Race, Ethnicity, Culture

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Race, Ethnicity, Culture

• And beyond the Primary Caregiver

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The Need to Understand Racial and Cultural
Differences in Caregiving
3
Population Changes

• Those older than 65 will increase to 20 by 2050
• Elderly White population will double 2000 2050
  (X 2)
• African American will quadruple (X 4)
• Hispanic increase by ( X7)
• Native Americans (X 3.5) and Pacific Islanders (X
  6.5)

4
Research on Race, Ethnicity

• Relatively few studies have compared the
  experience of caregiving across racial, ethnic or
  cultural lines.
• Mostly we know about more objective differences.

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Problems in the research
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Sampling

• Small, non-representative samples are the norm.
• Why is use of convenience samples a problem?
• Samples recruited through community orgs,
  Alzheimers associations, social and health
  service orgs., advertisements, radio, hospitals,
  etc. means it is difficult to determine the
  population represented by these samples.
• The sample may be biased in some unknown way.

7
Some Well-Documented Differences

• Rates of institutionalization for minority elders
  lower than for White elders
• Prevalence of severe functional limitations
  higher among minority seniors living at home than
  White elders
• AA and Hispanic Americans use fewer formal
  services, but report need for more assistance

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One study

• Navaie-Waliser, Feldman, Fould, Levine, Kuerbis
  Donelan 2001
• Random digit dialing identified 4991 family
  households in NYC
• After screening, 402 individuals who met
  eligibility agreed to participate.
• Complete data on 397

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Sample

• White, non Hispanic 164
• Black, non Hispanic 129
• Hispanic 87
• Other 17
• 17 overall prevalence of caregiving

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Results

• White caregivers and care receivers were older
  (71 vs. 65 for recipient).
• gt70 of all cg had no help from formal
• gt80 providing care for more than 1 yr.
• Black cg more likely to be providing higher
  intensity care (e.g. dressing, feeding,
  transferring)

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Black Caregivers

• Report heavier workload and more unmet needs.
• But, less likely to report difficulty providing
  care
• More likely to experience increased religiosity
  since becoming a caregiver

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Hispanic Caregivers

• More likely to have unmet needs than White
  caregivers
• More likely to receive help from paid caregivers
  than White
• Also, more likely to experience increased
  religiosity since becoming caregiver than White

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Overall

• Higher intensity care associated with greater
  unmet needs
• Caregivers providing higher intensity care were
  more likely to receive formal, paid help
• Increased religiosity associated with greater
  unmet needs and higher intensity care

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Overall Finding

• Caregiving workload, reported difficulty in care
  provision, having unmet needs and reliance on
  spirituality (e.g. meaning based coping) vary
  by race.

15
Beyond Primary Caregivers

• Most research has focused on a single individual
  identified as the primary caregiver but what
  happens if we look at the network of family
  members who provide care over time. How stable
  is it and how much change occurs?

16
Longitudinal Study

• Szinovacz and Davey, 2007
• Used waves 1 through 5 (1992 -2000) of a national
  survey that looked at adult children caring for
  one or more parents.

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Results

• Change in adult child caregivers occurred in 54
  of cases.
• gt 25 of primary adult child caregivers were
  replaced by a sibling
• 33 of all networks added at least one adult
  child
• 34.5 dropped at least one adult child.

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Systems of Support

• Williams and Dilworth-Anderson, 2002
• 187 African American caregivers looked at use of
  formal, church and informal support.
• Higher education associated with use of formal
  support
• Greater dependency in care receiver, more
  behavioral problems associated with less use of
  formal services

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• (Note did not look at effect of cognition..
  Presence of dementia as a predictor as did Birkel
  Canon)
• Higher levels of informal support and network
  density were associated with lower use of formal
  services.
• (Which may point to insularity)

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Linking

• More dense networks (cohesive) did not link to
  formal services.
• Larger networks did link to formal services.
• Church membership did link to formal supports.

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Networks
Low Density
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Networks
High Density
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Networks
Insularity
High Density
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Networks
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Networks
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Networks
Linking Function