Alzheimers Disease: Latino Caregivers

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Alzheimers Disease Latino Caregivers

• Elvira Jimenez
• CHS 286
• March 10, 2008

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Significance

• In 2000 an estimated 4.5 million Americans were
  diagnosed with Alzheimers disease
• It is projected that the Alzheimers disease
  population will increase 3-fold by the year 2050
• Latinos
• Currently, there are more than 42 million
  Hispanics in the United States (14 of the
  population)- National Alliance for Caregiving
  American Association of Retired Persons.
• 13 of Hispanic households currently provide care
  to an adult aged 50 or older (Velazques et al,
  2004)

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Alzheimers Disease (AD) and Related Dementias

• AD affects memory, ability to learn, reason,
  make judgments, communicate and carry out daily
  activities(Alzheimers Disease Association,
  2006)
• Progressive disease with increasing disability
• Currently there is no cure for Alzheimers
  disease and much of the resources focus on
  preserving quality of life of those affected
• This illness has substantial emotional, financial
  and physical demands on families

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Dementia Caregiving

• Caregiver has to resolve a range of issue
  (McMillan, 2005)
• activities of daily living
• Medication management
• eating
• transportation
• emotional support
• interacting with health care professionals
• Caregiver demands grow as the patient becomes
  more impaired

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Literature is Scarce

• Pub med search
• (caregiver ) OR caregiving) and (caregiver) OR
  (dementia) OR (Alzheimers Disease) 3459
• When crossed with (hispanic) OR (Latino) and
  limited to the last 5 years 30

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Findings Stress/ Burden

• Latinos do suffer from higher stress and
  depression due to their caregiving duties
• Higher cortical levels and perceived stress than
  non-caregiver however their levels were lower
  than for whites (Gallagher-Thompson et al, 2006)
• Two samples (USA and Spain) both groups had
  burden and depressive symptomology (Losada et
  al., 2003)
• Found a higher rate of depression among Latino
  caregivers using the Geriatric Depression Scale
  (Covinsky et al., 2003)
• However, compared to whites Latinos have less
  burden
• Latinos had lower level of depression and
  higher level of self acceptance than whites
  (Morano and King, 2003)

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AD-Severity

• Latinos with AD are not less impaired
• Black and Latino community-dwelling patients with
  moderate to severe dementia have a higher
  prevalence of dementia-related behaviors than
  whites (Sink et al., 2004)

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Quality of Caregiving

• Latinos reported higher self- efficacy when
  responding to disruptive behaviors and
  controlling negative behaviors (Depp et al., 2005)

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Service Utilization

• Latinos had smaller social support networks and
  less help-seeking behaviors (support groups)
  (Valle et al., 2004)
• Cognitively impaired Latinos were less likely to
  be institutionalize by their families compared to
  Caucasians (Mausbach et al., 2004)

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Culture is a factor in the AD

• Latinos incorporated folk with biomedical modes
  in their understanding of the illness (Hinton et
  al., 2005)
• Cultural influence beliefs about the nature of
  caregiving
• Participants expressed a firm commitment to
  family-based home care (Neary et al, 2005)
• Utilize the formal care system in order to keep
  their relatives at home
• Participants viewed nursing home placement as a
  breach of their familial duty and as an option of
  last resort.

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Culture Mediate Caregiver Burden

• Studies have found cultural factors to buffer or
  mediate caregiver stress and to inhibit respite
  service utilization.
• Familism putting the needs of the family and its
  members above the needs of individuals
• Familism was significantly correlated with lesser
  burden in the USA Hispanic caregiver sample, but
  with higher levels of depressive symptoms in the
  Spanish sample. (Losada et al., 2006)
• Religiosity
• Latinos had higher level of religiosity than
  whites correlating with low levels of
  depression (Morano and King, 2005)
• Covinsky et al (2003), found a high rate of
  depression among caregivers, however, multiple
  factors such as culture, patient and caregiving
  characteristics mediated this outcome.
• Lower appraisal of stress, greater perceived
  benefits in caregiving and greater use of
  religion to cope with caregiver stress (Coon et
  al., 2004)

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Intervention studies

• Overall Latinos do have a positive response to
  intervention studies
• Skill building vs. support group approaches-
  reported a significant reduction in depressive
  symptoms(Gallagher-Thompson et al., 2003)
• Family therapy and technology intervention-
  Cuban- Americans husbands and daughters showed
  high benefit and reduced depression (Eisdorfer et
  al., 2003)
• El Portal Evaluation- Increased service
  utilization when reduction of barriers to
  care.(Aranda et al., 2003)

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Research question

• How do cultural specific factors in Latinos
  affect access and utilization of caregivers
  services?

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Quantitative

• Are cultural factors a reason Latinos and their
  caregivers fail to access medical and respite
  care?
• Recognizing health disparities due to ethnicity
  it is hypothized that
• Latinos afflicted with dementia will have lower
  utilization of respite and medical dementia
  compared to whites
• Access to culturally sensitive services will
  result in higher utilization of medical and
  respite services among Latinos
• Latinos will report cultural factors, such as
  care giving beliefs, as a viable explanation for
  not utilizing services

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Andersen Model

• Service utilization based on the individuals
  predisposing, enabling and need factors.
• Predisposing variables- individual
  characteristics such as demographic variables
• Enabling factors- facilitate an individuals
  usage of services such as financial or supportive
  resources
• Need- users perception of that particular
  service such as the level of illness or disease

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Problem

• Quantitative studies only provide insight into
  relationships and fail to identify specific
  cultural factors that may mediate or increase
  caregiver stress

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Qualitatively

• What culture specific factors explain caregiving
  for Latinos and their caregivers in dementia
  care?
• Assumptions
• Latinos afflicted with dementia will state that
  they do not routinely use respite and medical
  services to manage the illness
• Latinos will report or the observations
  demonstrate cultural factors, such as care giving
  beliefs, as explanation for not utilizing
  services
• Caregivers will state that family is responsible
  for taking daily care of the needs faced by the
  patient.
• Latino caregivers will report Alzheimers disease
  to be a normal part of aging.
• Method (1) interviews of caregivers to Latino
  diagnosed participants and (2) observations at
  dementia care facilities providing services to
  Latinos in Los Angeles County.

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Grounded Theory (Strauss and Corbin 1998)

• Proven to be helpful in situations where a
  theory is not available to explain a process .
• Focus is on understanding how individuals
  experience the process and identify the steps in
  the process.
• A qualitative research design in which the
  inquirer generates an explanation (a theory) of a
  process, action or interaction shaped by the
  views of a large number of participants

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What Next.

• Database
• Alzheimers Disease Reseach Center (ADRC)
  Longitudinal study
• Clinical data
• Study sites
• Olive View medical center - ADRC satellite
• El Portal East LA

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Limitations

• Existing data may be limited to look at access
• Interview process lengthy
• Heterogeneity within Latino population

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• Thank you!!!!
• Comments Elvira_at_ucla.edu