Cultural, interpersonal and psychodynamic factors in caregiving: towards a greater understanding of treatment noncompliance

Abstract

The proportion of Hispanic elderly is steadily increasing in the USA. Concomitant to this increase are the problems associated with aging in Hispanic elders including their experience of caregiving. The needs of Hispanic caregivers have, typically, been overlooked and are especially problematic given the high levels of distress and depression within this group. The following case study examines the treatment of a depressed, Mexican–American woman's noncompliance with a cognitive–behavioral program for caregivers. Case data is analyzed within the framework of acculturation versus alternation models of adaptation. In addition, interpersonal and psychodynamic factors are examined to illuminate reasons for treatment failure. Concrete suggestions for improving the process and outcome of her treatment are offered. Copyright © 1999 John Wiley & Sons, Ltd.

The Experience of Families and Their Carers in Health Care

“…Ethnicity and culture contribute to a variation in the stress and coping process because of (a) differential risks to specific diseases and disorders, (b) differences in appraisal of stressors, and (c) the differential effects of stress-mediating factors such as family and social support. For example, the impact of role change and anticipatory grief is likely to be experienced quite differently by a traditionally home-based wife who must learn to run a household effectively while simultaneously trying to maintain the dignity of her disabled husband, than by the independent working woman who finds herself challenged by the domestic tasks of caring for her aging parents (Rivera & Marlo, 1999). Additionally, other factors such as socio-economic status, familial interdependence, level of acculturation, immigration status, and fear of stigma regarding a disease or physical disability (Aranda & Knight, 1997;Sotomayor & Randolph, 1988) may influence minority group members' experiences of caregiving, and place them at a disadvantage for social and professional services, resulting in levels of distress that are much greater than those documented in samples of non-minority carers.…”