RESUMO
Long-term care use among older Mexican-Americans is poorly understood, despite the adverse effects on health and economic disadvantage in this vulnerable population. This study examines gender-based risk of long-term care use in 628 women and 391 men, age 70 and over in the 2000-2001 and 2004-2005 waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Logistic regression models are employed to assess the impact of the opportunity cost implications of family support (kin availability and co-residence) relative to health care needs (quality-adjusted life years (QALY) weighted scores and functional limitations) on women's risk of entry into a nursing home. A small percentage (~5%) of men and women had entered a long-term care facility. Women had lower weights for QALY weights and greater disability than men, but on average were more likely to live with or in closer proximity to an adult child. Higher disability rates (p < 0.01) increased the risk of institutionalization regardless of gender because disability increases time burdens. Families with fewer adult children faced higher time burdens per child in caring for elderly parents; particularly for elderly mothers. Demographic trends suggest that the number of adult children available to share the caregiving load may decrease long-term care use.
Assuntos
Moradias Assistidas/estatística & dados numéricos , Efeitos Psicossociais da Doença , Assistência de Longa Duração/estatística & dados numéricos , Americanos Mexicanos , Casas de Saúde/estatística & dados numéricos , Idoso , Características da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco , Fatores Sexuais , Sudoeste dos Estados UnidosRESUMO
This study identifies the risk and protective factors associated with informal caregiving by older (≥70 years) Mexican Americans and profiles caregiving arrangements. Overall, a greater number of informal caregivers (n = 92) were married and female. They also had higher physical functioning and better cognition than non-caregivers (n = 1,888) but fewer visited a physician regularly. Informal caregivers also showed an increased risk of depressive symptoms. A third of caregivers spent more than 20 h/day caregiving and the majority (84%) of care recipients were family members. In order to support the efforts of this disproportionately burdened caregiver group, increased social support and healthcare services are needed.
Assuntos
Cuidadores/psicologia , Transtornos Cognitivos/psicologia , Depressão/psicologia , Americanos Mexicanos/psicologia , Apoio Social , Aculturação , Atividades Cotidianas , Adaptação Psicológica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Família/psicologia , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Qualidade de Vida , Análise de Regressão , Fatores Socioeconômicos , Estresse Psicológico , Inquéritos e QuestionáriosRESUMO
Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.
Assuntos
Serviços de Saúde para Idosos/normas , Americanos Mexicanos , Aculturação , Idoso , Efeitos Psicossociais da Doença , Família , Feminino , Serviços de Saúde para Idosos/economia , Serviços de Assistência Domiciliar/economia , Humanos , Masculino , Responsabilidade Social , Estados UnidosRESUMO
OBJECTIVE: We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia. METHODS: Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the US-Mexico border. We assessed caregivers' intrinsic, organizational and non-organizational religiosity with the Duke Religiosity Index, as well as Pargament's brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers' mental and physical health, depressive symptomatology and perceived burden. RESULTS: Using regression analysis, we controlled for sociocultural factors (e.g. familism, acculturation), other forms of formal and informal support, care recipients' functional status and characteristics of the caregiving dyad. Intrinsic and organizational religiosity was associated with lower perceived burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping (e.g. feelings that the caregiver burden is a punishment) predicted greater depression. CONCLUSION: Measures of well-being should be evaluated in relation to specific styles of religious and spiritual coping, given our range of findings. Further investigation is warranted regarding how knowledge of the positive and negative associations between religiosity and caregiving may assist healthcare providers in supporting Latino caregivers.
Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Americanos Mexicanos/psicologia , Religião e Psicologia , Estresse Psicológico/etnologia , Atividades Cotidianas , Adulto , Idoso , California , Pessoas com Deficiência , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , Masculino , Saúde Mental , Pessoa de Meia-Idade , Análise de Regressão , Adulto JovemRESUMO
BACKGROUND: We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. METHODS: Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. RESULTS: Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. CONCLUSION: Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.
Assuntos
Neoplasias da Mama/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos/psicologia , Apoio Social , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Neoplasias da Mama/etnologia , Feminino , Educação em Saúde , Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Cônjuges/psicologia , Neoplasias do Colo do Útero/etnologia , Adulto JovemRESUMO
This paper describes an innovative Pan-American survey on advanced-cancer care and examines the quality-of-care provided by Latin American institutions. A convenience sample of 777 physicians and nurses who treat cancer patients in Argentina, Brazil, Cuba, Mexico, and Peru were surveyed. Providers were identified through mass mailings, distribution at professional meetings and conferences, collaboration with regional institutions, professional organizations, and PAHO and online posting. Multiple linear regression analyses were conducted to identify predictors of quality-of-care assessments in each country. The five predictive models were subsequently compared descriptively. Higher access to care ratings and greater availability of end-of-life services corresponded with improved institutional quality-of-care ratings for all five countries. Barring respondents from Cuba, providers from the other four nations who practice in public institutions rated the quality of advanced-cancer care in their own institutions lower than those practicing in private hospitals or specialized cancer centers. Other institutional quality-of-care predictors included type of city, affordability-of-care ratings, availability of opioid analgesics, where patients die, barriers to cancer pain management, and the provider's specialty and gender. These findings highlight the need for providing accessible care and services to improve the quality of advanced-cancer care in Latin American institutions. Efforts should be aimed at improving the care offered in public institutions and addressing other types of disparities that may exist within countries by creating supportive and palliative cancer care programs that are accessible and affordable to those most in need.