Care Recipient Immigrant Status and Caregiver Well-Being

Background/Purpose

The population of immigrant individuals in the United States is now a record 14 percent and is predicted to increase to over 17 percent by the year 2065. This demographic trend is predicted to continue due to both the ageing of the existing foreign-born population in the United States and through ongoing admissions of older immigrants and refugees. Immigrant older adults are also more likely to live with and receive care informally through family and social networks compared older adults born in the United States.  Little research has been conducted on the potentially unique experiences and outcomes of caregivers (CGs) of foreign-born older adults (or care recipients (CRs)). Using a nationally representative sample of Medicare beneficiaries and Stress Process Model, we addressed the following hypotheses: 1) Relative to CGs of US-born CRs, the CGs of foreign-born CRs will report more care burden and poorer self-reported physical health and psychological well-being; 2) Race/ethnicity would have a significant interaction effect between CR’s immigrant status and CG’s care burden, self-rated physical health and psychological well-being.

Methods

The current study used Round 1 and Round 5 of National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) (N=1,293). We used the OLS regression to investigate the moderating effects of immigrant status (U.S. born vs foreign born) by race/ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, Others), controlling for background factors, primary stressors (help with ADL & IADL, help with medical care, help with medical insurance and appointments), secondary stressors (limited activities, financial difficulties, and family disagreement due to care), and resources (formal and informal support, relationship quality with CR).

Results

Without controlling for stressors, resources, and background factors, CGs of immigrant CRs in each subgroup showed higher level of self-reported care burden with significant difference observed for Non-Hispanic Black CGs of immigrant CRs. Psychological well-being and self-rated physical health did not significantly vary by immigrant status within racial/ethnic subpopulations. When we controlled for covariates, CGs of immigrant CRs reported statistically significantly less care burden and better psychological well-being than the CGs of U.S.-born CRs. We also observed the significant interaction effect by Black*immigrant status for self-rated physical health. Black CGs of immigrant CRs were more likely to experience poorer self-rated physical health than Black CGs of U.S. born CRs. 

Conclusion/Implications

The current study highlights differences and similarities in care stress by immigrant status and race/ethnicity. CR’s immigrant status and race/ethnicity may have complex effects on caregiving experience. Notably, Black US-born CGs reported poorer physical health compared to immigrant black CGs as well other subgroups. Given the high rates of disability reported by Black caregivers, especially U.S.-born caregivers, multicomponent interventions that promote self-care and enable caregivers to live healthier lives in addition to other caregiver coping strategies should be provided. With projections that there will be increased racial/ethnic diversity, and 16 million immigrant older adults in the U.S. by 2050, future studies should continue to examine the differences in the trajectory of caregivers’ stress by immigrant status and race/ethnicity.