Sang E. Lee

International Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review

This review begins by highlighting the fact that dementia is truly a global problem at this time, with incidence and prevalence rates rising rapidly in most parts of the world and only expected to increase. Along with this comes the growing demand for programs and services targeted to support both the person with dementia and his or her family caregivers. Around the globe such programs are being developed, evaluated, and put into practice, with government funding and needed infrastructures to support them. However, the many pressing needs of family caregivers for services to reduce their burden and improve quality of life for themselves and their relative far outstrip available programs—even in highly developed countries such as the United States, United Kingdom, and Australia. This is even more so the case in less developed countries and regions such as China, India, Africa, and South and Central America. We conducted an extensive search of existing databases and publications related to this topic, and in this article we both review and critique existing programs and service models. There are descriptive sections on evidence-based programs and practices, as well as discussion of promising areas for future research. In addition, we discuss some of the formidable barriers that prevent or delay access to care in even the more developed countries. Finally, we conclude with a set of recommendations that we believe will enhance growth and productivity in this field.

What do Korean American immigrants know about Alzheimer's disease (AD)? The impact of acculturation and exposure to the disease on AD knowledge.

The present study examined knowledge of Alzheimers disease (AD) and factors related to the disease knowledge among Korean American immigrants.

Expectations of Filial Obligation and Their Impact on Preferences for Future Living Arrangements of Middle-Aged and Older Asian Indian Immigrants

Filial obligation, described as culturally-defined rights and duties that prescribe how family members are expected to care for and provide support to each other, is an important variable that influences older immigrants’ preferences for living and care arrangements. This exploratory study examined variables associated with expectations of filial obligation among middle-aged and older, Asian Indian, first generation immigrants and explored the relationship between variations in expectations of filial obligation and expressed preferences for future living arrangements. Data were collected through telephone surveys of 226 English-speaking immigrants in Atlanta, GA. Although no significant relationships were observed between filial obligation expectations and length of residence in the U.S., respondents indicated a variety of preferred future living arrangements. Contrary to current living arrangement patterns found among older immigrants, very few respondents preferred to move in with their children. The most popular preference was to “move closer to children,” followed by “moving to a retirement community” with the majority preferring a retirement community geared to Asian Indians. Other preferences included “not moving” and “returning to India.” Variations in expectations of filial obligation, length of residence in the U.S., and self-rated health were significantly associated with these preferences. Implications are discussed for building capacity within ethnic communities to address living arrangement preferences and their repercussions for caregiving in ethnic families and in communities.

The Experience of Family Caregivers of Older Korean Americans With Dementia Symptoms

Despite the rapid growth of the older ethnic minority population, knowledge about dementia care for this population is limited. This study examined the experience of dementia caregiving among Korean Americans. We conducted four focus groups with 23 family caregivers of older Korean Americans with dementia symptoms and identified eight themes: (a) struggling and overwhelmed; (b) keeping the cultural roles and responsibility; (c) doing it by themselves; (d) family as a source of stress; (e) limited knowledge and misconceptions; (f) learning as they go; (g) undiagnosed dementia and misunderstandings about medical care; and (h) barriers to use of services and need for culturally responsive services. The findings underscore that Korean Americans need dementia caregiver programs that are linguistically and culturally responsive.

Burnout among Entering MSW Students: Exploring the Role of Personal Attributes

Although individual susceptibility to burnout within a similar structural context is well-documented in other helping professions, little is known about the relationship between personal attributes and burnout in social work. Furthermore, despite a large number of entering MSW students with prior work experience, there is a paucity of research documenting the burnout phenomenon among them. By using a sample of MSW students with prior work experience (N=60), the current study examined the effect of personal attributes on burnout (i.e., overidentification tendency, trait anxiety, and emotional contagion). Findings imply that burnout depends on personal attributes, rooted in cognitive role-taking levels, and that emotional contagion has a significant role in burnout. Implications for social work education and practice are discussed.

Exploring definitions of financial abuse in elderly Korean immigrants: the contribution of traditional cultural values.

The purpose of this study is to explore the cultural definitions of financial abuse from the perspective of 124 elderly Korean immigrants and to examine the role of traditional cultural values in their definitions by using a mixed methods approach. The qualitative analysis generated four themes relevant to definition of financial abuse. A binary logistic regression indicated that those with stronger cultural adherence to traditional values had higher odds of providing culture-based definitions of financial abuse. Education is needed for health professionals, social service providers, and adult protective workers to increase their understanding of culture-specific experiences of financial abuse among ethnic minority elders.

Causal attributions of dementia among Korean American immigrants.

To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.

Geriatric social work career tracking: graduates of the Hartford Partnership Program for Aging Education (HPPAE).

Despite a growing need for geriatric social workers, there is a question as to whether MSW graduates who are gerontologically prepared actually enter the workforce to serve older adults. By tracking MSW graduates who had special training in aging, this study aims to explore their job search and career experience. Findings show that most graduates located aging-related jobs 4 months postgraduation and remained committed to the field 1 to 2 years later. The majority were working in direct service provision in clinical settings. Their salaries compare favorably with those of generic social workers. Implications for geriatric social work education are discussed.

Attitudes toward Community Services Use in Dementia Care among Korean Americans

To understand the future demand for community services use in dementia care, this study examined attitudes toward community services use in potential dementia situations among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings revealed that, contrary to expectations about filial/family responsibility in Asian culture, Korean Americans showed favorable attitudes toward using community services in dementia caregiving. Multivariate analysis showed that those who rate their health poorer, and have more social network and greater awareness of community services, are more likely to be favorable toward using community services. The study provides practitioners and providers with an understanding about intentions to utilize services in dementia care and suggests ways to prepare for future service demands in the Korean American community.

Access barriers to and unmet needs for home- and community-based services among older Korean Americans.

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.