Coping with Stress Associated with Alzheimer's Caregiving: A Comparison Between Chinese American Caregivers in Phoenix and Their Counterparts in Shanghai

Purposes: Alzheimer’s disease or related disorders (ADRD) is becoming a global concern as the world population is aging rapidly.   In many cultures, family members are primary caregivers of relatives with ADRD.  Cultural values and beliefs are believed to influence the caregiving process including seeking diagnosis/services, appraising caregiving situations, coping with caregiving difficulties, and caregiver psychosocial well-being.  This study aims to understand the differences and commonalities in stress and coping experience of Chinese-background family caregivers in two large cities (i.e. Phoenix in the U.S. and Shanghai in China).

Methods:  Data of this study came from the investigator’s two projects: the 2009 Chinese family caregiver study in Shanghai, and the baseline interview data from a 12-month longitudinal qualitative study on Chinese American family caregivers collected between 2010 and 2011 in Phoenix, U.S.  Caregivers from Shanghai (n=18) ranged from 53 to 82 in their age; 14 were spousal caregivers and 4 adult children or children-in-law caregivers. Caregivers from Phoenix (n= 20) aged from 43 to 81; 9 spousal caregivers and 11 adult children caregivers.  Semi-structured interviews were used in both projects to collect information regarding perceived stressful behavioral problems of care recipients (CR), strategies or tactics used to deal with stress, and cultural explanations of their appraisal of caregiving situations and behaviors. 

Results: Thematic analysis revealed three common themes across two groups: 1) behavioral problems are most stressful when posing risks to the safety or health of CR; 2) family is a source of strength to overcome caregiving stress but also a place to trigger family conflict that exacerbates stress; and 3) caregivers draw on education, spirituality, cultural beliefs (i.e., fatalism, filial piety, and family cohesion), technology, and informal networks as coping strategies.  Differences between two groups are that Shanghai caregivers perceived more stress from the sociopolitical environment, such as the prevalent societal prejudice against AD patients and the complicated reimbursement system for medical care, while Phoenix caregivers tended to comment on the positive aspects of the U.S. health and social service systems.  In terms of coping, Shanghai caregivers showed more initiative in seeking strategies to help ADRD patient “recover”, such as utilizing alternative medicine treatment or creating physical or mental exercise activities for their CRs.    

Discussion: Chinese-background family caregivers living in Phoenix and China both struggle with their CRs’ behavioral problems, and draw on their family strengths to cope with stress associated with caregiving. Thus, CR behavioral problem management and facilitation of family support could be core components in intervention designs for caregivers from both countries. Moreover, in Shanghai more effort is needed to help decrease ADRD stigma in society and remove barriers to access health care services. Service agencies in the Phoenix need to find more culturally appropriate approaches (e.g., through word of mouth of existing Chinese clients and family members) to increase caregiver awareness of available resources.