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Alzheimers Disease: Latino Caregivers

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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


1
Alzheimers Disease Latino Caregivers
  • Elvira Jimenez
  • CHS 286
  • March 10, 2008

2
Significance
  • 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,
    2004)

3
Alzheimers Disease (AD) and Related Dementias
  • AD affects memory, ability to learn, reason,
    make judgments, communicate and carry out daily
    activities(Alzheimers Disease Association,
    2006)
  • 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

4
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

5
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

6
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
    burden
  • Latinos had lower level of depression and
    higher level of self acceptance than whites
    (Morano and King, 2003)

7
AD-Severity
  • 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)

8
Quality of Caregiving
  • Latinos reported higher self- efficacy when
    responding to disruptive behaviors and
    controlling negative behaviors (Depp et al., 2005)

9
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)

10
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
    caregiving
  • 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.

11
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)

12
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)

13
Research question
  • How do cultural specific factors in Latinos
    affect access and utilization of caregivers
    services?

14
Quantitative
  • Are cultural factors a reason Latinos and their
    caregivers fail to access medical and respite
    care?
  • 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

15
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
    resources
  • Need- users perception of that particular
    service such as the level of illness or disease

16
Problem
  • Quantitative studies only provide insight into
    relationships and fail to identify specific
    cultural factors that may mediate or increase
    caregiver stress

17
Qualitatively
  • What culture specific factors explain caregiving
    for Latinos and their caregivers in dementia
    care?
  • 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
    services
  • Caregivers will state that family is responsible
    for taking daily care of the needs faced by the
    patient.
  • 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.

18
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

19
What Next.
  • Database
  • Alzheimers Disease Reseach Center (ADRC)
    Longitudinal study
  • Clinical data
  • Study sites
  • Olive View medical center - ADRC satellite
  • El Portal East LA

20
Limitations
  • Existing data may be limited to look at access
  • Interview process lengthy
  • Heterogeneity within Latino population

21
  • Thank you!!!!
  • Comments Elvira_at_ucla.edu
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