Ethnic disparity seen in institutionalizing elders

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Hispanic women who care for older relatives with dementia may delay placing their relatives in nursing homes longer than white caregivers, new research suggests.

Cultural values and attitudes toward caregiving may help explain some of the differences, researchers say.

Taking care of a relative with Alzheimer’s disease or other forms of dementia can put a heavy burden on caregivers. Eventually, most people with dementia are placed in a nursing home or other long-term-care institution.

But most studies on the institutionalization of people with dementia have focused on non-Hispanic whites. There is some evidence that Latino caregivers wait longer before placing their loved ones in an institution.

To look at the relationship between ethnicity and care of people with dementia, a team led by Dr. Dolores Gallagher-Thompson at Stanford University School of Medicine and VA Palo Alto Health Care System in California studied 264 women who were caring for a loved one with dementia. Of the women, 154 were Caucasian and 110 were Latinas.

More than two-thirds of the Hispanic women were Mexican American, with the rest having roots in Cuba, Puerto Rico and other parts of Latin America.

Participants were interviewed about a number of topics, including their attitudes toward caregiving and their acculturation into the larger U.S. society. Kin being cared for were also evaluated at the start of the study.

Eighteen months later, Gallagher-Thompson’s team compared what percentage of non-Hispanic whites and Hispanics had placed a loved one in a nursing home or other institution.

Overall, non-Hispanic white caregivers placed their relatives with dementia in an institution sooner than Hispanic women, the researchers report in the July issue of the Journal of the American Geriatrics Society.

The difference by ethnic group persisted even when researchers accounted for factors that might have influenced when a person was institutionalized, including memory and behavioral problems, declines in mental function and need for daily assistance.]

The findings are related to Latino cultural values that tend to emphasize the importance of family and the expectation that family members will care for each other, according to Dr. Brent T. Mausbach of Stanford University School of Medicine and VA Palo Alto Health Care, who is the lead author of the report.

The study also indicated that Latinos in the study tended to report greater benefits or more positive aspects of caregiving, Mausbach said.

Acculturation was another factor related to when a caregiver placed their loved one in an institution. Latina women who were less acculturated to U.S. society were less likely to institutionalize their relative, the study showed.

The study suggests that cultural values about caregiving play a role in when caregivers decide to place a relative in an institution, the authors conclude.

But the researchers caution against assuming that all Latino caregivers share the same attitudes. Mausbach’s team points out that Latino caregivers who had less positive attitudes about caregiving placed their relatives in an institution sooner than other Latino and Caucasian caregivers.

SOURCE: Journal of the American Geriatrics Society, July 2004.

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