Predictors of Caregivers' Consideration for Institutionalization of Care Recipients with Alzheimer's Disease Among Three Different Ethnicities
Abstract
Purpose: The increasing number of older adults in the US suggests accordingly increasing older populations with Alzheimer’s Disease (AD). As some studies found a higher prevalence of AD among ethnic minority older adults, understanding different needs of ethnic minority caregivers is an important task. Unfortunately, despite a growing interest in the ethnic differences that shape the context of caregiving experiences, previous studies have so far been mostly exploratory and atheoretical and focused on White caregivers (Dilworth-Anderson, Williams & Gibson, 2002; McLennon et al., 2010). Culturally relevant and reliable practices are needed for caregivers of individuals with AD across different ethnic groups. To promote deeper understanding of diverse ethnic caregivers’ consideration for institutionalization, the aim of the current study is to examine variations in consideration about institutionalization among different ethnic groups of caregivers using the secondary analysis of the Resources for Enhancing Alzheimer’s Caregiver Health II (REACH) data.
Methods: The study used 2002-2004 REACH II baseline data with 615 caregivers [n=204(Hispanic), n=211(Caucasian), & n=200 (African-American)] and their care recipients with Alzheimer’s disease. Employing a model of ethnic differences in caregiving variables (Pinquart & Sorensen, 2005), seven variables of interest were identified. The outcome variable, caregivers’ consideration about institutionalization, was measured with the Desire to Institutionalize (DIS) scale to record information regarding the caregiver’s plans for institutionalization of a care recipient. Other variables of interest include caregivers’ race/ethnicity, use of formal services, caregiver burden, hours of caregiving, and care recipients’ ADL and IADL, and their cognitive functioning measured by MMSE scores. A binary logistic regression was used to predict the caregivers’ having consideration/no consideration about institutionalization.
Results: The results indicate that caregivers’ ethnicity and stress were strong predictors of caregivers’ consideration about institutionalization (p < .001). Interestingly, caregivers’ ethnicity was only significant for Hispanic (p < .001) and not for African Americans. Other significant predictors include caregivers’ use of transportation service and caregiving hours (p < .05). The only significant characteristic of care recipients was their IADL level (p < .01).
Implications: As caregivers’ ethnicity is found to be significant for Hispanic but not for African Americans, the effort to understand different perceived burden and needs of different ethnic minorities is urgently needed. Social workers and policy makers should not be misinformed that being an ethnic minority makes caregivers immune from feeling stressed. Practitioners and clinicians should work toward meeting the diverse needs of caregivers related to transitioning their loved ones to an institution.