women, but they draw on multiple sources of support to adapt to those stressors.

Predictors of Social Isolation in Older Southern Adults: A Cross-Racial Analysis

Using data collected from a sample of older Mississippians, we examine whether race has a modifying effect on the predictors of three underlying dimensions of social isolation: interaction with relatives, feelings of loneliness, and interaction with friends and neighbors. The study shows similarities and differences between black and white respondents regarding those factors predictive of social isolation within each subgroup. These findings are helpful in developing profiles to describe those older blacks and whites who may be at greatest risk of experiencing social isolation.

Correlates of Social Function: A Comparison of a Black and a White Sample of Older Persons in Los Angeles

This study compares social functioning between one Black (n = 560) and one White (n = 1350) urban, community-based sample of older persons in Los Angeles. A 3-item social function scale that assessed visiting with family and friends, participating in community activities, and taking care of other people was administered; the instrument also assessed basic activities of daily living (BADL) and intermediate activities of daily living (IADL). In multivariate analysis, social function was substantially higher for Blacks than for Whites, although BADL and IADL scores were somewhat lower for Blacks. BADLs, IADLs, being male, and being married were positively associated with social function among Blacks; IADLs, owning a home, and history of falls were negatively associated with social function among Whites. The high social function of Blacks, despite more physical limitations, suggests that even physically impaired Black older persons in the South Central Los Angeles community may remain actively involved in the family and community.

Limit of support and reaction to illness: An exploration of black elders' pathways to long-term care settings

This paper explores the differences between apparently similary impaired black elders who either were placed in nursing homes or received in-home services. The two groups differed most consistently in how they talked about the progression of their illness and how they described their reaction to it. Home care clients had experienced illness for a long time; they struggled for independence and were determined to define themselves as competent. In contrast, nursing home residents portrayed themselves as having been toppled by a health crisis; they defined themselves as incompetent and accepted others' definition of them as incompetent. The two groups also differed in the limit of their informal support. It is suggested here that the concept of the limit of support adds a useful dimension for exploring the relationship between institutionalization and informal support. It is also suggested that the participants' perception of their functional status and of their informal support was influenced by their health histories.

Correlates of Emotional Support and Negative Interaction Among African Americans and Caribbean Blacks

This study explores the relationship of family and demographic factors to the frequency of receiving emotional support and the frequency of engaging in negative interactions with family members (i.e., criticism, burden, and being taken advantage of). The study uses the ambivalence framework and data from the National Survey of American Life, a national sample of African Americans and Caribbean Blacks (Caribbean Blacks). Overall, no significant differences were found between African Americans and Caribbean Blacks in the frequency of emotional support or negative interaction; several significant correlates (e.g., age, family closeness) were found for both groups. However, a number of unique associations were also demonstrated (e.g., marital status, frequency of family contact), indicating differences in the ways that these variables operate within the two populations. These and other findings are discussed in relation to the ambivalence framework and subgroup differences in family phenomena within the Black population.

What do network members know? Network members as reporters of depression among Caucasian-American and African-American older women

OBJECTIVE

To determine whether family members and friends can be accurate reporters of depression in older women and whether their reports predict diagnostic depression concurrently and across a one-year time interval.

METHOD

African-American and Caucasian older women (N = 153; mean age = 75) previously screened for depression nominated network members (NMs) who could be contacted as informants. NMs completed an informant version of the CES-D, described their closeness to the participant, the extent of the participant's support from family and friends, and their assessment of the participant's typical coping strategies. These reports were then used to predict participant CES-D, Hamilton depression scores, and Structured Clinical Interview (SCID) depression diagnoses concurrently and at six-month and one-year intervals.

RESULTS

NMs' estimates of participants CES-D status were highly correlated with participants own CES-D scores, and also predicted Hamilton depression scores and SCID diagnoses concurrently and at six months and one year later. NMs' ratings of participants' use of positive coping also predicted depression at six months and one year.

CONCLUSION

NMs knew when elderly women were depressed and their reports were accurate predictors of depression even one year later, which implies that elderly depression does not abate spontaneously. Future research should test the possibility that family and friends might be recruited as allies in encouraging earlier treatment and in providing support to older adults through difficult life transitions.

Are social relationships a healthy influence on obesogenic behaviors among racially/ethnically diverse and socio-economically disadvantaged residents?

OBJECTIVE

To examine associations between social support and ties (family, friend, and neighbors) individually and jointly with diet and physical activity among an ethnically-diverse, low-income population.

METHODS

The Health in Common study (2005-2009) was designed to examine risk factors among individuals residing in low-income housing in the Boston, MA area. Cross-sectional surveys (n = 828) were administered in residents' homes. Linear/logistic multivariable analyses were employed with clustering of individuals within housing sites controlled as a random effect.

RESULTS

In multivariable analyses, total social support was significantly associated with higher red meat consumption per day (p = 0.029). Having more friends was significantly associated with more daily fruit and vegetable intake (p = 0.007) and higher levels of daily vigorous physical activity (p = 0.011). Those who reported having a greater number of family ties also reported higher daily consumption of sugary drinks (p = 0.013) and fast food (p = 0.011). More neighbor social ties were associated with more fast food per day (p = 0.024).

CONCLUSIONS

Social relationships can have both positive and negative associations with health behaviors. Understanding these relationships could help to inform the design of interventions that promote healthy behavior change among vulnerable populations.

Likelihood of African American Primary Caregivers and Care Recipients Receiving Assistance From Secondary Caregivers: A Rural-Urban Comparison

We examine rural-urban differences in reliance on secondary caregivers for African American female primary caregivers (250 rural, 242 urban) and their care recipients. Logistic regression was used to identify caregiver and care recipient characteristics significantly associated with the likelihood of having a secondary caregiver within rural and urban samples. Post hoc Wald chi-square tests were used to identify significant between-sample differences in regression coefficients. Secondary caregivers were more common in urban than rural contexts. Having a secondary caregiver was more strongly related to primary caregivers' poorer physical health and nonresidence with care recipients in rural than urban contexts. Findings suggest that policy initiatives, such as the National Family Caregivers Support Act and the cash and counseling model, may benefit rural and urban residents, particularly rural residents as the majority of them lacked secondary caregiver assistance.

Patient satisfaction: African American women's views of the patient-doctor relationship

African American women are less likely than other groups of women to use health care services despite an equal or greater need. In particular, they may rely more frequently on informal sources of health care advice, such as family members and/or social support networks. Very little is known about how African American women view the health care system because few studies have investigated the impact of race and gender on patient satisfaction. To address this gap, we analyzed transcripts of focus groups conducted with African American women about their attitudes toward health care, especially their expectations and experiences of the doctor-patient relationship. African American (AA) women in this study reported preferences for doctors who did not rush them through their appointments, who explained what was happening during the examination, who respected their need for self-determination, and who had a holistic focus on the patient. During this period of rapid change in the health care system, such information about how individuals of diverse backgrounds perceive the health care system is critical to ensure broad access and reduce disparities in utilization.

Mosaic of difference: enhancing culturally competent aging-related knowledge among social workers

The professional literature has not adequately addressed the behavioral and social factors that contribute to different coping outcomes for African American elder caregivers as compared to non African Americans. Awareness and understanding of these unique experiences would better prepare professionals to work with such clients. This study examines the predictors of emotional distress among 46 African American women who provide care to dependent elderly parents. Multivariate statistical analyses show that elder caregivers' rating of quality of life, their years of caregiving, as well are their poor heath constitute significant predictors of risk for depression. The results of the study provide support for the inclusion of more culturally appropriate measures of caregiver distress, and provide insights to inform social work practice, policy and research concerning African American female elder caregivers in the 21st century.

Home- and Community-Based Service Use by Older African American, Hispanic, and Non-Hispanic White Women and Men

This study examined associations between use of home- and community-based services and race, ethnicity, and gender. Using the 1994 Second Longitudinal Study of Aging (n = 9,447) and descriptive, standard logistic, and multinomial logistic analyses, both the likelihood of service use and intensity of use were examined for nine home- and community-based services. In descriptive analyses, African Americans used the largest number of services, followed by Hispanics, and non-Hispanic whites. In multivariate results, all compared with non-Hispanic white women, African American women had higher odds of using Personal Care Aides, Transportation, Adult Day Centers, and Information and Referral. Hispanic women had higher odds of using Adult Day Centers and Transportation services. Non-Hispanic white men were less likely to use Personal Care Aides, Senior Centers, and Transportation. In the intensity analysis, compared with non-Hispanic white women, African American women used services more intensively. Non-Hispanic white men used services less intensively. Results highlight the need for flexibility in services provision, and a continued emphasis on supporting a range of services.

Racial Differences in Formal Long-Term Care: Does the Timing of Parenthood Play a Role?

OBJECTIVE

This article examines the association between race and the timing of formal long-term care (LTC) service use, both institutional and community based. It seeks to understand whether early parenthood predicts the timing of LTC use later in life and whether it in turn mediates the association between race and LTC use. In particular, it explores whether the lower rate of formal LTC use among African Americans is due in some part to the earlier inception of parenthood.

METHODS

Linking measures from the 1989 National Long-Term Care Survey with Medicare claims (1989-1993), we model age at first use of institutional (skilled nursing facility) care and home health as competing risks using a Cox proportional hazards model.

RESULT

Early parenthood accelerates first use of home health for Whites but delays first use for Blacks. The likelihood of any LTC use by race group converges as timing of parenthood increases.

DISCUSSION

Differential effects of teen childbearing across race groups indicate differential vulnerability to LTC needs among early parents.

Involving rural, older African Americans and their female informal caregivers in research

OBJECTIVE

This article presents the methodology, procedures, and results for involving rural, older African Americans and recruiting their female informal caregivers for a well-being and service use study.

METHODS

Using a list of 1,994 Medicare enrollees, this study adapted a reversed screening telephone methodology tested on urban African American elders and their caregivers. It used trained screeners, local African American female interviewers, and a mixed-mode procedure (i.e., telephone and canvassing) to screen elders and recruit caregivers.

RESULTS

Adequate information for 1,547 listings allowed screeners to contact qualified elders meeting the study criteria. Using chi-square analysis, significant differences were found between telephone and canvassing screening methods on nonreferral cases and referral cases. Elders or a proxy referred 286 caregivers. Interviewers obtained 265 of 300 proposed caregiver interviews.

DISCUSSION

Knowledge about the involvement of rural, older African Americans and recruitment of their female informal caregivers in research is essential to understanding recruitment successes and pitfalls in ethnic minority research.

Caring too much? Cultural lag in African Americans' perceptions of filial responsibilities

This paper explores African Americans' ideas about filial obligations. The findings are based on focus groups with eight different age-homogeneous groups. Although all age groups expressed strong commitment to filial obligations, they differed in their ability to recognize and accept constraints on family care. This variation was clearly related to cohort differences and participants' own experiences as caregivers or care receivers. Viewing our data through the lens of Clark and Anderson's (1965) adaptation model that distinguishes between adaptation, which is always positive, and adjustment, which may be negative, we found that younger cohorts' unbending idealism may lead to maladaptive behaviors should they be called upon suddenly and without preparation to assume the role of primary caregivers.

Correlates of emotional support and negative interaction among older Black Americans

OBJECTIVES

The study investigates the social and demographic, personality and social contact correlates of emotional support and negative interaction among older Black Americans.

METHODS

The present analyses are based on the responses of 519 older African American respondents (55-96 years old) from the Americans' Changing Lives Survey. Structural equation modeling (e.g., LISREL) was used to estimate the direct and indirect effects of sociodemographic variables (i.e., age, gender, education, income, marital status, and presence of children), social contact factors (i.e., frequency of face-to-face and telephone contact), and personality (i.e., extraversion and neuroticism) on emotional support and negative interaction with relatives and friends.

RESULTS

Gender, marital status, and extraversion were significantly associated with emotional support. Age, education, marital status, having a child, and neuroticism were identified as correlates of negative interaction.

DISCUSSION

The majority of older Black adults in this sample participated in emotionally supportive relations with relatives and friends, whereas negative social interactions were reported with less frequency. The distinctive group of predictors explaining emotional support and negative interaction suggests that they are different social occurrences. This analysis particularly underscores the role of personality factors in these processes.

Do age differences in close and problematic family ties reflect the pool of available relatives?

Older adults consistently report having fewer close and fewer problematic social ties than do younger adults. Yet, prior studies have not explicitly examined associations between the availability of living relatives and the nature of family ties in later life. One hundred sixty-four individuals ages 13 to 99 described their networks of close and problematic social ties. Then they provided information about specific living relatives (e.g., spouse, mother, father, sons, daughters, siblings, grandparents, and grandchildren). Older individuals reported more living relatives than did adolescents or young adults. Although individuals of all ages tended to name the majority of living relatives as close social contacts, most adults did not name all available relatives as close contacts. Age differences emerged with regard to naming relatives as problematic social ties. Older adults were less likely to indicate that their relatives caused problems. Findings are discussed in terms of an extension of investment theory, the availability hypothesis, which suggests that individuals with few living relatives are likely to view more of these relatives as close ties and fewer of these relatives as problematic.

Religion and health: public health research and practice

Research examining the relationships between religion and the health of individuals and populations has become increasingly visible in the social, behavioral, and health sciences. Systematic programs of research investigate religious phenomena within the context of coherent theoretical and conceptual frameworks that describe the causes and consequences of religious involvement for health outcomes. Recent research has validated the multidimensional aspects of religious involvement and investigated how religious factors operate through various biobehavioral and psychosocial constructs to affect health status through proposed mechanisms that link religion and health. Methodological and analytical advances in the field permit the development of more complex models of religion's effects, in keeping with proposed theoretical explanations. Investigations of religion and health have ethical and practical implications that should be addressed by the lay public, health professionals, the research community, and the clergy. Future research directions point to promising new areas of investigation that could bridge the constructs of religion and health.

The contribution of hope to the quality of life among aging African Americans: 1980-1992

This study examined age differences between 1979-80 and 1992 in the quality of life of African Americans using panel data from the National Survey of Black Americans. Of particular interest was the role of the hope dimension of personal efficacy in accounting for variance in general well-being, beyond that contributed by social demographic and economic indicators. Hierarchical regression analyses revealed that hope and family satisfaction in 1980 consistently accounted for significant amounts of variance in general life satisfaction in the 1992 fourth wave of data among all three cohorts. For older respondents, increased frequency of contact with friends and family help were the most important contributors to high satisfaction. Across waves in all age cohorts family satisfaction and contact with friends were most important in contributing to life satisfaction. Implications for further research on well-being among African Americans were discussed.

Social support for spouse caregivers of persons with dementia

OBJECTIVES

This study analyzes the value of simultaneously taking helper and caregiver characteristics into account when examining social support received by spouse caregivers of persons with dementia. This study questions whether sources and types of received support vary by the gender and relationship of the helper and/or by the caregiver's race and gender.

METHODS

Drawing on a sample of 210 spouse caregivers of persons with dementia, the Generalized Estimating Equation (GEE) method was used to estimate a population-average logistic regression model to address cross-level helper and caregiver interactions.

RESULTS

Results indicate that helper and caregiver characteristics interact in complex ways. White male caregivers are more likely to receive emotional support from adult children and to receive practical assistance from formal sources compared with other types of support and to other race-gender caregiver groups.

DISCUSSION

Description of social status characteristics of caregivers as determinants of their social network may be less fruitful in understanding the benefits of social support than a focus on which helpers assist with what kinds of task for which groups of caregivers.

Effects of caregiving, gender, and race on the health, mutuality, and social supports of older couples

OBJECTIVES

The purpose of this article is to report caregiving, gender, and race effects on the physical health, social supports, and mutuality of older couples.

METHODS

The study involves cross-sectional results from a longitudinal study of 234 older couples, 118 in caregiving situations and 116 comparison couples. Spouses were interviewed in their homes.

RESULTS

Spousal older caregivers are in poorer physical health than noncaregivers but have no greater numbers of social supports to help them in the caregiving role. Also, African Americans are in poorer physical health than Caucasians; yet, as caregivers, they have no greater numbers of social supports than Caucasian caregivers. Although females have more social supports than males, female caregivers have more negative feelings about their husbands than male caregivers have about their wives.

DISCUSSION

Males and African Americans are in potentially more severe caregiving situations than their female and Caucasian counterparts. Results of this study are compared to Wallsten (1999), which found that African Americans and males had more favorable psychological indicators of stress. The two studies complement each other but open the question of response bias as a factor.

The relationship between perceptions of social support and adherence to dietary recommendations among African-American elders with hypertension

Social support is generally thought to facilitate adherence to recommended treatment regimens. Despite a well-documented tradition of social support among African Americans, much of the existing research indicates a very limited level of adherence, especially to dietary modification. To account for this seeming contradiction, forty-one rural-dwelling African Americans with hypertension age 65+ participated in a series of structured and semi-structured interviews. Results indicate that 1) informants perceived themselves to be well-supported by family and friends; 2) most informants have achieved a moderate to high level of dietary adherence; and 3) no statistically significant relationship existed between perceived social support and dietary adherence. The discussion focuses on three reasons for this lack of association, including: 1) modest sample size; 2) informants' identification of helpful others who defied standard evaluations of support; and 3) incremental and gradual dietary changes that required little need for social support.

The menopausal experience of African American women: overview and suggestions for research

Menopause and its effects on women's health status and needs have only recently received the increased attention of scholars and clinicians that many feel is long overdue. However, one major area of neglect that continues today regards the climacteric in minority populations within the United States, including the largest minority group, African Americans. This review summarizes issues that have potentially limited the amount of information available regarding menopause in African Americans. These issues include differing perspectives on the climacteric within research and clinical arenas, the difficulty of studying race as a variable in scholarly investigations, and methodological factors that have led to underrepresentation of minorities in studies of menopause. General considerations, as well as specific suggestions, for research questions when investigating the climacteric experiences of African American women are offered.

Deterrents to access and service for blacks and Hispanics: the Medicare Hospice Benefit, healthcare utilization, and cultural barriers

The Medicare Hospice Benefit may limit access for Blacks and Hispanics because of its requirement of continuity of care, entailing the availability of a primary caregiver. The literature on utilization of healthcare services by Blacks and Hispanics shows these groups were likely to receive too little care, too late. Kalish and Reynolds' (1976) research on attitudes of Blacks, Mexican-Americans, and Whites toward dying shows cultural differences that could affect acceptance of hospice philosophy. In other research reviewed in this paper distrust of White service providers was a significant cultural barrier for Blacks in using health services. Lack of familiarity with the health care system and language barriers were barriers most often for Hispanics. Black caregivers are more likely than Whites to have dying persons living with them, to be extended family members or nonrelated, and to be more limited in their ability to provide caregiving support because of a lack of economic resources. Hispanics appear to have a circumscribed support system, narrowly defined by blood kinship, with females as the expected caregivers.

A research review: family caregivers of chronically ill African-American elderly

1. The African-American elderly population continues to have higher incidence of specific chronic illnesses. 2. The African-American caregiver plays an integral part in maintaining the chronically ill elderly in the home setting. 3. Available research has indicated important differences in how African-Americans cope with caregiving that may assist the nurse in better understanding of these caregiving families. 4. As a result of limited research, African-American caregivers are a rich, largely untapped resource that deserves careful study toward improved elderly care.