Sense of Filial Obligation and Caregiving Burdens Among Chinese Immigrants in the United States

Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App

BACKGROUND

Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials.

OBJECTIVE

This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs.

METHODS

Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases.

FINDINGS

Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens.

DISCUSSION

The co-design process appears to be beneficial in having participants voice both barriers and preferences.

Loneliness, Spirituality, and Health-Related Quality of Life in Hispanic English-Speaking Cancer Caregivers: A Qualitative Approach

Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.

Caring From a Distance: Experiences of Polish Immigrants in the United States Providing Care to Parents With Dementia Overseas

OBJECTIVES

Aging populations and an increasing number of immigrants in recent years have led to numerous changes in intergenerational relationships. Although many studies have investigated the impact of providing care to a parent with dementia, little is known about the impact of caregiving activities provided from a distance, such as in the case of immigration, and over a long period of time to a person with dementia. Our understanding of how transnational caregiving for a person with dementia affects relationships is also limited. Using the Intergenerational Solidarity Theory as a theoretical framework, this paper examines the experiences of adult children and immigrant caregivers of a parent with dementia living in Poland.

METHODS

A qualitative, semistructured interview was conducted with 37 caregivers living in the United States while providing transnational care to a parent with Alzheimer's disease or other forms of dementia. The data analysis was based on the thematic analysis strategy.

RESULTS

Four themes were identified: (1) filial obligations and solidarity, (2) caregivers' contradictory emotions regarding transnational care, (3) financial and emotional exhaustion, and (4) challenges of nursing home dilemmas.

DISCUSSION

Transnational caregivers represent a unique group who face distinctive challenges related to competing demands and limited resources. This study contributes to a better understanding of their experiences whereas the findings highlight the importance of addressing the mental and physical well-being of immigrant caregivers of individuals with dementia and have important implications for health care professionals and immigration policies. Implications for future research were also identified.

Understanding the caregiving experiences of Asian Indian, Chinese, Korean, and Vietnamese American family care partners of persons living with dementia

OBJECTIVES

Disparities impacting dementia health care exist in racial/ethnic minority groups, including Asian Americans, an understudied population in Alzheimer's disease and related dementias. The qualitative study explored caregiving experiences and potential cultural influences among Asian Indian, Chinese, Korean, and Vietnamese family care partners of persons living with dementia.

METHODS

We conducted focus groups and individual interviews with 32 care partners from these four Asian subgroups using Zoom, WeChat, or telephone.

RESULTS

Four themes emerged from the data: (1) Family obligations influencing caregiving decisions; (2) Evolving challenges related to dementia caregiving; (3) Caregiving burdens/negative impacts from caregiving (relationship burdens and emotional distress); and (4) Coping with their situation in their own ways (cognitive, behavioral, and social strategies).Conclusion: Cultural values (e.g. familism or filial piety) played a significant role in caregiving decisions and experiences. There was a need to raise public awareness of dementia and create culturally and linguistically appropriate training programs for this population.

Emotional Coping Strategies for Informal Caregivers of Hospitalized Patients: A Study of Distress and Overload

Purpose

Informal caregivers constitute a vulnerable population group that has forsaken their activities and life projects with the sole purpose of caring for a dependent individual without receiving any form of compensation in return. Emotionally, this population has been neglected by both the state and family members, exacerbating distress levels among them. The objective is to analyze the impact of emotional coping strategies on the experiences of distress and emotional burden among adult informal caregivers tending to hospitalized individuals.

Sample and Methods

The role of emotional coping strategies in caregiver burden and psychological distress was examined in 460 informal adult caregivers from Guayaquil, Ecuador, who participated in an online survey. The instruments used included the Depression, Anxiety, and Stress Scale (DASS 21), the Zarit Burden Inventory (ZBI), and the Emotional Coping Questionnaire (Cuestionario de Afrontamiento Emocional). The analysis involved a multiple regression to iteratively select variables, aiming to build a simpler and more explanatory model.

Results

Employing multiple regression analysis with a stepwise model selection procedure, it was found that 16.5% of the variance in depression, 19.5% of the variance in anxiety, 19.8% of the variance in stress, and 32% of the variance in burden were predicted by specific coping strategies. Additionally, the impact of burden was estimated by the participants' gender, with greater burden observed among males due to societal role expectations.

Conclusion

This study underscores the importance of emotional coping in the experience of informal caregivers and suggests that psychological interventions should focus on developing adaptive strategies to manage the stress and emotional burden associated with caregiving.

Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis

BACKGROUND

The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs.

PURPOSE

To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework.

METHODS

A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis.

FINDINGS

Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity.

CONCLUSION

Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.

The enrichment process for family caregivers of persons living with dementia: A grounded theory approach

AIM

Many persons living with dementia (PLWD) reside in the community and are cared for by family members. The aim of this qualitative study was to gain an understanding the enrichment process for family caregivers of PLWD in Taiwan.

DESIGN

A grounded theory approach with face-to-face semi-structured interviews was conducted with family caregivers of PLWD in Taiwan.

METHODS

Interview data from 30 family caregivers of PLWD recruited from dementia clinics or support groups in Taiwan were obtained from the first wave of a larger study conducted from January 2018 to September 2021. Glaser's grounded theory approach with theoretical sampling was used to understand the enrichment process of family caregivers of PLWD.

RESULTS

Analysis indicated the core category that characterized the process of enrichment was 'holding together'. Caregivers were able to maintain their connection to the person with dementia through activities that deepened their relationship and strengthened their bond. 'Holding together' included four components: maintaining continuity, creative interactions, interacting with humour and sharing pleasurable activities. Through these components, family caregivers generated positive interactions and relationships with the person living with dementia and sustained their motivation for caregiving. Three modifying elements facilitated or impeded the process of holding together: 'previous daily interactions', 'caregiving beliefs' and 'filial piety'.

CONCLUSION

Through the enrichment process of 'holding together', family caregivers used different strategies to conduct pleasurable and meaningful activities with the person living with dementia to maintain and improve their relationship and enhance their happiness in life.

IMPACT

To facilitate the enrichment process, health care providers should encourage activities between family caregivers and PLWD that promote continuity, increase interactions, provide humour and foster pleasurable activities.

REPORTING METHOD

This study adhered to the COREQ guideline checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries: a systematic review and meta-synthesis

BACKGROUND

The cultural and religious beliefs and values of family caregivers of people with dementia have a profound impact on the use of dementia care services in high-income countries. Yet, little is known about how caregivers of people with dementia from a Muslim migrant background in high-income countries perceive their caregiving journey.

AIM

To synthesise findings from rigorous qualitative studies on the experiences of family caregivers of people with dementia from a Muslim migrant background in high-income countries.

METHODS

Meta-ethnography of qualitative studies was applied to address the aim. Five databases including MEDLINE, CINHAL, PsycINFO, Web of Science and Scopus were searched. Inclusion criteria were qualitative or mixed study design studies on family caregivers of people with dementia from a Muslim migrant background in a home care setting in high-income countries. Studies were excluded if they used a quantitative research design, were not written in English and were not original studies.

FINDINGS

In total 17 articles met the inclusion criteria and were included in the study. Meta-synthesis of the data revealed three themes from the life course intersectionality perspective: caregiving as both positive and negative experiences; factors affecting caregivers' experiences; and coping strategies used by caregivers.

CONCLUSION

Caregivers of people with dementia from a Muslim migrant background living in high-income countries have both positive and negative caregiving experiences. However, dementia care services were not tailored to address their care needs and expectations arising from their religious and cultural beliefs.

Cultural Diversity Impacts Caregiving Experiences: A Comprehensive Exploration of Differences in Caregiver Burdens, Needs, and Outcomes

Background Many Americans are informal caregivers providing unpaid care for their loved ones living with chronic conditions, such as dementia and heart failure. As the US population continues to age and live longer with more complex chronic conditions, informal caregivers play an increasingly important role in the care of older adults with functional impairment and multiple comorbidities. Caregivers face many challenges in managing the health of themselves and their loved ones, including physical, emotional, and financial burdens, which may potentially vary by race and ethnicity. Therefore, it is critical to develop culturally tailored solutions, such as smart technology, aimed at improving the quality of life of informal caregivers and care recipients from diverse backgrounds. Methods Data were collected from a convenient sample of 69 informal caregivers in Texas who were members or volunteers for either the International Buddhist Progress Society-Dallas (IBPS Dallas) or University of Texas Medical Branch (UTMB). Caregivers answered questions about their caregiving experiences, including the type of care they provided, challenges they faced, and lessons learned. Responses were stratified by race/ethnicity (White, Hispanic, or Asian American) to assess for potential cultural differences in caregiving experiences. A chi-squared test and one-way analysis of variance (ANOVA) were conducted. Results White, Hispanic, and Asian American caregivers all reported high non-medical related needs. White, Hispanic, and Asian American care recipients all had a high degree of neurological disease and functional impairment. White and Hispanic caregivers were also more likely to offer emotional support (p=0.007) and financial support (p=0.025) than Asian American caregivers. Asian American caregivers reported greater worry about the health-related knowledge of their family members (p=0.040) than White and Hispanic caregivers. Hispanic (18.8%) and Asian American caregivers (12.5%) reported the least knowledge of caregiving-related government policies than White caregivers (43.2%) (p=0.025). Hispanic (18.8%) and Asian American caregivers (18.8%) also reported the least knowledge of available support programs and services for care recipients (p=0.001). Conclusions White, Hispanic, and Asian American informal caregivers vary in their types of worries, care provided, and challenges faced. Our study found that Asian American caregivers reported greater worry about the health-related knowledge of their family members than White and Hispanic caregivers. White caregivers were better at navigating government resources and caregiver support programs than Hispanic and Asian American caregivers. While race and ethnicity are potential factors for these observed differences, several other factors may have played a role, including age, gender, income, education, patient diagnosis, and disease severity. Future research should consider these factors and evaluate a larger and more diverse sample for more definitive racial and ethnic comparisons. Understanding disparities in caregiving experiences is a critical initial step to developing culturally appropriate interventions to reduce caregiving burden and promote the health and well-being of both patients and their informal caregivers from diverse backgrounds.

Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore

INTRODUCTION

Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore.

METHOD

Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized.

RESULTS

Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play.

DISCUSSION

Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.

Of duty and diaspora: (Re)negotiating the intergenerational contract in South Asian Muslim families

In recent years, there has been exponential growth in the South Asian Muslim population in the United States. This demographic trend, along with a rapidly aging North American population, implies that very soon, a significant proportion of U.S. adults 65 years and older will identify as South Asian Muslim. Moreover, more than one-half of Muslims (57%) live in a multi-person/multi-generation household where all members identify as Muslim. Despite this evidence, limited research exists on the dynamics of multigenerational living in aging South Asian Muslim households, particularly around intergenerational support exchanges and the nature and strength of affectual bonds between generations. Additionally, research suggests that espoused within internalized cultural norms around filial obligation and duty, kinwork in South Asian families remains highly gendered. Less is known, however, about the gendered nature of kinwork in immigrant South Asian Muslim families. Based on 30 in-depth narrative interviews with three generations of South Asian Muslim women living in the U.S., this paper addresses these gaps, specifically focusing on intersections of faith, culture, gender, age, immigrant status, and age at migration. The findings from this study point to a renegotiation of the intergenerational contract, wherein care and support for a parent or grandparent were understood and enacted within the framework of an overarching Muslim identity, while simultaneously, for their older relatives, it was reinterpreted within shifting local and global realities such as the increasing participation of the middle generation, the daughters and daughters-in-law, in the paid workforce. In addition to providing insights into ethnic and religious-oriented experiences of aging and care, these findings may help inform policymakers and stakeholders (e.g., community service providers and faith leaders such as imams of mosques, researchers, and family members) in culturally congruent ways to support the health and well-being of aging South Asian Muslim families.

Diverse demands and resources among racially/ethnically diverse caregivers

OBJECTIVES

The family caregiver population in the US is growing in conjunction with greater numbers of older adults with serious illness and complex care needs, and is becoming increasingly diverse. This study described and compared resources, demands, and health outcomes among diverse family caregivers by race/ethnicity.

DESIGN

This study was a cross-sectional secondary analysis of nationally representative data collected for Black/African-American, Asian American & Pacific Islander, Latino/Hispanic and non-Latino/Hispanic white caregivers (n = 2,010) in the Home Alone Revisited Study. We described available resources (e.g. income, paid help, social support) and demands (e.g. medical/nursing task performance) by racial/ethnic group. Using survey-weighted logistic regression, we examined relationships of resources and demands with caregiver outcomes (i.e. heath status; strain; depressive symptoms) by race-ethnicity controlling for socio-demographic variables.

RESULTS

Distribution of resources and demands was similar by race/ethnicity, except for higher income for non-Latino/Hispanic white caregivers. Nearly half assisted with personal care (47.5%) or medical/nursing tasks (49.7%). Higher social support and satisfaction with social relationships was associated with positive health outcomes regardless of race/ethnicity, while income was consistently associated with positive health outcomes only for non-Latino/Hispanic white caregivers. Medical/nursing task performance was significantly associated with negative health outcomes for Asian American & Pacific Islanders in multivariable models.

DISCUSSION

Many caregiving demands and tasks are similar by race/ethnicity and represent considerable investment of time, energy and care. Differences in the effects of resources and demands by race/ethnicity should be explored in future research as they may have implications for assessment and planning of culturally and linguistically appropriate interventions.

Physical limitations and loneliness: The role of guilt related to self-perception as a burden

BACKGROUND

Limitations in performing physical activities have been associated with greater loneliness in older adults. This association could be moderated by maladaptive social cognition or feelings, such as guilt related to perceiving oneself as a burden. This study analyzes the effect of guilt related to self-perception as a burden on the relationship between physical limitations and loneliness in older adults.

METHODS

Participants were 190 community-dwelling people aged over 60 years who did not show cognitive or functional limitations in daily life activities. We used linear regression to test the influence of guilt related to self-perception as a burden on the association between physical limitations and loneliness.

RESULTS

The interaction between physical limitations and guilt related to self-perception as a burden was found to be significant in the explanation of loneliness, explaining 18.10% of the variance. Specifically, the relationship between physical limitations and loneliness was stronger when levels of guilt related to self-perception as a burden were high or medium than when these levels were low.

CONCLUSIONS

The findings suggest that feelings of loneliness are more frequent in people who report more physical limitations and, at the same time, report guilt for perceiving themselves as a burden. Guilt related to perceiving oneself as a burden seems to be a relevant modulator variable for understanding the effects of physical limitations on loneliness.

'24/7' Caregiving: A Qualitative Analysis of an Emerging Phenomenon of Interest in Caregiving

The COVID-19 pandemic has exacerbated the difficulties faced by caregivers who have to provide continuous '24/7' care to persons with dementia with minimal formal and informal support. While caregivers have reported heightened levels of caregiving distress and burden during the pandemic, there remains a dearth of research pertaining to their lived experiences of providing continuous care with little respite and the corresponding physical, psychosocial and emotional impacts of caregiving '24/7'. The present study uses data obtained from interviews with dementia caregivers (N = seven) that were collected as part of a larger study on Carer Matters, a hospital-based holistic caregiver support program held during COVID-19, to conduct a secondary thematic analysis. The findings revealed three themes that defined the shared experiences of '24/7' caregivers: (1) A World Overturned, which refers to the increase in caregiving intensity and burden due to the pandemic; (2) Burning on Both Ends, which refers to the impossible balance between caregiving and their personal lives; and (3) At Wits' End, which refers to an overwhelming sense of hopelessness and helplessness over their caregiving situation. These findings highlight the challenges and unsustainability of '24/7' caregiving and the detrimental impact that round-the-clock care wields on caregivers' physical and mental well-being. Implications and recommendations are discussed in accordance with the cultural particularities of the study's Asian context (Singapore), with calls for greater caregiver support to be better integrated into society and the community, especially at the neighborhood and grassroots level, to alleviate caregiving burden and safeguard their well-being.

Understanding Challenges and Coping Strategies Experienced by Chinese American Family Caregivers of Persons with Dementia

The purpose of this study was to explore the caregiving experience of Chinese American family caregivers of persons with dementia with a focus on challenges and coping strategies. Using a qualitative study design, we conducted semi-structured interviews with 26 Chinese American family caregivers and analyzed the data using thematic analysis. We also identified their caregiving experience specific to the COVID-19 pandemic. First, four themes were discovered: (1) filial obligations, (2) preference for utilizing home- and community-based supports, (3) relying on primary care doctors, and (4) helping behaviors. Two additional COVID-19-related themes were identified: (1) social isolation and (2) perceived discrimination. We suggested interventions at the individual, community, and societal level not only to support various challenges experienced by this ethnic group but also to promote their coping strategies.

The Relationship Between Dual Filial Piety and Caregiver Burden Among Arab Family Caregivers in Israel

The current study examined the association between dual filial piety (FP) (reciprocal and authoritarian) and caregiver burden in adult children caregivers and attempted to understand the underlying mechanisms of these links. A cross-sectional study of 222 family caregivers of older relatives in an Arab community in Israel was performed. Data were collected via face-to-face interviews in Arabic using structured questionnaires. Bootstrapping with resampling strategies tested the multiple mediator model. Reciprocal and authoritarian components of FP were associated negatively with caregiver burden. The link with reciprocal FP was partially mediated by role engagement and relationship strain between caregiver and care recipient, whereas the link between authoritarian FP and caregiver burden was mediated by role engagement, but not by relationship strain between caregiver and care recipient. The study highlights the positive effect of cultural values (dual FP) and the underlying mechanisms working against the harmful effects of caregiving stressors in traditional societies, such as Arab-Israeli society. Practitioners should be sensitive to issues of family cultural values and family care among traditional populations. [Research in Gerontological Nursing, xx(x), xx-xx.].

Cultural adaptation of World Health Organization iSupport for Dementia program for Chinese-Australian caregivers

BACKGROUND

Home-based dementia care is common in the Chinese-Australian community. However, dementia education programs for Chinese-Australians in the language of their choice are scarce. The World Health Organization has developed iSupport for Dementia, an online education program for informal caregivers. Cultural adaptation of the program for Chinese-Australian caregivers is an opportunity to address this gap in caregiver support.

AIM

The aims of the study were (1) to understand stakeholders' perspectives on the cultural and linguistic appropriateness of the Chinese iSupport for Dementia content and design and (2) to explore factors affecting the future implementation of the Chinese iSupport program in Australia.

METHODS

A qualitative descriptive design was applied to address the aims of the study. Focus group discussions with Chinese-Australian caregivers and community aged care workers were conducted to collect data. Thematic analysis was used to analyse data.

RESULTS

In total, six focus groups were conducted with 18 Chinese-Australian caregivers and 17 care workers. Six themes were identified and described as follows: (1) appropriateness of the Chinese iSupport content; (2) acceptability of the online Chinese iSupport design; (3) motivations to engage in the iSupport program; (4) desire to interact with peers and professional facilitators; (5) concerns about program accessibility; and (6) the need to extend the iSupport program to care workers.

CONCLUSIONS

Engagement with Chinese-Australian caregivers and care workers will inform further revisions of the Chinese iSupport program contents to ensure the program is culturally congruent to Chinese-Australian caregivers. Factors affecting the implementation of the program identified in the study will be considered in the intervention phase of the program.

Care v. Caring: Obligation, Duty, and Love Among Latino Alzheimer's Family Caregivers

The number of Latinos living with Alzheimer's disease is projected to grow. Latinos currently make one-fifth of U.S. family caregivers. In this paper, we explore the cultural scripts and gendered practice of care in Latino families in relation to the underutilization of services to persons with Alzheimer's disease and related dementias. We conducted interviews with 24 Latino caregivers in Miami-Dade, Florida representing six Latin American countries of origin. Interviews were analyzed using a grounded theory approach. We critically examined the concept of familism in order to better understand in-depth experiences of diverse Latino caregivers and concluded that an ethics of care model better elucidates the complexities of the care experience. Our analysis illustrates the ambivalence, contradictions, and changes in the beliefs and practice of care. These findings can help advance understanding among researchers and providers to develop a formal support system that is responsive to Latino caregiver needs.

Association between sleep and quality of life in heart failure patient-caregiver dyads and mediation of fatigue: An actor-partner interdependence mediation model

AIMS

Quality of life is essential to heart failure patients and their family caregivers. This study aimed to examine the mediating role of fatigue in the association between sleep and quality of life in heart failure patient-caregiver dyads.

DESIGN

A cross-sectional descriptive study was conducted from November 2017 to August 2018.

METHODS

A total of 269 heart failure patient-caregiver dyads at two hospitals in China were included. The Chinese version of the Pittsburgh Sleep Quality Index, the Chalder Fatigue Scale and the 12-item Short-Form Health Survey were used to collect data on heart failure patients and their family caregivers. The structural equation model was employed in the dyadic analysis based on the actor-partner interdependence mediation model.

RESULTS

Regarding the actor effects, poor sleep was negatively associated with physical and mental quality of life in heart failure patients and their family caregivers, respectively, and the relationship was mediated by their fatigue. Regarding the partner effects, caregivers' fatigue was positively associated with patients' physical quality of life and mediated the association between caregivers' sleep and patients' physical quality of life.

CONCLUSIONS

Heart failure patients and their family caregivers experience reduced quality of life when they have poor sleep and fatigue, and caregivers' fatigue is related to patients' improved physical quality of life. Hence, dyadic interventions targeting to improving sleep and fatigue may be beneficial to their quality of life.

IMPACT

This study highlights the importance of routinely measuring and managing sleep and fatigue for heart failure patients and their family caregivers. Effective dyadic-based interventions that maintain equal attention to family caregivers should be considered by healthcare providers to maximize the improvement of patients' quality of life.

Four of a kind: Salient caregiver archetypes to better understand the psychosocial needs and behavioral patterns of dementia caregivers in Singapore

BACKGROUND

Family caregivers' lived experiences are often perceived as a homogenous entity, preventing effective identification of unique caregiving needs and appropriate support. Our study examined and classified the varying dementia caregiving experiences in an Asian setting, through establishing caregiver archetypes.

METHODS

Secondary analysis of semi-structured interviews conducted with 16 dementia family caregivers in a Singapore hospital was performed. Thematic analysis and typological analysis were utilized.

RESULTS

Four caregiver archetypes (Reluctant, Ambivalent, Enlightened, and Selfless) were identified: Reluctant caregivers possessed poor understanding of dementia and experienced immeasurable distress; Ambivalent caregivers carried mixed feelings towards caregiving and felt unsupported; Enlightened caregivers preserved care-recipients' dignity and accepted challenges with priority on sustainable care; Selfless caregivers were overly-devoted and enmeshed in the caregiver identity.

CONCLUSION

Our findings are useful in providing a framework for: (1) rapid understanding of informal caregivers' varying needs, (2) targeted support in a holistic caregiver-centered manner.

Dementia Family Caregiving in Rural Appalachia: A Sociocultural Model of Care Decisions and Service Use

OBJECTIVES

Examinations of cultural variations in caregiving experiences and practices tend to focus on racially and ethnically diverse family caregivers. We extended this research by exploring the role of place-based cultural constructs on care decisions of family caregivers for persons living with dementia in rural Appalachia whose experiences and backgrounds dwell outside the lines of dominant culture.

METHODS

Guided by our sociocultural conceptual model of service use and a descriptive qualitative study design, we conducted in-depth interviews with 30 caregivers for persons living with dementia to understand how predisposing and enabling factors influence caregiving decisions, including the use of services to care for persons living with dementia.

RESULTS

Three predisposing factors reflecting the culture of rural Appalachian counties in Virginia (reasons for becoming a caregiver, previous caregiving experience, and deference to the person living with dementia) shaped decisions about caregiving responsibilities and service use. Three place-based enabling factors (a personal sense of belonging, knowledge of services, and family support for service use) played an important role in facilitating access to services.

DISCUSSION

Findings revealed subtle variation across caregivers in this study and in comparison, to caregivers' experiences more generally. We interpret these variations in light of culturally influenced attitudes, family norms, and sources of information about formal services. Place-based cultural experience influenced dementia family caregivers' behaviors and choices regarding formal service use, suggesting that investigators should pay more attention to cultural influences in future caregiving research.

Societal Narratives on Caregivers in Asia

Although there has been an increase in awareness of the struggles experienced by caregivers, discourse on caregiving remains confined mostly to academia, policy circles or the family unit. There have been suggestions that public discourse on informal caregiving dwells overwhelmingly on the outsize toll it takes on the health of caregivers. However, few studies have examined societal narratives on caregivers-a gap our study aims to fill. We leveraged an online media database of 12 billion words collated from over 30 million articles to explore societal narratives on caregivers in six Asian countries. Computational linguistics and statistical analysis were applied to study the content of narratives on caregivers. The prevalence of societal narratives on caregivers was highest in Singapore-five times higher than Sri Lanka, which evidenced the lowest prevalence. Findings reveal that the inadequacies of institutional care as well as the need to train and empower caregivers are pressing issues that need to be prioritized on the policy agenda in Asia. Of broader significance, the diverse capabilities across Asia present opportunities for cross-country learning and capacity-building.

Caregiving and Care Receiving Experiences Among Older Chinese Immigrants and Their Home Health Aide

INTRODUCTION

There is limited information about how racial and cultural similarities or differences between patient and caregiver may affect quality care. The purpose of this study was to explore caregiving and receiving experiences among older Chinese immigrants and their home health aides by using in-depth interviews in culturally concordant dyads in a community setting.

METHODOLOGY

A purposive sample of 10 dyads of older Chinese immigrants and their home health aides were recruited using a snowball sampling method (N = 20). All interviews were audio recorded, transcribed, and coded for qualitative content analysis.

RESULTS

The majority of older adults were female (n = 8) and their average age was 76.8 years. The following themes emerged: companionship and rapport, reconciling the need for care services with the expectations of family, the value of matched gender, language, and ethnic foodculture, assisting with daily routines, and experiencing caregiving burden due to a dual role.

DISCUSSION

This study elucidated the dynamics between care recipients and their caregivers with shared cultural backgrounds.

Stressors and coping mechanisms of family care-givers of older relatives living with long-term conditions in mainland China: a scoping review of the evidence

As the ageing population in China continues to grow, more people will be living with long-term health conditions and require support from family care-givers. This scoping review therefore aims to explore sources of stress and coping mechanisms adopted by care-givers of older relatives living with long-term conditions in mainland China. Literature searches were conducted in English (CINAHL, EMBASE, MEDLINE, PsycINFO and SCOPUS) and Chinese (CNKI, WANFANG DATA, CQVIP and CBM) databases between October and November 2019. The searches focused on the stressors and coping mechanisms utilised by family care-givers residing in the community. Narrative synthesis was used to identify themes within the data. Forty-six papers were included: 20 papers from English and 26 from Chinese databases. Six themes captured stressors: care-giving time (N = 22), financial resources (N = 17), role and personal strains (N = 42), preparedness (N = 4), social roles (N = 10) and lack of adequate formal support (N = 22); and one theme captured coping (N = 14). Unmet needs of care-givers of older relatives in mainland China were found to be extensive. Only a few studies had attempted to explore the causal link between stressors, coping and the influence of culture. Findings underscore the significance of adequately capturing intricacies around care-givers’ unmet needs, rather than generalising on the basis of culture. Qualitative studies are critical to providing a better understanding of the relationship between stressors, coping and resources afforded to care-givers by their cultural environment. Having such understanding is crucial to inform the development of competent care, which promotes self-efficacy and self-actualisation in care-givers in mainland China.

Perspectives on Aging-Related Preparation

When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.

Family care across diverse cultures: Re-envisioning using a transnational lens

In an increasingly globalized world, the importance of developing a more culturally complex understanding of family care has been clearly identified. This study explored family care across three different cultural groups - Chinese, South Asian, and Latin American - living in a metropolitan, Pacific-West, Canadian city. In-depth qualitative interviews were conducted with 29 family members from one of the three family groups exploring how they practiced 'care' for their aging, often frail, relatives. The importance of conceptualizing family care as a transnational, collective undertaking emerged from the outset as critical for understanding care practices in all three cultural communities. Three themes identified contributed to this conceptualization: the need to broaden the understanding of family care; the centrality of geographic mobility, and the need to rethink the location of aging and consider its relationship to mobility; and the use of technology by extended family networks to facilitate continuity and connection. An over-riding notion of 'flow' or fluid movement, rather than a fixed, static arrangement, emerged as critical for understanding family care. This perspective challenges the dominant approach to studying family care in gerontology that generally conceptualizes family care practice as one local primary caregiver, often female, with some support from other family members. Understanding family care from a transnational lens builds support for the importance of a feminist Ethics of Care lens and has important implications for policy and service delivery practices.

Caregiver Well-Being and Burden: Variations by Race/Ethnicity and Care Recipient Nativity Status

BACKGROUND AND OBJECTIVES

Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others).

RESEARCH DESIGN AND METHODS

The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (N = 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver's outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts of the inclusion of caregiving factors (background factors, primary stressors, secondary stressors, and resources).

RESULTS

Regression analyses showed that only care burden significantly varied by care recipient nativity status after controlling for covariates. Caregivers of foreign-born care recipients reported a higher burden. However, when interactions of care recipient nativity status × caregiver race/ethnicity were introduced, non-Hispanic black and Hispanic caregivers of foreign-born care recipients were more likely to report better psychological well-being and self-rated health compared to their counterparts. Across caregiver groups, better caregiver-care recipient relationship quality and less caregiver chronic conditions were associated with less burden and better caregiver psychological well-being and self-rated health.

DISCUSSION AND IMPLICATIONS

Care recipient nativity status and caregiver race/ethnicity may have complex effects on caregiving experiences. Given the observed significant interaction effects for caregiver psychological well-being and self-rated health, cultural factors may affect the extent to which these caregivers appraise their caregiving. Future research should delve into the appropriate ways to assess care stress as well as resilience among each caregiver group. Our results indicate the need for research, education, and practice that assess cultural and within-group differences among caregivers and inform needed changes to structural barriers.

Perceptions and expectations of filial piety among older Chinese immigrants in Canada

Much of the literature discusses filial piety in general and ambiguous terms. This study, in contrast, investigates specific perceptions of filial piety and parental expectations of filial duty among older Chinese immigrants in Canada. The study is based on thematic analysis of 46 Chinese immigrants in seven focus groups conducted in the Greater Toronto Area. Findings show the perceptions of filial piety varied, but almost all participants had reduced expectations of their children. Nevertheless, they still valued and expected emotional care from their children. The study argues that changes in institutional settings, social policies and welfare systems define parents’ support needs and affect their expectations in the host society, while norms and institutional settings in the place of origin influence their perceptions of filial piety.