An Exploration of Service Needs and Preferences of Dementia Caregivers in Kentucky

As Americans live longer, the prevalence of Alzheimer’s disease and related dementias will increase. Caregivers are critical to the care and life quality of people with dementia. Yet, dementia caregivers are at increased risk for health issues, social isolation, and financial challenges. To help educators with the University of Kentucky Cooperative Extension Service work with their local Alzheimer’s Association and the University of Louisville to better support dementia families, we explored caregiver needs and service utilization using an online survey. Our findings highlighted the need for counseling/support, care management skills, resource education, self-care strategies, and legal services. Extension Service Educators can use this information to inform program development and support dementia families

Caregiver Well-Being and Burden: Variations by Race/Ethnicity and Care Recipient Nativity Status

Background and Objectives: Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others). Research Design and Methods: The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (N = 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver’s outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts of the inclusion of caregiving factors (background factors, primary stressors, secondary stressors, and resources). Results: Regression analyses showed that only care burden significantly varied by care recipient nativity status after controlling for covariates. Caregivers of foreign-born care recipients reported a higher burden. However, when interactions of care recipient nativity status × caregiver race/ethnicity were introduced, non-Hispanic black and Hispanic caregivers of foreign-born care recipients were more likely to report better psychological well-being and self-rated health compared to their counterparts. Across caregiver groups, better caregiver–care recipient relationship quality and less caregiver chronic conditions were associated with less burden and better caregiver psychological well-being and self-rated health. Discussion and Implications: Care recipient nativity status and caregiver race/ethnicity may have complex effects on caregiving experiences. Given the observed significant interaction effects for caregiver psychological well-being and self-rated health, cultural factors may affect the extent to which these caregivers appraise their caregiving. Future research should delve into the appropriate ways to assess care stress as well as resilience among each caregiver group. Our results indicate the need for research, education, and practice that assess cultural and within-group differences among caregivers and inform needed changes to structural barriers

Age of Migration Differentials in Life Expectancy With Cognitive Impairment: 20-Year Findings From the Hispanic-EPESE

Background and Objectives To examine differences in life expectancy with cognitive impairment among older Mexican adults according to nativity (U.S.-born/foreign-born) and among immigrants, age of migration to the United States. Research Design and Methods This study employs 20 years of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to estimate the proportion of life spent cognitively healthy and cognitively impaired prior to death among older Mexican adults residing in the southwestern United States. We combine age-specific mortality rates with age-specific prevalence of cognitive impairment, defined as a Mini-Mental Status Exam score of less than 21 points to calculate Sullivan-based life table models with and without cognitive impairment in later life. Results Foreign-born Mexican immigrants have longer total life expectancy and comparable cognitive healthy life expectancy regardless of gender compared to U.S.-born Mexican-Americans. However, the foreign-born spend a greater number of years after age 65 with cognitive impairment relative to their U.S.-born counterparts. Furthermore, we document an advantage in life expectancy with cognitive impairment and proportion of years after age 65 cognitively healthy among mid-life immigrant men and women relative to early- and late-life migrants. Discussion and Implications The relationship between nativity, age of migration, and life expectancy with cognitive impairment means that the foreign-born are in more need of support and time-intensive care in late life. This issue merits special attention to develop appropriate and targeted screening efforts that reduce cognitive decline for diverse subgroups of older Mexican-origin adults as they age

Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States

Background and Objectives: To document racial/ethnic and nativity differences by gender in cognitive life expectancies among older adults in the United States. Research Design and Methods: Sullivan-based life tables were used to estimate cognitively normal, cognitively impaired/ no dementia (CIND), and dementia life expectancies by gender for White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults 50 years and older in the Health and Retirement Study. Results: Among women, the number of years spent living with dementia for Whites, Blacks, U.S.-born Hispanics, and foreign-born Hispanics was 1.6, 3.9, 4.7, and 6.0 years, respectively. For men, Whites lived 1.1 years with dementia compared to 3.1 years for Blacks, 3.0 years for U.S.-born Hispanics and 3.2 years for foreign-born Hispanics. Similar patterns were observed for race/ethnic and nativity differences in CIND life expectancies. Blacks and Hispanics spend a larger fraction of their remaining years with CIND and dementia relative to Whites, regardless of gender. Foreign-born Hispanic men and women and Black men are particularly disadvantaged in the proportion of years spent after age 50 with CIND and/ or dementia. Discussion and Implications: Disparities in cognitive life expectancies indicate that intervention strategies should target the specific needs of minority and immigrant older adults with dementia. Given that education is a strong predictor of cognitive health, improving access to the social and economic resources that delay dementia onset is key to improving the well-being of diverse older adults

Living Arrangements and Dementia Among the Oldest Old: A Comparison of Mexicans and Mexican Americans

Background and Objectives The growing population of adults surviving past age 85 in the United States and Mexico raises questions about the living arrangements of the oldest old and those living with dementia. This study compares Mexican and Mexican American individuals aged 85 and older to identify associations with cognitive status and living arrangements in Mexico and the United States. Research Design and Methods This study includes 419 Mexican Americans in 5 southwestern states (Hispanic Established Population for the Epidemiologic Studies of the Elderly) and 687 Mexicans from a nationally representative sample (Mexican Health and Aging Study). It examines characteristics associated with living alone using logistic regression and describes the living arrangements of older adults with probable dementia in each country. Results Older adults with dementia were significantly less likely to live alone than with others in the United States while there were no relationships between dementia and living arrangements in Mexico. However, a substantial proportion of older adults with dementia lived alone in both nations: 22% in the United States and 21% in Mexico. Among Mexican Americans with dementia, those living alone were more likely to be women, childless, reside in assisted living facilities, and less likely to own their homes. Similarly, Mexican individuals with dementia who lived alone were also less likely to be homeowners than those living with others. Discussion and Implications Contextual differences in living arrangements and housing between the United States and Mexico pose different challenges for aging populations with a high prevalence of dementia

Disability and the Immigrant Health Paradox: Gender and Timing of Migration

Although research has documented better health and longer life expectancy among the foreign-born relative to their U.S.-born counterparts, the U.S. Mexican-origin immigrant population is diverse and the healthy immigrant effect likely varies by key structural and demographic factors such as gender, migration history, and duration in the United States. Using a life course framework, we use data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE 1993–2013) which includes Mexican-American individuals aged 65 and older to assess the heterogeneity in the immigrant health advantage by age of migration and gender. We find that age of migration is an important delineating factor for disability among both men and women. The healthy immigrant hypothesis is only observable among mid- and late-life migrant men for ADL disability. While among immigrant women, late-life migrants are more likely to have an IADL disability putting them at a health disadvantage. These findings illustrate that Mexican immigrants are not a homogeneous group and migrant health selectivity depends on both gender and when migrants arrived in the United States

Characteristics and Consequences of Family Support in Latino Dementia Care.

The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions - including, when appropriate, employing tactics to mobilize family support

Coping with racial discrimination: Assessing the vulnerability of African Americans and the mediated moderation of psychosocial resources.

Research demonstrates that the mental health of African Americans is negatively affected by discrimination, but few studies have investigated the effects of racial discrimination specifically and whether these effects vary by poverty and education levels. Using a sample of 3,372 African Americans from the National Survey of American Life (NSAL), we find a positive relationship between racial discrimination and depressive symptoms, with both lifetime and daily racial discrimination being more salient for depressive symptoms among impoverished African Americans than those living above 200% of the poverty line. Evaluating mediated moderation models, we also find that the conditional effects of socioeconomic status are mediated by poor African Americans’ having fewer psychosocial resources. Namely, lower levels of mastery are influential in accounting for poor African Americans’ greater vulnerability to both daily and lifetime discrimination. The findings highlight the importance of examining specific reasons for discrimination as well as mediated moderation in future research