Latino Alzheimer's Family Caregivers: Does Spirituality Enhance the Experience of Caregiving?

Background and Purpose: According to Pearlin and associates' (1990) stress process model, spirituality and religion (S/R) mediate the relationship between caregiving stressors and caregiving outcomes. While previous research has documented the protective role of S/R among non-Hispanic White and African American family caregivers, little research has been conducted with Latino samples. In light of the growing size and cultural distinctiveness of the Latino population, this study examined the role of S/R in relation to caregiving stressors and positive aspects of caregiving (PAC) [e.g., feelings of reward/usefulness as a result of caregiving] among a sample of Latino Alzheimer's family caregivers.

Methods: The study was conducted using baseline Latino participants (N=209) from the NIH-funded Resources for Enhancing Alzheimer's Caregiver Health (REACH) II dataset. The sample (Mage=58, SD=13.7) was 82.3% female and 34.6% Cuban American, 21.6% Mexican heritage, 21.2 % Puerto Rican, and 22.5% other Latino. Guided by Pearlin and associates' model (1990), we assessed objective stressors (i.e., care recipient difficulties in performing ADL/IADL, care recipient cognitive functioning), subjective stressors (i.e., caregiver burden, caregiver strain due to assistance with care recipient ADL/IADL), and caregiving outcome (i.e., PAC). S/R was indicated by frequency of prayer, church attendance, and positive and negative religious coping. Covariates included caregiver socioeconomic status (SES), social support, caregiver years in the U.S., and caregiver country of origin. Given the latent constructs in the model, we conducted structural equation modeling (SEM) using LISREL 8.51.

Results: The confirmatory factor analysis with a maximum likelihood estimation method indicated the measurement model fit the data reasonable well (CFI=.92, SRMR=.06, RMSEA=.07). All factor loadings on latent constructs were statistically significant. A good model fit was also achieved for the structural model (CFI=.93, SRMR=.07, RMSEA=.06). The direct effects of subjective stressors on PAC were not significant in the multivariate structural model. Cuban caregivers were less likely to engage in S/R than other Latino caregivers (B= -.72, p < .01); participants with higher levels of S/R tended to have higher PAC (B=.29, p<.01); social support was positively related to PAC (B=.20, p< .01), while SES was inversely related to PAC (B=-.39, p< .01).

Conclusions and Implications: The findings suggest that the stress process model can be used to at least partially explain the caregiving process among Latino Alzheimer's family caregivers. The differential results regarding Cuban Americans suggest that future researchers should consider the variability that exists within the larger Latino population. The inverse relation between PAC and SES led us to wonder if caregivers with higher SES might perceive that they sacrifice more to provide care for their family members, thereby resulting in fewer positive feelings about caregiving. Still, more research is needed to ascertain how income and education influence Latino caregivers' positive feelings of caregiving. Social support and S/R both enhanced experiences of caregiving. This implies that practitioners working with Latino family caregivers with Alzheimer's patients may increase levels of PAC among caregivers by identifying and working with clients to eliminate barriers that mitigate social support and S/R engagement.