Title: Caregiving
1Caregiving
2Caregiving Statistics
- About 64 of older persons living in the
community and in need of long-term care depend on
informal caregivers (family and friends). - Caring for a person with dementia has a negative
impact on the caregivers psychological and
physical health, social life and career, and
relationships with the care recipient.
3Spousal Caregivers
- More likely to be women than men.
- Likely to have played traditional gender roles
and to report taking over tasks previously
carried out by their ill spouse. - Female spousal caregivers report that they
curtail their other activities such as spending
time with friends and family members more than
male spousal caregivers (42.6 vs. 21). - Female spousal caregivers are more likely to
report receiving no help at all and to report
dissatisfaction with received assistance.
4Family Assistance Provided to Spousal Caregivers
- Assistance provided to spousal caregivers by
adult children depends on whether the mother or
father is the spousal caregiver, with more
assistance provided to fathers caring for ill
mothers. - More male spousal caregivers receive help from
siblings than do female spousal caregivers.
5Paid Assistance Provided to Spousal Caregivers
- No gender difference in use of formal support
- Male spousal caregivers report the CR receives
enough support from family and friends - Female spousal caregivers report the CR does not
need additional help - Male spousal caregivers are more likely than
female spousal caregivers to pay others to cook
or perform housekeeping tasks.
6Caregiving Gender and Mental Health
- In comparison with male spousal caregivers,
female spousal caregivers report - Greater dissatisfaction with received social
support - More feelings of isolation
- Lack of sleep and privacy
- More feelings of embarrassment and rejection by
their ill spouse
7Adult Child Caregivers
- Due to the developmental stage / social roles of
adult children, caregiving can have a greater
impact on their lifestyle than on that of spousal
caregivers. - More likely to be employed
- More likely to be caring for children
- Adult-child caregivers are more likely than
spousal caregivers to report role captivity in
caregiving. - Adult-child caregivers may also be long-distance
caregivers.
8Statistics RE Aging and Ethnicity
- US Census Data 2000 reports that the US elderly
population increased from 5 in 1930 to 13 in
1990, with projected increase to 20 of the total
US population by 2050. - The percentage of racial and ethnic minority
elders will increase at a much higher rate than
that of non-Hispanic white elders over the next
50 years. - The prevalence of severe functional impairments
among minority elderly is higher than among their
white counterparts (SES, access, life-context
issues).
9Race and Caregiving1980 through 2000
- Not limited to dementia, though dementia
predominates caregiving research. - Parameters of inclusion (N 59 studies)
- Published in refereed professional journals
- Focus on informal caregiving of dependent elderly
people with race, ethnicity or culture as a
primary focus - Parameters of exclusion
- Race used only as a control variable
- Caregiving of institutionalized elderly
- Only care recipient views were reported
- Most data available for white and AA caregivers.
10Race and Caregiving1980 through 2000 Part II
- Four domains of research with at least 10
published articles regarding the topic - Social support study n 32
- Negative effects of caregiving study n 29
- Coping with caregiving stress study n 13
- Cultural effects on caregiving study n 20
11Race and Caregiving1980 through 2000 Part III
- Social support study n 32
- 14 theoretical 18 atheoretical studies
- Stress and coping models predominate
- 11 comparisons of AA and white
- Ethnic minority elders have more diverse informal
support networks - Ethnic minority elders use informal support
networks similarly in comparison with whites - Ethnic minority elders use formal services less
than nonminority caregivers
12Race and Caregiving1980 through 2000 Part IV
- Negative effects of caregiving study n 29
- In the rare cases where theory-driven research
was conducted, stress process models predominate - Regarding depression, 6 studies report no
difference between AA and white caregivers
(mostly small samples) 4 studies report that
white caregivers are significantly more depressed
than AA.
13Race and Caregiving1980 through 2000 Part IV
(cont)
- More on race and caregiver depression
- In one study, the relationships among depression,
positive reappraisal, and heart rate reactivity
were found to operate differently for AA and
white caregivers (Knight McCallum, 1998) - Positive reappraisal may increase stress among
whites while decreasing stress among AAs. - The relationship between race and depression may
be mediated by stress and coping appraisals
(Haley et al 1996)
14Race and Caregiving1980 through 2000 Part IV
(cont)
- Race and caregiver burden
- Five studies found white caregivers reported
significantly higher burden than AAs 4 studies
found no difference - Lack of consideration of the relationship of
culture and caregiver burden (personal and family
hx, sociopolitical factors)
15Race and Caregiving1980 through 2000 Part IV
(cont)
- Race and caregiver role strain (4 studies)
- Hispanic caregivers reported higher role strain
and personal strain than AA caregivers (Cox
Monk, 1996). - Best predictors of role strain include being
white, having greater behavioral bother and task
distress, and higher CR (spouse) ADL need (Farran
et al 1997 ). - Lower levels of provisional and ultimate meaning
for white vs AA caregivers provisional meaning
decreases depression and role strain (Farran et
al 1997). - As caregiving mastery decreases, role strain
increases (Miller et al., 1995). - Role conflict, respite, and care relationship
effects differ between white and AA caregivers
(Mui, 1992).
16Race and Caregiving1980 through 2000 Part IV
(cont)
- Race and caregiver relationship strain (1 study)
- No differences between white and AA caregivers,
but levels are high (Cox, 1993).
17Race and Caregiving1980 through 2000 Part IV
(cont)
- Race and caregiver psychological distress (3
studies) - Distressed AA caregivers reported being less
satisfied with SS, greater role strain, poorer
health, and less mastery (Dilworth-Anderson et
al., 1999). - AA caregivers report lower distress and appraised
caregiving more favorably than whites (Farran et
al., 1997).
18Race and Caregiving1980 through 2000 Part V
- Coping with caregiving stress study n 13
- Primarily theoretical with predominance of the
stress and coping model. - AA caregivers using more emotion-focused coping
(including Escape-Avoidance) than whites. Whites
use more approach coping (Knight et al., 2000
Haley et al, 1996). - Quality of SS may predict confrontive coping,
appraisals of perceived rewards may predict
palliative coping, and appraisals of perceived
costs may predict emotive coping (Picot, 1995). - Urban AA caregivers use more behavioral and
cognitive coping than rural AA or white
caregivers (Wood Parham, 1990).
19Race and Caregiving1980 through 2000 Part V
(cont)
- Coping with caregiving stress study n 13
- AA caregivers cope with difficulties of
caregiving with prayer, faith in God, and
religion.
20Race and Caregiving1980 through 2000 Part VI
- Cultural effects on caregiving study n 20
- Little attention given to defining culture from a
sociohistorical perspective. - Most researchers found cultural groups have
values about reciprocity, filial obligation, and
a sense of responsibility for caring for older
family members. - Cultural perceptions about illness and disease
shape the meanings groups assign to a dependent
OAs illness.
21Race and Caregiving Research Needs
- Need to measure culture directly and not rely on
race as a proxy measure. - Need more studies on additional ethnic minorities
and to break whites down into ethnic groups. - Need to make stress process models more
culturally relevant.
22General Caregiving Research Needs
- Need to incorporate noncaregiving comparison
groups. - Need to use similar measures in probability
samples and make multivariate not bivariate
comparisons. - Need for mixed method studies.
- Need to investigate positive caregiving outcomes.
- Need to investigate gender.