Patricia Flynn Weitzman

The role of religion and ethnicity in the help seeking of family caregivers of elders with Alzheimer's disease and related disorders.

Stages of help seeking during illness have been identified as follows: disease experience, symptom attribution, decision to seek care, and contact with care providers. These stages have not been evaluated amongst family caregivers of elders affected with Alzheimers disease and related disorders (ADRD). Since minority families typically care for ADRD elders at home, it seems important to understand the help seeking of minority family caregivers in particular, and the role of religious/ethnic factors. Thematic analyses were conducted on in-depth interviews from 10 caregivers from 4 groups (total n = 40): African-American, Chinese-American, Puerto Rican, and Irish-American. Aside from the disease experience stage, where religious/ethnic themes were negligible, between-group differences existed in these themes at other stages. For example, themes of extended family support emerged around decision making, with much between-group variation. At the contact with providers stage themes of contacting religious or ethnic service organizations were present, again with between-group variation. Chinese-American and Puerto Rican narratives contained themes of language barriers to care, and a lack of culturally-competent services. Both Irish-American and African-American narratives showed themes of alienation from religious groups on the one hand, and using prayer to cope on the other. Narratives from all groups contained themes of religious and/or ethnic imperatives for providing care. Overall, findings reveal that religious/ethnic factors may both aid and impede the help seeking of caregivers.

Stress and Service Use Among Minority Caregivers to Elders with Dementia

Abstract Research indicates that minority caregivers use fewer outside social and medical services than white, European-American caregivers. Qualitative research has shown non-caregiving stressors stemming from family and community environments as affecting burden and service use among minority caregivers. Yet few studies of caregiver service use include multiple groups of minority caregivers, or quantitatively evaluate the influence of non-caregiving stress. Using Pearlin, Mullan, Semple and Skaffs (1990) model of caregiver stress, we examined the relationship of ethnicity, non-caregiving stressors, and other stress-associated variables to service use by African-American, Chinese, and Latino caregivers. A group of white, European-American caregivers served as a reference group. Results show ethnicity, non-caregiving stress, and the dementia-affected elders impairment level to predict unmet service need. The results also point to the usefulness of a new measure of non-caregiving stress in evaluating service use among minority caregivers.

Use of an Online Community to Provide Support to Caregivers of People With Dementia

One challenge faced by many family members caring for persons with dementia is lack of information about how to take care of others and themselves. This is especially important for persons from ethnic minority groups, because linguistically and culturally appropriate information is often not available. In response to these needs, we developed a web site for Spanish-speaking caregivers. Cuidatecuidador.com provides bilingual information on dementia and caregiver issues. Content was developed and then evaluated by caregivers residing in 3 countries. Findings suggest trends that exposure to information may be related to a higher sense of mastery and a reduction of depressive symptomatology.

Promoting communication with older adults: protocols for resolving interpersonal conflicts and for enhancing interactions with doctors

In this paper, we review the importance of effective communication in older adulthood, and ideas for promoting it. We focus on theoretical and applied work in two communicative encounters that have particular relevance for older adult health, i.e., interpersonal conflict and visits with a healthcare provider. Little applied work has aimed to adapt training protocols for older adults in these two areas. We will present training protocols we have developed in constructive conflict resolution for older adults, and on enhancing doctor-patient communication. We present these protocols to stimulate ideas on the part of the reader on how to further develop and refine training efforts for older adults in effective communication.

Middle-Aged and Older Latino American Women in the Patient-Doctor Interaction

Latino womens views of and actual experiences in the patient-doctor interaction have been little explored. In focus groups with middle-aged and older Latino women, topics including assertiveness in the medical encounter, experiences in actual medical encounters, and characteristics of the “ideal” doctor were explored. Contrary to conceptualizations in the literature, assertiveness was viewed as a reciprocal process between patient and doctor, rather than the behavior of the patient alone. Assertiveness centered on obtaining answers to patient health questions. Strategies for self-advocacy were indirect, primarily changing doctors when dissatisfied; while strategies for advocating for family members were direct, primarily expressing dissatisfaction directly to medical staff. Undocumented immigrant status was described as limiting self-assertion and medical care access. Age was linked to doctor gender preferences. Middle-aged women preferred female doctors, while older women preferred male doctors. Across groups, women expressed preference for Spanish-speaking doctors, but not for doctors of the same ethnicity. Trustworthiness was identified by participants as the most important doctor characteristic, and learnable behaviors as exemplifying trustworthiness.

Interpersonal Negotiation Strategies in a Sample of Older Women

Suppressed anger resulting from poorly resolved interpersonal conflicts can increase morbidity. The current generation of older women may be particularly susceptible to morbidity caused by anger inhibition due to socialization to be submissive in interpersonal conflicts. For purposes of disease prevention, we asked 35 older women to describe an interpersonal conflict experienced recently, and how they responded to it. Data coding was based on Selmans model of interpersonal negotiation strategies, which has been used to assess the conflicts of children, adolescents, and young adults, but not older adults. We found that many participants used strategies in which they expressed their point of view in order to persuade the other person. Of those who were expressive, however, many ended up submitting to the other persons demands nonetheless. Thus, overall, most participants used submissive strategies. Conflicts with strangers and acquaintances were frequently reported, and reports included comments about feeling vulnerable. Stereotypic beliefs about age and health also emerged in reports, and seemed related to submissive responses. Our findings suggest that older women would benefit from training in constructive strategies for resolving interpersonal conflicts. Training efforts should reflect the ways in which stereotypic beliefs about age, health, and vulnerability may interfere with constructive strategy choice, and should emphasize the health benefits of constructively dealing with conflict.

Combining Qualitative and Quantitative Methods in Health Research with Minority Elders: Lessons from a Study of Dementia Caregiving

The merits of combining qualitative and quantitative methods are well known. While used often in evaluation research, a combined methods approach is rarely used in health studies with minority elders. This approach can be particularly useful for overcoming theoretical and recruitment problems specific to health research with minority elders. A cross-cultural study of family caregiving for demented-affected elders is presented to show how issues of rigor, theory building, language, and cultural adaptation of diagnostic tools can be effectively dealt with using combined methods. Specifically, the authors found qualitative data valuable in ensuring the cultural appropriateness of quantitative measures and in confirming causal relationships to which quantitative data pointed. They also found applying quantitative data collection techniques to qualitative data collection to be useful in theory building and in overcoming some of the reliability problems associated with qualitative data.

Bodily Aesthetic Ideals Among Latinas With Type 2 Diabetes: Implications for Treatment Adherence, Access, and Outcomes

Purpose The purpose of this study was to examine how attitudes and practices related to bodily aesthetic ideals and self-care might inform the engagement of Latinas with type 2 diabetes (T2DM). Methods Focus groups were used to collect qualitative data concerning bodily aesthetic ideals and diabetes management, including help-seeking experiences, from Latina women with T2DM (n = 29) receiving care through Latino Diabetes Initiative at the Joslin Diabetes Center. Focus groups were conducted in Spanish, audiotaped, transcribed, and content analyzed. Results Four main themes emerged: (1) a preference among participants for a larger than average body size, although perceptions of attractiveness were more closely linked to grooming than body size; bodily dissatisfaction centered on diabetes-induced skin changes, virilization, and fatigue rather than weight; (2) diabetic complications, especially foot pain, as a major obstacle to exercise; (3) fatalistic attitudes regarding the inevitability of diabetes and reversal of its complications; and (4) social burdens, isolation, and financial stressors as contributing to disease exacerbation. Conclusions Interventions that emphasize reduced body size may be less effective with Latinas who have T2DM than those that emphasize the benefits of exercise and weight loss for skin health, energy levels, and reduced virilization.

A social cognitive examination of responses to family conflicts by Arfican-American and Chinese-American carrgivers

Conflict between caregivers and their family members has been examined in relation to caregiver burden. However, specific theoretical models have not been applied to analyses of caregiver family conflicts. Nor has there been much research on the family conflicts of ethnic minority caregivers. Using Selmans1 interpersonal conflict strategies and their related levels of social perspective coordination as our framework, we content analyzed conflict reports of African-American and Chinese-American caregivers. Overall, there were more similarities in the strategies and social perspective coordination levels of the two groups than differences. In narratives where conflict was present (78 percent), about half of caregivers in both groups reported higherlevel conflict strategies, and half reported lower-level strategies. More advanced social perspective coordination seemed associated with greater satisfaction with family sharing of responsibilities in both groups. If these data patterns bear up under further testing, training in conflict resolution and social perspective coordination skills may prove an effective means of fostering better social relationships and sharing arrangements between caregivers and family members, and be a worthwhile complement to existing stress reduction interventions for caregivers.

Everyday conflict and stress among older african american women: Findings from a focus group study and pilot training program

Abstract Older African American women are at high risk for morbidity due to anger suppression and stress. Yet sources of everyday stress and conflict in the lives of older African American women have not been documented. Such information is essential for developing health promotion programs. A focus group study was conducted with older African American women on everyday stress and conflict. Everyday stress stemmed from worries about functional disability and about accessing transportation. Everyday conflicts occurred with adult children, teen-aged grandchildren, and older neighbors or peers. Conflicts with adult children centered on how the adult child was raising his/her children. Conflicts with grandchildren centered on social respect. Conflicts with neighbors/peers centered on perceived rudeness or past transgressions. Participant strategies for dealing with stress and conflict tended to be avoidant. A training program in constructive conflict strategies for older African American women is presented that draws on information gained in the focus groups.