Factors that contribute to stress among Japanese-American and Caucasian-American family caregivers of frail elders

Abstract

Care for frail elderly adults in the U.S. has increasingly become the financial, physical and emotional responsibility of family members. Over twenty years of caregiving research has documented many factors that contribute to stress among caregivers. Due to the inherent stresses associated with informal caregiving, and an increase in multi-ethnic elders in the U.S., this study was designed to investigate factors that contribute to caregiving stress among Japanese-American and Caucasian-American caregivers of frail elders. The purpose of this study was to examine a model of factors associated with stress, and to compare the utility of this model in the prediction of stress among Japanese-American and Caucasian-American caregivers of frail elders in Hawaiʻi. Specifically, this study examined the importance of (1) employment status, (2) time spent caregiving, (3) use of formal services, (4) functional ability, (5) social support, (6) health problems, and (7) attitude toward family care in explaining stress among caregivers. Stress was measured by two indicators, depression and life satisfaction. A correlational design was used to test the hypothesized relationships. Participants in this study were 98 Japanese-American and 86 Caucasian-American adult family caregivers who were caring for a frail elder at home. Participants were recruited from two caregiver support groups, two adult day care centers, and one home health care agency on O'ahu. Multivariate analysis of variance revealed that there were significant differences between the Japanese-American and Caucasian-American samples with regard to the model of factors hypothesized to predict stress among caregivers. Simultaneous multiple regression analyses were used to test the hypothesized relationships between predictor and criterion variables. Decreased social support and more health problems of the caregiver were significant in the prediction of depression among Japanese caregivers; increased employment, decreased service use, and more health problems were significant in the prediction of depression among Caucasian caregivers. The variable "attitude toward family care" significantly predicted depression in both groups. Decreased time spent caregiving, increased social support, and stronger attitude toward family care were significant in the prediction of life satisfaction among Japanese caregivers. Only the variable "attitude toward family care" was significant in the prediction of life satisfaction among Caucasian caregivers. The results of this study are limited with regard to generalizability. The use of a convenience sample, the use of a correlational design (limiting causal inferences), and modifications made to the ATPLTC scale that measured "attitude toward family care," a scale not previously tested for psychometric properties or for use among multiethnic populations, limit the generalizability of these findings beyond the sample participants. In light of these limitations, future research could examine the continued use of the modified ATPLTC scale among multiethnic populations due to the promising results found in this study. "Attitude toward family care of elders" was the only variable that was significant with both samples, and with both indicators of stress. The importance of attitudes in determining behaviors associated with caregiving for frail elders among ethnically diverse caregivers may greatly assist social workers, gerontologists, and other health care professionals in providing culturally competent services and interventions.