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We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veterans Affairs (VA) and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p < 0.05) behavioral health costs. Differences in other types of services use were detected. [ABSTRACT FROM AUTHOR]

With rapidly growing concerns about the high rates of dementing illness in Korea, this study presents findings from in-depth qualitative interviews with fifteen family caregivers and health professionals on: (1) perceptions of dementia among Korean family caregivers, (2) cultural influences on caregiving, and (3) status of the development and utilization of formal services for the older population with dementia in Korea. Practices of the traditional familism are demonstrated in the multigenerational family where both material support and respect for the aged are the social norm. Thus, providing informal care for a demented parent is expected in the context of fulfilling filial responsibilities. In assessing the current situation in Korea, there is a lack of social services established by the Korean government for the older individuals, which can be attributed to the norm of parental caregiving. This cultural influence poses significant challenges to Korean caregivers of dementia-impaired elders. [ABSTRACT FROM AUTHOR]

The National Institutes of Health is making efforts to increase the representation of minority elders in aging research. While it is often noted that cultural barriers may make the recruitment of minority elders into research more difficult, relatively little empirical exists to support this claim. The purpose of this study was to identify sociocultural barriers to recruitment that emerged during a four-year study of dementia caregiving among Chinese families in the Boston area. More specifically, this paper examines how culturally shaped conceptions of health, aging, and dementia impacted the recruitment process. This paper is based on a qualitative analysis of interviews with 23 Chinese families and extensive fieldnotes generated by project ethnographers and interviewers. The following themes emerged in this analysis: 1) dementia-related changes were construed as a normal part of the aging process rather than a disease, making it more difficult to identify dementia-affected elders and to recruit families, 2) research participation was viewed as potentially harmful because it can lead to excessive worry 3) Alzheimer's disease carries a social stigma among Chinese, leading families to shun formal diagnosis and research participation, and 4) practitioners viewed research as an intrusion offering no direct benefit to participants. [ABSTRACT FROM AUTHOR]

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 Alzheimer's 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. [ABSTRACT FROM AUTHOR]

Presents a set of papers featured in the December 1999 issue of "Culture, Medicine and Psychiatry," which analyzed narratives of caregivers of elders with dementia in Boston, Massachusetts. Methods shared across the papers; Multidimensional framework for ethnicity; Directions for future research.

This paper is a qualitative study based on retrospective, unstructured, qualitative interviews with Mrs. Jones and other African-American, Chinese-American, Irish-American and Latino family caregivers in the Boston area. A narrative approach is used to show how family caregivers draw on their cultural and personal resources to create stories about the nature and meaning of illness and to ask how ethnic identity may influence the kinds of stories family caregivers tell. Three different story types are identified and described, each with a distinctive configuration of illness meanings and overarching theme, or storyline: a subset of African-American, Irish-American, and Chinese-American caregivers told us stories about Alzheimer's as a disease that erodes the core identity of a loved one and deteriorates their minds; a subset of Chinese caregivers narrated stories that emphasized how families managed confusion and disabilities, changes ultimately construed as an expected part of growing old; a subset of Puerto Rican and Dominican families, while using the biomedical label of Alzheimer's disease or dementia, placed the elder's illness in stories about tragic losses, loneliness, and family responsibility. To construct their stories, caregivers drew upon both biomedical explanations and other cultural meanings of behavioral and cognitive changes in old age. Their stories challenge us to move beyond the sharp contrast between ethnic minority and non-ethnic minority views of dementia-related changes, to local clinics and hospitals as sites where biomedical knowledge is interpreted, communicated, discussed, and adapted to the perspectives and lived realities of families. [ABSTRACT FROM AUTHOR]

This pilot study uses an anthropological gaze to analyze transcripts of extended in-home interviews among a set of ten caregivers of African-American elders with dementia. How are race and ethnicity made to matter in the recognition of, the meaning-making around and the responses to dementing illness among a sample of African-American caregivers? The essay contrasts prevailing cultural representations of African-American caregiver burden with caregiver interview data. What we find is that current constructs which consistently demonstrate "lesser burden" among African-American caregivers compared with Whites may not adequately capture these caregivers' experiences. Interpretations of experiences, meanings of "burden" and the logic of symptoms in the illness narratives generated by these African-American caregivers of elders with dementia require attention to the embodiment of large scale sociopolitical and historical forces like residential, educational and occupational segregation, institutional racism, and economic exploitation over the life course. [ABSTRACT FROM AUTHOR]