Cultural Diversity and Caregiving

Rates of caregiving vary somewhat by ethnicity. For example, among the U.S. adult population, approximately one-fifth of both the non-Hispanic White and African-American populations are providing care to a Asian caregiverloved one, while a slightly lower percentage of Asian-Americans — 18 percent — and Hispanic Americans — 16 percent — are engaged in caregiving (National Alliance for Caregiving (2009). In a national survey which looked only at people 70 years of age or older, however, 44 percent of Latinos were found to receive home-based family caregiving compared to 34 percent of blacks and 25 percent of non-Hispanic Whites (Weiss et al, 2005).

Studies show that ethnic minority caregivers provide more care than their White counterparts and report worse physical health than White caregivers (McCann et al, 2000). Several studies have found that African-American caregivers experience less stress and depression and garner greater rewards from caregiving than White caregivers (Cuellar, 2002; Haley et al, 2004). Hispanic and Asian American caregivers, however, exhibit more depression than white caregivers (Haley et al, 2004).

Additional findings reported in a 2005 meta-analysis of 116 empirical studies, conducted by Pinquart & Sörensen, suggest further ethnic differences among caregivers:

  • Asian-American caregivers made less use of professional support services than did White caregivers.
  • Ethnic minority caregivers had a lower socioeconomic status, were more likely to receive support from family members and friends, provided more care than White caregivers, and had stronger filial obligation beliefs than White caregivers.
  • All ethnic minority caregiving groups reported worse physical health than the White caregivers experienced.
  • African-American caregivers had lower levels of caregiver burden and depression than White caregivers. Hispanic and Asian-American caregivers were more depressed than White caregivers.

Ethnic differences are also found with regard to the care-recipient. Among people aged 70 and older who require care, Whites are the most likely to receive help from their spouses, Hispanics are the most likely to receive help from their adult children and African Americans are the most likely to receive help from a non-family member (National Academy on an Aging Society, 2000).

Research also shows that Americans also vary from caregivers in other countries. Among caregivers for older adults with disabilities, Americans appear to have spent less time with a care-recipient than their Swiss counterparts before assuming the caregiver role (Karlin, O’Reilly & Williams, 1997). In addition, while family caregivers of loved ones with Alzheimer’s disease and other forms of dementia in the U.S. and China were found to have similar coping styles, the Americans reported experiencing more depression and anxiety (Shaw et al., 1997).

The main reason for all of these divergences, research suggests, is that cultural perspectives differ across ethnic groups and may impact caregiver experiences in several domains, including perceptions of the caregiving role, utilization of support services, and clinical presentations and interactions. In addition, psychological characteristics often predict adjustment among family members in a theoretically consistent and interpretable manner (Chan, Lee & Lieh-Mak, 2000).

Lesbian, Gay, Bisexual and Transgender Caregiving

An estimated 1.75 million to 4 million older adults are lesbian, gay, bisexual or transgender (LGBT), and this number is expected to double by 2030 (Administration on Aging, 2010). About one in three LGBT older people lives alone (as compared to one in five non-LGBT people), while 40 percent of LGBT older people say that their support networks have become smaller over time. African-American LGBT adults are three times as likely as White or Hispanic LGBT adults to say that people from their churches or faith are part of their support systems (SAGE, 2014). 

LGBT older adults are more likely to have provided care for an adult friend or relative in the past six months (Family Caregiver Alliance, 2012).  

LGBT older adults are also more likely to face poverty or economic difficulty, and they deal with significant physical health and mental health disparities; despite this, many supports in place for the aging in America do not cater to the special needs of LGBT seniors (SAGE, 2014).

Rural Caregiving

While caregiving occurs everywhere in society, rurality likely affects caregiving. Factors related to caregiving in a rural community, to some extent, are responsible for differences in the nature and outcomes of caregiving. For many rural caregivers, poverty combines with lack of health services, fewer resources and living in an underserved area to negatively impact caregiving. Often family members, neighbors and friends provide both direct and indirect caregiving services. However, family members may migrate to other areas seeking education, employment and other opportunities. This often reduces the number of family members or paid caregivers available to provide care for rural elders.  

Although caregivers of varying ages and backgrounds may need to perform similar activities, living in an underserved area may influence the way rural caregivers perceive and respond to their responsibilities. Caregiver reactions, coping strategies, distress levels, acceptance of symptoms and attitudes toward clinicians and outside help may vary considerably across different cultures (“Culture and Caregiving,” 1992) and potentially within rural areas as well. 


References

Administration on Aging (2010). Diversity. Retrieved from http://www.aoa.acl.gov/AoA_Programs/Tools_Resources/diversity.aspx

Chan, C.K., Lee, P. & Lieh-Mak, F. (2000). Coping with spinal cord injury: Personal and marital adjustment in the Hong Kong Chinese setting. Spinal Cord, 38, 687–696.

Cuellar, N.G. (2002). Comparison of African American and Caucasian American Female Caregivers of Rural, Post-Stroke, Bedbound Older Adults. Journal of Gerontological Nursing 28, 36-45.

Easter Seals & National Alliance for Caregiving (2006). Caregiving in Rural America. Retrieved from: http://es.easterseals.com/site/DocServer/Caregiving_in_Rural-saveas-compress.pdf?docID=49463

Family Caregiver Alliance (2012).  Selected Caregiver Statistics (Fact Sheet). Retrieved from https://www.caregiver.org/selected-caregiver-statistics

Haley, W.E., L.N. Gitlin, S.R. Wisniewski, D.F. Mahoney, D.W. Cood, L. Winter, M. Corcoran, S. Schinfeld,& M. Ory (2004). Well-being, Appraisal, and Coping in African-American and Caucasian Dementia Caregivers: Findings from the REACH Study. Aging and Mental Health, 8, 316-29.

Karlin, N.J., O’Reilly, B.K. & Williams, S. (1997). Cross-cultural differences between Swiss and American caregivers of Alzheimer’s disease family members. Journal of Clinical Geropsychology, 3, 257–265.

McCann, J.J., L.E. Hebert, L.A. Beckett, M.C. Morris, P.A. Scherr, & D.A. Evans (2000). Comparison of Informal Caregiving by Black and White Older Adults in a Community Population. Journal of the American Geriatrics Society 48,1612-1617.

National Academy on an Aging Society (2000). Caregiving: Helping the Elderly with Activity Limitations. Challenges for the 21st century: Chronic and Disabling Conditions, No. 7. Washington, DC: Author.

National Alliance for Caregiving (2009). Caregiving in the U.S. Retrieved Nov. 1, 2010 from: http://www.caregiving.org/data/Caregiving_in_the_US_2009_full_report.pdf

Pinquart, M. & Sörensen, S. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. The Gerontologist, 45, 90-106.

SAGE (2014). Out and Visible: The Experiences and Attitudes of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults, Ages, 45-75. Retrieved from http://www.sageusa.org/resources/publications.cfm

Shaw, W.S., Patterson, T., Semple, S., Grant, J., Grant, I., Yu, E., Zhang, M., Hi, Y. &Wu,W. (1997). A cross-cultural validation of coping strategies and their associations with caregiving distress. Gerontologist, 27, 490–504.

Weiss, C.O., H.M. Gonzalez, M.U. Kabeto, and K.M. Langa (2005). Differences in Amount of Informal Care Received by Non-HispanicWhites and Latinos in a Nationally Representative Sample of Older Americans. Journal of the American Geriatric Society 53,146-151.