The study aimed to examine the differences in caregiving context and psychological distress outcome between non-immigrant and immigrant caregivers; to investigate these differences by relationship type; and to examine the factors related to psychological distress. Spouse or adult child caregivers (213 non-immigrants and 206 immigrants from the Former Soviet Union) were interviewed. Based on stress and appraisal conceptual framework, caregiving stressors, primary appraisal, psychosocial resources, secondary appraisal and psychological distress were measured. A series of two-way MANOVA, followed by ANOVA, was used to examine the differences by immigration status, by relationship type and their interaction. Hierarchical multiple linear regression was conducted to examine variables associated with psychological distress. Negligible differences in caregiving stressors, but significant differences in caregiving primary and secondary appraisal, psychosocial resources and psychological distress were found by immigration status and by relationship type, and significant interactions only in caregiving primary appraisal. The regression models showed that the differences in psychological distress by immigration status and by relationship type were fully explained by caregiving stressors (care recipient's problem behavior), psychosocial resources (mastery) and caregiving secondary appraisal (role overload, captivity, economic difficulties). The results suggest that socio-cultural background and role relationship shape caregiving appraisal and psychosocial resources, and that these factors explain psychological distress outcomes.
An indication of the lack of clarity concerning family caregiving roles stems from the finding that family members were frequently viewed as unengaged and neglectful, yet at times they were criticized for being overly involved in patient care. Implications for the care of hospitalized older adults are discussed.
The present study aimed to compare caregiving appraisal and psychological and physical health between caregivers and non-caregivers and between wives or daughters, and to examine the associations of caregiving context variables (intensity, duration, and co-residence) with health. The sample included 201 individually matched pairs of caregivers and non-caregivers, wives and daughters of older patients discharged from the three Internal Medicine wards at Hadassah Medical Centre in Jerusalem, Israel, during 2003. Caregivers reported significantly more negative appraisal and poorer health compared with non-caregivers, wives differed from daughters in burden appraisal and had significantly poorer health. Almost no significant interactions of caregiving status by kinship tie were observed, suggesting that caregivers differed from non-caregivers irrespective of kinship tie. The multivariate analyses of health measures by caregiving context revealed that high-intensity caregivers and co-residing daughter caregivers were most vulnerable to poor health. Health services providers need to develop ways for early identification of vulnerable caregivers, providing support and care programs and targeting resources.
The study compared caregiving stressors and psychological distress between Israeli veteran resident and immigrant family caregivers. It examined whether psychosocial variables (appraisal of caregiving, mastery, social support and coping) mediate the differences in psychological distress between these two groups. A total of 213 veteran resident and 206 immigrant (from the former Soviet Union) caregivers of chronically ill elderly were recruited from health services. The comparisons between the two groups were examined separately for spouse and adult child caregivers. The immigrant spouse and adult child caregivers reported significantly higher levels of caregiving stressors than veteran resident caregivers, but psychological distress was significantly higher only among the immigrant adult child caregivers. In multivariate analyses, the difference in psychological distress disappeared when caregiving stressors and mediating psychosocial variables were included in the regression models. Different caregiving stressors and psychosocial variables were associated with psychological distress among the spouses and among the adult child caregivers. The findings suggest that the caregiving stressors and psychosocial variables explain differences in psychological health outcomes between veteran resident and immigrant caregivers. Social work interventions should address these factors among caregivers, take into account the relationship to the care recipient, be culturally adapted to the immigrant caregivers, and target immigrant adult child caregivers in particular.
Israel partially addresses its nursing shortage by allowing paid home care workers to take an active role in the care of hospitalized older adults. This can have both a positive and a negative impact on the role and perception of nursing.
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