Factors Affecting Caregiver Burden Among Caregivers of Frail Older Korean Immigrants

Purpose: Population aging, longer life expectancy, and increasing disability with age all lead to increasing need for long-term care and services for older Americans. Because of structural and cultural barriers, immigrants may face challenges in accessing service they need. Caregiving research in the last several decades has made a significant contribution to our understanding of informal caregiving, but caregiving research with immigrants is limited. This study focused Korean immigrants, one of the fastest growing immigrant groups. Because of their foreign-born status, limited English proficiency, and lack of insurance, caregivers of older Korean immigrants are left vulnerable in a time of need for long-term care. Guided by the stress-coping process model, this study assessed relationships on measures of caregiving stress, support and efficacy on caregiver burden in a sample of Korean American caregivers.

Methods: This cross-sectional survey recruited participants from social service agencies, senior centers, churches, and adult day care centers that serve Korean immigrants in a mid-Atlantic metropolitan area. Inclusion criteria included being an adult caregiver (18+) for an older adult relative (age 60+) of Korean ethnicity. A total of 142 caregivers completed the survey in his/her preferred language (English or Korean) by telephone or in-person. Data were collected on demographics, the caregiving context, caregiving demand, secondary stressors, caregiving support, and caregiving self-efficacy. We regressed a caregiver burden measure on variable representing the above groupings in blocks and assessed improvement in the model using R2adj values. A final model tested the relationship of all independent variables with caregiver burden.

Results: The base model included caregiver and older adult demographics (R²adj=.15). Addition of caregiving context (DR²=.08; p=.03), caregiving demand (DR²=.07; p=.05), secondary stressors (DR²=.18 p<.001) all led to increasing increments of variance explained. Addition of caregiving support variables to the model did not improve the model but the caregiving self-efficacy, the last block, did improve R² (DR²=.04; p=.02), resulting in R²adj of the final model =.46. In the final model, male gender (ß=-25; t=-3.08; p=.003), being an adult child caregiver (ß=-.38; t=-3.15; p=.002), a son/daughter-in-law (ß=-.20; t=-2.08; p=.04.) or other relative/friend caregiver (ß=-.21; t=-2.35; p=.02), being currently employed (ß=-.20; t=-2.40; p=.02), relationship satisfaction (ß=-.24; t=2.69; p=.008), and self-efficacy in care management (ß=-.26; t=-2.78; p=.007) were all associated with lower burden levels. Conversely, greater family conflict was associated with higher levels of burden (ß=.19; t=2.27; p=.03).

Conclusions and Implications: Among Korean-American caregivers, results suggest that being a spousal caregiver is associated with increased burden compared with children and other relatives. Negative and positive family relationships (i.e. relationship satisfaction and family conflict) may be an important part of understanding burden. Caregiver confidence in helping the older adult cope with symptoms and their employment outside the home may protect against undue burden. Interventions targeted at Korean-American caregivers should prioritize spousal caregivers and offer skills in caregiving. Future research should consider the role of family context in Korean-American caregiving experience.