Working with Families, Caregiving, and Social Support

Social Support

Social support and family caregiving within the context of the Hispanic/Latino elders can include not only nuclear and extended family, but also fictive (non-relatives) kin, friends, church members, and neighbors who can serve in many roles for these elders. Based on previous studies social support networks appear to be more available for Hispanic/Latino elders (Aranda & Miranda, 1997). Earlier studies report that Mexican American, Cuban American, and Puerto Ricans rely on informal support networks post hospitalization more than formal support (Commonwealth Fund Commission, 1989). Whether or not the traditional extended family can still be viewed as a viable support network for Hispanic/Latino elders, however, has been debated in the literature (Aranda & Miranda, 1997). In contrast, elderly Mexican Americans with numerous chronic conditions and from lower to middle socioeconomic incomes believed they would not have a caregiver available should they become ill (Talamantes, et al., 1996).

Family obligations and the perception of the family changed with level of acculturation in that the higher the level of acculturation, the lower the perception of family obligations and the family as a referent. However, perception of family support did not change due to acculturation (Sabogal, et al., 1987). There were no ethnic differences found among the Mexican American, Cuban American and Puerto Ricans in relationship to their cultural values regarding the family even though there was heterogeneity among groups regarding accessibility to family (Sabogal et al., 1987).

Both earlier and current research emphasize the importance of the family (nuclear and extended) and community (friends & neighbors) as the most important social and supportive entities for Cuban, Puerto Rican and Mexican Americans (COSSMHO, 1995; Gallagher-Thompson, Talamantes,. Ramirez, & Valverde, 1996). Some studies have reported that elderly Hispanic/Latinos expect their children to provide support as found (Cox & Monk, 1990; Markides, Boldt, and Ray, 1986). Mutual reciprocity continues to be exhibited by the elders and their families for care provison by well elders and for disabled elders (Sotomayor, 1992; Gallagher-Thompson, Talamantes, Ramirez, Valverde, 1996).

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Family Caregiving

With the elderly Hispanic/Latino population growing, caring for this population will present numerous challenges for families and opportunities for service provision by the community. A growing body of research provides information on stress, burden and the coping process experienced by Hispanic/Latino caregivers from the various ethnic groups (Angel, et. al, 2004; Talamantes et al., 2006; Aranda, Knight, 1997; John & McMillian, 1998; Delgado & Tennstedt, 1997; Saldana, Dassori, Miller, 1999; Phillips, Torres de Ardon, Komnenich, Killeen & Rusinak, 2000).

Aranda et al.,(1997) conducted a sociocultural analysis on the influence of ethnicity and culture on stress and the coping process. They reported that Hispanic/Latino caregivers may either experience increased levels of stress and burden resulting in higher levels of depressive symptoms which was also supported by Friss, Whitlatch, & Yale in 1990. Ethnicity may serve as a protective mechanism for experiencing caregiver burden (Talamantes, Fabrizio, Lichtenstein, Hazuda, 1996). Wallace and Lew-Ting (1992), found that accessibility to family reduced the use of in-home services; however, it is not known whether Latino elders were unaware of availableformal services, or whether a distrust of the service network existed.

In a cross-sectional longitudinal study on aging between Mexican Americans (MA) and European Americans (EA), caregiver burden was examined. Results showed that there were no differences in caregiver burden between the two groups. Although among the MAs, those caring for a parent or sibling experienced higher levels of burden compared to elders caring for a spouse or other (Talamantes, et al., 1996).

In a study comparing Cuban American and European American caregiving daughters with similar socioeconomic backgrounds, no significant differences were found in level of depression (Minzter, Rupert, Lowenstein, et al., 1992). Examining Cuban caregiver predictors of positive (satisfaction) and negative (burden) appraisal, researchers found that older caregivers and higher levels of support predicted higher satisfaction (Harwood, Barker, Ownby, 2000). Behavioral disturbances, being female, and perceiving less social support predicted increased levels of burden by the subjects (Harwood, et al., 2000).

More symptoms for depression, however, were found with a small sample of primarily Puerto Rican caregivers as measured by the CESD (Cox & Monk, 1990). In another study Puerto Rican caregivers were found to be providing instrumental and affectional support to their elderly family members. Noteworthy were that only about half of the sample utilized formal resources, and they reported a lack of trust with formal providers (Sanchez-Salgado, 1994). Puerto Rican caregivers have reported that if they were unable to provide care to their elders, other family members would provide the care rather than use formal resources (Delgado & Tennstedt, 1997).

Studies have reported that Hispanic/Latino caregivers find themselves as the sole caregivers despite the “overidealization” of the family support system. Feelings expressed by Mexican American caregivers included a sense of isolation and frustration in focus groups (John & McMillian, 1998). In another study Mexican American caregivers perceived their social support networks as smaller compared to the European American sample of caregivers (Phillips, et al., 2000).

In this same study, caregiving spouses perceived more burden than adult children. In many of these studies, the primary caregiver has usually been a daughter, especially if a spouse was not available (Phillips, et al., 1997; Gallagher, et., al., 1996).

For a detailed description of caregiving and caregiving interventions from the Mexican American, Puerto Rican and Cuban perspectives see Ethnicity and the Dementias, (2006) edited by Gwen Yeo and Dolores Gallagher-Thompson.

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Working with Families

Due to the heterogeneity of the Hispanic/Latino caregivers and their use of formal and informal resources, it is critical for health providers to assess the social and family networks to determine the extent of support that is being provided to the primary caregiver. The following suggestions are recommended for providers:

  • Organize a very inclusive family meeting to help families see the role of the primary caregiver and provide recommendations for how other members can support the primary caregiver and care recipient.
  • Help family caregiver(s) identify resources which have bilingual/bicultural staff for the provision of services.
  • Link primary caregiver to support groups in their preferred language and if they are not available in the community, link caregiver to another caregiver who is further along in their resource development and support systems.
  • Provide family caregivers with several types of educational programs for teaching them about the disease or issues related to their aging parent. Educational programs can consist of video or audiotapes (Spanish language if client is monolingual), simple handouts related to illness and recommendations for care.
  • Conduct “call-in” telephone media presentations on aging issues. If they are consistently aired, referrals will increase.

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