This study examines the associations of ethnicity, caregiver burden, familism, and physical and mental health among Mexican Americans (MAs) and non-Hispanic Whites (NHWs).
Methods
We recruited adults 65+ years with possible cognitive impairment (using the Montreal Cognitive Assessment score<26), and their caregivers living in Nueces County, Texas. We used weighted path analysis to test effects of ethnicity, familism, and caregiver burden on caregiver’s mental and physical health.
Results
516 caregivers and care-receivers participated. MA caregivers were younger, more likely female, and less educated compared to NHWs. Increased caregiver burden was associated with worse mental (B = −0.53; p < .001) and physical health (B = −0.15; p = .002). Familism was associated with lower burden (B = −0.14; p = .001). MA caregivers had stronger familism scores (B = 0.49; p < .001).
Discussion
Increased burden is associated with worse caregiver mental and physical health. MA caregivers had stronger familism resulting in better health. Findings can contribute to early identification, intervention, and coordination of services to help reduce caregiver burden.
AARP, & National Alliance for Caregiving. (2020). Caregiving in the United States 2020. AARP, & National Alliance for Caregiving. https://doi.org/10.26419/ppi.00103.001
2.
AdelmanR. D.TmanovaL. L.DelgadoD.DionS.LachsM. S. (2014). Caregiver burden: A clinical review. JAMA, 311(10), 1052–1060. https://doi.org/10.1001/jama.2014.304
AndrénS.ElmståhlS. (2008). The relationship between caregiver burden, caregivers’ perceived health and their sense of coherence in caring for elders with dementia. Journal of Clinical Nursing, 17(6), 790–799. https://doi.org/10.1111/j.1365-2702.2007.02066.x
5.
AngelJ. L.Torres-GilF.MarkidesK. (2012). Aging, health, and longevity in the Mexican-origin population. Springer Science and Business Media.
6.
ArrighiH. M.NeumannP. J.LieberburgI. M.TownsendR. J. (2010). Lethality of Alzheimer disease and its impact on nursing home placement. Alzheimer Disease and Associated Disorders, 24(1), 90–95. https://doi.org/10.1097/WAD.0b013e31819fe7d1
BriceñoE. M.MehdipanahR.GonzalesX.HeeringaS.LevineD. A.LangaK. M.GarciaN.LongoriaR.MorgensternL. B. (2020). Methods and early recruitment of a community-based study of cognitive impairment among Mexican Americans and non-Hispanic whites: The BASIC-Cognitive study. Journal of Alzheimer's Disease, 73(1), 185–196. https://doi.org/10.3233/JAD-190761
9.
BrownS. L.SmithD. M.SchulzR.KabetoM. U.UbelP. A.PoulinM.YiJ.KimC.LangaK. M. (2009). Caregiving behavior is associated with decreased mortality risk. Psychological Science, 20(4), 488–494. https://doi.org/10.1111/j.1467-9280.2009.02323.x
10.
CamposB.UllmanJ. B.AguileraA.SchetterC. D. (2014). Familism and psychological health: The intervening role of closeness and social support. Cultural Diversity and Ethnic Minority Psychology, 20(2), 191–201. https://doi.org/10.1037/a0034094
ChangH.-Y.ChiouC.-J.ChenN.-S. (2010). Impact of mental health and caregiver burden on family caregivers’ physical health. Archives of Gerontology and Geriatrics, 50(3), 267–271. https://doi.org/10.1016/j.archger.2009.04.006
13.
ConnorsM. H.SeeherK.Teixeira-PintoA.WoodwardM.AmesD.BrodatyH. (2020). Dementia and caregiver burden: A three-year longitudinal study. International Journal of Geriatric Psychiatry, 35(2), 250–258. https://doi.org/10.1002/gps.5244
14.
CrockettL. J.IturbideM. I.Torres StoneR. A.McGinleyM.RaffaelliM.CarloG. (2007). Acculturative stress, social support, and coping: Relations to psychological adjustment among Mexican American college students. Cultural Diversity and Ethnic Minority Psychology, 13(4), 347–355. https://doi.org/10.1037/1099-9809.13.4.347
15.
de OliveiraG. R.NetoJ. F.de CamargoS. M.LucchettiA. L. G.EspinhaD. C. M.LucchettiG. (2015). Caregiving across the lifespan: Comparing caregiver burden, mental health, and quality of life. Psychogeriatrics, 15(2), 123–132. https://doi.org/10.1111/psyg.12087
16.
EttersL.GoodallD.HarrisonB. E. (2008). Caregiver burden among dementia patient caregivers: A review of the literature. Journal of the American Academy of Nurse Practitioners, 20(8), 423–428. https://doi.org/10.1111/j.1745-7599.2008.00342.x
17.
FreedmanV. A.PattersonS. E.CornmanJ. C.WolffJ. L. (2022). A day in the life of caregivers to older adults with and without dementia: Comparisons of care time and emotional health. Alzheimer's and Dementia: The Journal of the Alzheimer’s Association, 18(9), 1650–1661. https://doi.org/10.1002/alz.12550
18.
GelmanC. R. (2014). Familismo and its impact on the family caregiving of latinos with alzheimer’s disease: A complex narrative. Research on Aging, 36(1), 40–71. https://doi.org/10.1177/0164027512469213
19.
HughesS. L.Giobbie-HurderA.WeaverF. M.KubalJ. D.HendersonW. (1999). Relationship between caregiver burden and health-related quality of life. The Gerontologist, 39(5), 534–545. https://doi.org/10.1093/geront/39.5.534
20.
JohnR.ResendizR.de VargasL. W. (1997). Beyond familism? Familism as explicit motive for eldercare among Mexican American caregivers. Journal of Cross-Cultural Gerontology, 12(2), 145–162. https://doi.org/10.1023/A:1006505805093
21.
KarlinN. J.WellJ.GouldJ. (2012). Comparisons between hispanic and non-hispanic white informal caregivers. Sage OPEN.
22.
Katiria PerezG.CruessD. (2014). The impact of familism on physical and mental health among Hispanics in the United States. Health Psychology Review, 8(1), 95–127. https://doi.org/10.1080/17437199.2011.569936
23.
KesselringA.KrulikT.BichselM.MinderC.BeckJ. C.StuckA. E. (2001). Emotional and physical demands on caregivers in home care to the elderly in Switzerland and their relationship to nursing home admission. The European Journal of Public Health, 11(3), 267–273. https://doi.org/10.1093/eurpub/11.3.267
24.
KimJ.-H.KnightB. G.LongmireC. V. F. (2007). The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 26(5), 564–576. https://doi.org/10.1037/0278-6133.26.5.564
25.
KindrattT. B.SylversD. L.YoshikawaA.López-AnuarbeM.WebsterN. J.BouldinE. D. (2023). Dementia caregiving experiences and health across geographic contexts by race and ethnicity. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 78(Suppl 1), S48–S58. https://doi.org/10.1093/geronb/gbac182
LamarM.EstrellaM. L.CapuanoA. W.LeurgansS.FleischmanD. A.BarnesL. L.Lange‐MaiaB. S.BennettD. A.MarquezD. X. (2023). A longitudinal study of acculturation in context and cardiovascular health and their effects on cognition among older latino adults. Journal of the American Heart Association, 12(6), Article e027620. https://doi.org/10.1161/JAHA.122.027620
28.
LennonJ. C.AitaS. L.BeneV. A. D.RhoadsT.ReschZ. J.EloiJ. M.WalkerK. A. (2022). Black and White individuals differ in dementia prevalence, risk factors, and symptomatic presentation. Alzheimer's and Dementia, 18(8), 1461–1471. https://doi.org/10.1002/alz.12509
29.
LinP.-J.ZhuY.OlchanskiN.CohenJ. T.NeumannP. J.FaulJ. D.FillitH. M.FreundK. M. (2022). Racial and ethnic differences in hospice use and hospitalizations at end-of-life among Medicare beneficiaries with dementia. JAMA Network Open, 5(6), Article e2216260. https://doi.org/10.1001/jamanetworkopen.2022.16260
30.
LiuC.MarinoV. R.HowardV. J.HaleyW. E.RothD. L. (2023). Positive aspects of caregiving in incident and long-term caregivers: Role of social engagement and distress. Aging and Mental Health, 27(1), 87–93. https://doi.org/10.1080/13607863.2021.2000935
LosadaA.Robinson ShurgotG.KnightB. G.MárquezM.MontorioI.IzalM.RuizM. A. (2006). Cross-cultural study comparing the association of familism with burden and depressive symptoms in two samples of Hispanic dementia caregivers. Aging and Mental Health, 10(1), 69–76. https://doi.org/10.1080/13607860500307647
33.
LuchsingerJ. A.TipianiD.Torres-PatiñoG.SilverS.EimickeJ. P.RamirezM.TeresiJ.MittelmanM. (2015). Characteristics and mental health of Hispanic dementia caregivers in New York City. American Journal of Alzheimer’s Disease and Other Dementias, 30(6), 584–590. https://doi.org/10.1177/1533317514568340
34.
MeghaniZ.EckenwilerL. (2009). Care for the caregivers? Transnational justice and undocumented non-citizen care workers. IJFAB: International Journal of Feminist Approaches to Bioethics, 2(1), 77–101. https://doi.org/10.3138/ijfab.2.1.77
35.
MehdipanahR.BriceñoE. M.GonzalesX. F.HeeringaS. G.LevineD. A.LangaK. M.GarciaN.LongoriaR.MorgensternL. B. (2021). Dementia care needs for individuals and caregivers among Mexican Americans and non-Hispanic Whites. Aging and Mental Health, 26(8), 1–12. https://doi.org/10.1080/13607863.2021.1925222
36.
NasreddineZ. S.PhillipsN. A.BédirianV.CharbonneauS.WhiteheadV.CollinI.CummingsJ. L.ChertkowH. (2005). The Montreal Cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
37.
PinquartM.SörensenS. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(2), P112–P128. https://doi.org/10.1093/geronb/58.2.p112
38.
RacineL.FordH.JohnsonL.Fowler-KerryS. (2022). An integrative review of Indigenous informal caregiving in the context of dementia care. Journal of Advanced Nursing, 78(4), 895–917. https://doi.org/10.1111/jan.15102
39.
RiedijkS. R.VugtM. E. D.DuivenvoordenH. J.NiermeijerM. F.SwietenJ. C. vanVerheyF. R. J.TibbenA. (2006). Caregiver burden, health-related quality of life and coping in dementia caregivers: A comparison of frontotemporal dementia and alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 22(5–6), 405–412. https://doi.org/10.1159/000095750
40.
RiffinC.Van NessP. H.WolffJ. L.FriedT. (2017). Family and other unpaid caregivers and older adults with and without dementia and disability. Journal of the American Geriatrics Society, 65(8), 1821–1828. https://doi.org/10.1111/jgs.14910
41.
RomeroA. J.EdwardsL. M.CorkeryS. (2013). Chapter 17 - assessing and treating latinos: Overview of mental health research. In PaniaguaF. A.YamadaA.-M. (Eds.), Handbook of multicultural mental health (2nd ed., pp. 327–343). Academic Press. https://doi.org/10.1016/B978-0-12-394420-7.00017-5
42.
RoteS. M.AngelJ. L.MoonH.MarkidesK. (2019). Caregiving across diverse populations: New evidence from the national study of caregiving and hispanic EPESE. Innovation in Aging, 3(2), igz033. https://doi.org/10.1093/geroni/igz033
43.
RothD. L.BrownS. L.RhodesJ. D.HaleyW. E. (2018). Reduced mortality rates among caregivers: Does family caregiving provide a stress-buffering effect?Psychology and Aging, 33(4), 619–629. https://doi.org/10.1037/pag0000224
44.
RothD. L.HaleyW. E.OwenJ. E.ClayO. J.GoodeK. T. (2001). Latent growth models of the longitudinal effects of dementia caregiving: A comparison of african American and white family caregivers. Psychology and Aging, 16(3), 427–436. https://doi.org/10.1037/0882-7974.16.3.427.
45.
SabogalF.MarínG.Otero-SabogalR.MarínB. V.Perez-StableE. J. (1987). Hispanic familism and acculturation: What changes and what doesn’t?Hispanic Journal of Behavioral Sciences, 9(4), 397–412. https://doi.org/10.1177/07399863870094003
46.
SpillmanB. C.FreedmanV. A.KasperJ. D.WolffJ. L. (2020). Change over time in caregiving networks for older adults with and without dementia. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 75(7), 1563–1572. https://doi.org/10.1093/geronb/gbz065
47.
TarlowB. J.WisniewskiS. R.BelleS. H.RubertM.OryM. G.Gallagher-ThompsonD. (2004). Positive aspects of caregiving: Contributions of the REACH project to the development of new measures for alzheimer’s caregiving. Research on Aging, 26(4), 429–453. https://doi.org/10.1177/0164027504264493
48.
TingeyJ. L.LumJ.MoreanW.FranklinR.BentleyJ. A. (2020). Healthcare coverage and utilization among caregivers in the United States: Findings from the 2015 behavioral risk factor surveillance system. Rehabilitation Psychology, 65(1), 63–71. https://doi.org/10.1037/rep0000307
49.
U. S. Census Bureau. (n.d.) U.S. Census Bureau QuickFacts: Nueces county, Texas. U. S. Census Bureau.
50.
WareJ. E.SherbourneC. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.
51.
WeirD.LangaK.RyanL.RyanL. (2016). 2016 harmonized cognitive assessment Protocol (HCAP) study Protocol summary. In Health and retirement study (pp. 1–15). Survey Research Center, Institute for Social Research, University of Michigan. https://hrs.isr.umich.edu/publications/biblio/9950
52.
ZaritS. H.ReeverK. E.Bach-PetersonJ. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20(6), 649–655. https://doi.org/10.1093/geront/20.6.649
53.
ZaritS. H.ToddP. A.ZaritJ. M. (1986). Subjective burden of husbands and wives as caregivers: A longitudinal study. The Gerontologist, 26(3), 260–266. https://doi.org/10.1093/geront/26.3.260
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