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Alzheimers Disease: Latino Caregivers


It is projected that the Alzheimer's disease population will increase 3-fold ... Currently, there are more than 42 million Hispanics in the ... (Strauss ... – PowerPoint PPT presentation

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Title: Alzheimers Disease: Latino Caregivers

Alzheimers Disease Latino Caregivers
  • Elvira Jimenez
  • CHS 286
  • March 10, 2008

  • 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,

Alzheimers Disease (AD) and Related Dementias
  • AD affects memory, ability to learn, reason,
    make judgments, communicate and carry out daily
    activities(Alzheimers Disease Association,
  • 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

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

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

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
  • Latinos had lower level of depression and
    higher level of self acceptance than whites
    (Morano and King, 2003)

  • 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)

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

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)

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
  • 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.

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)

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)

Research question
  • How do cultural specific factors in Latinos
    affect access and utilization of caregivers

  • Are cultural factors a reason Latinos and their
    caregivers fail to access medical and respite
  • 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

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
  • Need- users perception of that particular
    service such as the level of illness or disease

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

  • What culture specific factors explain caregiving
    for Latinos and their caregivers in dementia
  • 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
  • Caregivers will state that family is responsible
    for taking daily care of the needs faced by the
  • 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.

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

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

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

  • Thank you!!!!
  • Comments