Family Caregivers’ Role in Navigating Diet: Perspectives from Caregivers of Older Asian Americans

Abstract

Family caregivers uphold significant healthcare responsibilities including language translation and diet management. This study sought to understand family caregivers’ experiences and challenges navigating and managing their older Asian American relative’s diet. We conducted an exploratory sequential mixed-methods study with family caregivers involving (1) qualitative interviews (n = 40) and (2) a nationwide survey (n = 100). Interviewees discussed their role and challenges with (a) applying American/Western clinical dietary recommendations to their relative’s traditional meal preferences and (b) managing misalignment between their relative’s traditional dietary preferences and the food offered in hospitals and long-term care environments. Survey responses triangulated; almost 65% of family caregivers prepared and brought traditional meals to healthcare facilities upon observing a lack of culturally relevant food options. Culturally relevant nutrition training for family caregivers can help them support their relative in community settings. Creating an inclusive healthcare system requires transforming the food environment within healthcare facilities.

Keywords

Asian Americans family caregivers nutrition culture inclusion mixed methods

Get full access to this article

View all access options for this article.

References

AARP, & National Alliance for Caregiving . (2020). Caregiving in the United States 2020. AARP, & National Alliance for Caregiving. https://www.aarp.org/content/dam/aarp/ppi/2020/05/full-report-caregiving-in-the-united-states.doi.10.26419-2Fppi.00103.001.pdf

Administration for Community Living . (2020). 2020 profile of asian AMERICANS age 65 and older. Administration for Community Living. https://acl.gov/sites/default/files/ProfileofOA/AsianProfileReport2021.pdf

Alibhai

S. M. H.

Greenwood

Payette

(2005). An approach to the management of unintentional weight loss in elderly people. Canadian Medical Association Journal, 172(6), 773–780. https://doi.org/10.1503/cmaj.1031527

Anthony

K. P.

John Geldhof

Mendez-Luck

C. A.

(2017). Characterizing caregiving intensity among Mexican-origin women caregivers. The Gerontologist, 57(6), 1084–1092. https://doi.org/10.1093/geront/gnw090

Auer

Penikalapati

Parekh

Merdjanoff

A. A.

DiClemente

R. J.

Ali

S. H.

(2023). ‘We know what he likes, even if he doesn’t know’: How the children of south Asian immigrants characterize and influence the diets of their parents. Health Education Research. https://doi.org/10.1093/her/cyad036

Beatty

P. C.

Willis

G. B.

(2007). Research synthesis: The practice of cognitive interviewing. Public Opinion Quarterly, 71(2), 287–311. https://doi.org/10.1093/poq/nfm006

Bryman

(2006). Integrating quantitative and qualitative research: How is it done? Qualitative Research, 6(1), 97–113. https://doi.org/10.1177/1468794106058877

Budiman

(2020). Key findings about U.S. immigrants. In Pew research center. Jagadeesh. https://www.pewresearch.org/short-reads/2020/08/20/key-findings-about-u-s-immigrants/

CARE AAPI . (2022). About us. CARE AAPI. https://careregistry.ucsf.edu/about-care-registry#

10.

Carman

(2023). Hospital food is a punchline. These chefs are redefining it. The Washington Post. https://www.washingtonpost.com/food/2023/02/27/hospital-food-fine-dining-northwell/

11.

Cresswell

J. W.

(2009). Research design: Qualitative, quantitative, and mixed methods approach. Sage.

12.

Cresswell

J. W.

Plano Clark

V. L.

(2017). Designing and conducting mixed methods research. SAGE Publications, Inc; 3rd edition.

13.

Crotty

(1998). The foundations of social research: Meaning and perspective in the research process. Sage.

14.

Cypress

(2018). Qualitative research methods: A phenomenological focus. Dimensions of Critical Care Nursing: DCCN, 37(6), 302–309. https://doi.org/10.1097/DCC.0000000000000322

15.

Dall’Oglio

Nicolò

Di Ciommo

Bianchi

Ciliento

Gawronski

Pomponi

Roberti

Tiozzo

Raponi

(2015). A systematic review of hospital foodservice patient satisfaction studies. Journal of the Academy of Nutrition and Dietetics, 115(4), 567–584. https://doi.org/10.1016/j.jand.2014.11.013

16.

Derose

K. P.

Escarce

J. J.

Lurie

(2007). Immigrants and health care: Sources of vulnerability. Health Affairs, 26(5), 1258–1268. https://doi.org/10.1377/hlthaff.26.5.1258

17.

Diamond

Izquierdo

Canfield

Matsoukas

Gany

(2019). A systematic review of the impact of patient–Physician non-English language concordance on quality of care and outcomes. Journal of General Internal Medicine, 34(8), 1591–1606. https://doi.org/10.1007/s11606-019-04847-5

18.

Ding

E. C.

(2022). How cultural and religious differences impact caregiving. AARP.

19.

Hanssen

Kuven

B. M.

(2016). Moments of joy and delight: The meaning of traditional food in dementia care. Journal of Clinical Nursing, 25(5–6), 866–874. https://doi.org/10.1111/jocn.13163

20.

Howson

F. F. A.

Sayer

A. A.

Roberts

H. C.

(2017). The impact of trained volunteer mealtime assistants on dietary intake and satisfaction with mealtime care in adult hospital inpatients: A systematic review. The Journal of Nutrition, Health & Aging, 21(9), 1038–1049. https://doi.org/10.1007/s12603-016-0847-2

21.

Hussain

S. M.

Newman

A. B.

Beilin

L. J.

Tonkin

A. M.

Woods

R. L.

Neumann

J. T.

Nelson

Carr

P. R.

Reid

C. M.

Owen

Ball

Cicuttini

F. M.

Tran

Wang

Ernst

M. E.

McNeil

J. J.

(2023). Associations of change in body size with all-cause and cause-specific mortality among healthy older adults. JAMA Network Open, 6(4), Article e237482. https://doi.org/10.1001/jamanetworkopen.2023.7482

22.

Kennedy

Ruiz

N. G.

(2020). Polling methods are changing, but reporting the views of Asian Americans remains a challenge. Pew Research Center.

23.

Lin

Bryant

Boldero

Dow

(2015). Older Chinese immigrants’ relationships with their children: A literature review from a solidarity–conflict perspective. The Gerontologist, 55(6), 990–1005. https://doi.org/10.1093/geront/gnu004

24.

McMinn

Steel

Bowman

(2011). Investigation and management of unintentional weight loss in older adults. BMJ, 342, 342. https://doi.org/10.1136/bmj.d1732

25.

Miyawaki

C. E.

(2016). Caregiving practice patterns of Asian, hispanic, and non-hispanic white American family caregivers of older adults across generations. Journal of Cross-Cultural Gerontology, 31(1), 35–55. https://doi.org/10.1007/s10823-016-9281-5

26.

National Alliance for Caregiving . (2021). Caregiving in a diverse America. National Alliance for Caregiving.

27.

Netterville

(2020). Caregiver nutrition education Toolkit. The National Resource Center on Nutrition & Aging.

28.

Nong

Raj

Creary

Kardia

S. L. R.

Platt

J. E.

(2020). Patient-reported experiences of discrimination in the US health care system. JAMA Network Open, 3(12), Article e2029650. https://doi.org/10.1001/jamanetworkopen.2020.29650

29.

Ordovas

J. M.

Ferguson

L. R.

Tai

E. S.

Mathers

J. C.

(2018). Personalised nutrition and health. BMJ, 361, 361. https://doi.org/10.1136/bmj.k2173

30.

Padmanabhan

(2019). For aging immigrants, food from their homelands is key to happiness. The Bold Italic. https://thebolditalic.com/for-aging-immigrants-food-from-their-homelands-is-key-to-happiness-c3715c4c3650

31.

Pharr

J. R.

Dodge Francis

Terry

Clark

M. C.

(2014). Culture, caregiving, and health: Exploring the influence of culture on family caregiver experiences. ISRN Public Health, 2014, 1–8. https://doi.org/10.1155/2014/689826

32.

Raj

Zhou

S. S.

Kwon

(2021). Caregiving across cultures: Priority areas for research, policy, and practice to support family caregivers of older Asian immigrants. American Journal of Public Health, 111(11), 1920–1922. https://doi.org/10.2105/AJPH.2021.306494

33.

Riffin

Van Ness

P. H.

Wolff

J. L.

Fried

(2019). Multifactorial examination of caregiver burden in a national sample of family and unpaid caregivers. Journal of the American Geriatrics Society, 67(2), 277–283. https://doi.org/10.1111/jgs.15664

34.

Roberts

A. W.

Ogunwole

S. U.

Blakeslee

Rabe

M. A.

(2018). The population 65 Years and older in the United States: 2016. U.S Census Bureau.

35.

Schure

Goins

R. T.

Jones

Winchester

Bradley

(2019). Dietary beliefs and management of older American Indians with type 2 diabetes. Journal of Nutrition Education and Behavior, 51(7), 826–833. https://doi.org/10.1016/j.jneb.2018.11.007

36.

Shune

S. E.

Namasivayam-MacDonald

(2020). Swallowing impairments increase emotional burden in spousal caregivers of older adults. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 39(2), 172–180. https://doi.org/10.1177/0733464818821787

37.

Silver

H. J.

Wellman

N. S.

(2002). Nutrition education may reduce burden in family caregivers of older adults. Journal of Nutrition Education and Behavior, 34(Suppl 1), 53–58. https://doi.org/10.1016/s1499-4046(06)60312-6

38.

Silver

H. J.

Wellman

N. S.

Galindo-Ciocon

Johnson

(2004). Family caregivers of older adults on home enteral nutrition have multiple unmet task-related training needs and low overall preparedness for caregiving. Journal of the American Dietetic Association, 104(1), 43–50. https://doi.org/10.1016/j.jada.2003.10.010

39.

Singleton

(2020). The future of family caregiver support is diverse and inclusive. AARP.

40.

The White House . (2022). Biden-Harris administration national strategy on hunger, nutrition, and health. The White House. https://www.whitehouse.gov/wp-content/uploads/2022/09/White-House-National-Strategy-on-Hunger-Nutrition-and-Health-FINAL.pdf

41.

The White House . (2023). Fact sheet: Biden-⁠Harris administration announces most sweeping set of executive actions to improve care in history. The White House.

42.

Trickett

E. J.

Sorani

Birman

(2010). Towards an ecology of the culture broker role: Past work and future directions. MediAzoni.

43.

Trinca

Duizer

Keller

(2022). Putting quality food on the tray: Factors associated with patients’ perceptions of the hospital food experience. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 35(1), 81–93. https://doi.org/10.1111/jhn.12929

44.

Weinstein

Badaracco

Akabas

(2023). Why current “food is medicine” solutions are falling short. Health affairs forefront. https://doi.org/10.1377/forefront.20230510.637312

45.

Willis

G. B.

(2004). Willis

(Ed.), Cognitive interviewing: A tool for improving questionnaire design: A tool for improving questionnaire design. Sage Publications.

46.

Wolff

J. L.

Spillman

(2014). Older adults receiving assistance with physician visits and prescribed medications and their family caregivers: Prevalence, characteristics, and hours of care. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(Suppl 1), S65–S72. https://doi.org/10.1093/geronb/gbu119

47.

Wolff

J. L.

Spillman

B. C.

Freedman

V. A.

Kasper

J. D.

(2016). A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Internal Medicine, 176(3), 372–379. https://doi.org/10.1001/jamainternmed.2015.7664

48.

Yoo

G. J.

Musselman

Lee

Y.-S.

Yee-Melichar

(2015). Addressing health disparities among older Asian Americans: Data and diversity. Journal of the American Society on Aging, 38(4), 74–81. https://www.jstor.org/stable/26556081

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.07 MB