Monday, August 6, 2007

Ethnicity and Cultural Differences in Family Caregiving

by Chris von Spitzer

What describes a caregiver? (Janevic 2006)

Caregivers are individuals who take care of usually older adults, most often parents, the elderly or spouses, who are disabled or ill.

The people receiving the care usually need help with their basic daily tasks including, eating, dressing, bathing, toileting, giving medicine, paying bills, cooking, and house cleaning.

About one in four American families or 22.4 million households care for someone over the age of 50.

Most caregivers are middle-aged from 35-64 yrs old

About 75% of caregivers are women

What is caregiver stress? (Janevic 2006)

Caregiver stress is the emotional force that can take over a family member who has the responsibility to take care of another human being. It tends to affect a person’s physical and emotional health. When an individual is caregiving, they are taking endless amount time and effort to take care of a person. Since caregivers usually have full time jobs on the side, their own needs are put aside. Thus this can lead to depression and numerous health problems like diabetes and heart disease than non-caregivers.

Women caregivers especially are prone to feel more stress and overwhelmed. Research shows that female caregivers have more emotional and physical health problems, financial strain, and employment-related problems than male caregivers. Other studies show that people who care for their spouses are more prone to care-giving related stress than those who care for other family members.

What describes ethnic or ethnocultural groups?

Such groups are distinguished on the basis of a common locale or country of origin, a unique language, a common history, normative expectations and related customs and practices, identifiable group-held values and beliefs, and the intergenerational transmission of these shared norms and values (Pinquart & Sorensen 2004)

What are the differences between ethnic minority caregivers and white caregivers?**

(1) The relationship between stressors and outcomes?

Let’s focus on four main stressors: care recipient’s cognitive impairments, limitations in activities of daily living, frequency of memory and behavior problems, and intensity of care provision.

In the area of care recipient’s cognitive impairments, studies show that care recipient’s disruptive behavior and cognitive impairments are associated with more caregiver depression for White caregivers but not for African Americans; other authors find no significant ethnic differences in the relationship of behavior problems or cognitive impairment with psychological outcomes (Pinquart & Sorenson 2005).

In the area of limitations in activities of daily living, there has been no ethnic differences reported.

In the area of frequency of memory and behavior problems, African-American care givers, known for having such a high respect for elders, tend to not view disturbed behavior as a cause of embarrassment or social unease compared to White caregivers.

In the area of intensity of care provision, Hispanic and African Americans provide more hours of care than White caregivers. Since providing care for an elderly family member is considered more socially normative for caregivers of color than for White caregivers, the association between the intensity of care provision and caregiver depression and physical health may be weaker for African American and Hispanic caregivers. According to a study the amount of care provided is associated with depression in White but not African American caregivers (Cox 1995).

(2) The association of resources with caregiver outcomes?

Let’s focus on religious coping, informal support, availability and the use of formal support and income.

Religious coping often plays a huge role with Hispanics and African Americans. According to a study called REACH, Coon et al. (2004) and Haley et al. (2004) found that religious coping is greater for Hispanic and African American caregivers than for White caregivers.

Most of the time, religious involvement is frequently associated with more access to social support as well. Yet since religion may provide a personal coping strategy and a social support network to people with few other resources, it may also reduce the search for external caregiver resources, such as dementia-specific support groups or respite care. One would then expect that the protective effect of religion on mental and perceived physical health is stronger for African Americans and Hispanic caregivers, because of their access to alternative sources of support is so limited.

With informal support, ethnic minorities receive more support from their relatives, friends, and neighbors due to strong family and community ties (Pinquart & Sorenson 2005). African American caregivers also may be more likely than Whites to benefit from this source of support, because their family support is highly valued as a sign of “caring for one’s own” and they have a greater than average of baseline rates of stressful events.

In the area of availability and the use of formal support, African American caregivers use more informal but equal amounts of formal as do White caregivers, while Hispanic caregivers use more informal and less formal support than White caregivers (Belgrave & Bradsher, 1994).

In the area of income, African Americans and Hispanics have lower average income, higher poverty rates, and are over-represented in unskilled and service jobs than Whites. The buildup of financial stress may be a greater source of elevated levels of depression for African American and Hispanic than for White caregivers due to their limited access to resources (Pinquart & Sorensen 2005).

**Please note: “Ethnic minority caregivers” and the use of “caregivers of color” are interchangeable to denote non-White caregivers. The specific ethnic minority groups involved in this section are African Americans and Hispanics.

References & Further Reading

Belgrave, L.L. & Bradsher, J.E. (1994). Health as a factor in institutionalization: Disparities between African Americans and Whites. Research in Aging 115-141.

Coon D. W. Rubert, M.P., Solano, N.M., Mausbach, B., Kraemer, H, Arguelles, T., et al. (2004). Well-being, appraisal, and coping in Latina and Caucasian female dementia caregivers: Findings from the REACH study. Aging and Mental Health, 8, 330-345

Cox, C. (1995). Comparing the experience of black and white caregivers of dementia patients. Social Work, 3, 343-349.

Janevic, Mary. (2006) Women’s Health.Gov: The Federal Government Source for Women’s Health Information, “Caregiver Stress.”

Pinquart, M. & Sorenson, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journals of Gerontology: Psychological Sciences & Social Sciences, 58B, 112-128

Pinquart, M. & Sorenson, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. The Gerontologist, 45, 90–106.