Caregivers of African-American Elderly with Dementia: A Review and Analysis
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Rita Hargrave, MD
Epidemiological studies predict that there will be a dramatic increase in the number of ethnic elderly persons in the United States in the coming years. Many of these individuals will suffer from such chronic illnesses as dementia, and will be cared for by family members. Over the past 20 years, there has been a growing body of literature describing the attitudes and experiences of ethnically and culturally diverse family caregivers of persons with dementia. This article reviews the current literature on African-American caregivers of persons with dementia in terms of the following: (1) caregiver characteristics; (2) explanatory models of dementia; (3) attitudes towards caregiving; (4) caregiver burden; (5) positive aspects of caregiving; (6) treatment recommendations; and (7) high-priority areas for future research.
According to current research, the nature of the relationship between the dependent elder and his/her caregiver varies across ethnic group lines. White caregivers are more likely to be spouses, whereas African-American caregivers are more likely to be adult children, extended relatives, or friends.1-4 In general, African-American caregivers as compared to white caregivers, are more likely to be younger, unmarried, with less formal education, and fewer financial resources.1,5 Because of their lower income and higher poverty rates, the financial stress of caregiving may pose a greater emotional burden on African-American caregivers.6,7
African-American caregivers, as compared to white caregivers, are more likely to provide more hours of care, higher-intensity care, and are more likely to report more unmet needs in terms of support and access to services.1,8-12 Many African-American caregivers are also actively caring for other people in addition to the frail elderly, such as minor children, grandchildren, and other family members.11,13
Even though African-American caregivers are caring for severely debilitated elders and other family members, they are less likely than white caregivers to use formal care services like nursing homes.14,15
Numerous studies have reported that African-American family caregiving of dependent elderly persons is performed within a collectivistic structure composed of different people with varying levels of involvement in daily caregiving activities.16,17 Since kinship ties are a very powerful force in African- American families, many investigators thought that African-American caregivers receive significant support from their network of family members. However, more recent studies suggest that prior research may have overestimated the availability and extent of support that African-American caregivers receive from other family members.1,18,19 These studies suggest that adult children of dependent elderly persons may be adversely affected by the other commitments in their own lives, which may severely limit the amount of assistance they can offer frail African-American elderly.
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