Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Gerontologist. 2020 Sep 15;60(7):1244-1253. doi: 10.1093/geront/gnaa042.
Racial disparities in health and socioeconomic characteristics of older adults have implications for the experiences of their family and unpaid caregivers, but knowledge to date has primarily drawn from convenience samples. Using a population-based sample, we examine associations between caregiver race and caregiving-related effects.
Study participants include white (n = 992) and black (n = 556) respondents to the 2015 National Study of Caregiving who assisted community-dwelling older adults with disabilities who participated in the National Health and Aging Trends Study. Guided by Pearlin's Stress Process Model, hierarchical logistic regression models were constructed to examine race differences in caregiving-related effects after adjusting for caregiving context, stressors, and resources.
Relative to white caregivers, blacks more often provided in excess of 40 hr of care per week (54.3% vs 38.6%) and more often cared for an older adult with dementia (27.1% vs 20.7%) who was living below the federal poverty line (31.7% vs 11.9%) or was Medicaid-eligible (42.2% vs 11.8%). Black caregivers more often used supportive services (32.9% vs 24.8%). In fully adjusted regression models, black caregivers were more likely to report gains and less likely to report emotional difficulty than whites. Service utilization did not attenuate caregiving-related emotional difficulty or participation restrictions, regardless of race.
Findings highlight caregiving disparities and counterintuitive differences in experiences and indicate the importance of identifying supports such as paid family leave and faith and community-based programming to better support community-dwelling low-income older adults and their family and unpaid caregivers.
老年人的健康和社会经济特征方面存在种族差异,这对他们的家庭和无薪照顾者的体验产生影响,但迄今为止的知识主要来自于方便样本。本研究使用基于人群的样本,研究了照顾者种族与照顾相关影响之间的关联。
研究参与者包括参加 2015 年国家照顾者研究的白人(n = 992)和黑人(n = 556)受访者,他们为参加国家健康与老龄化趋势研究的居住在社区中的残疾老年人提供帮助。在 Pearlin 的压力过程模型的指导下,构建了分层逻辑回归模型,以检验在调整了照顾背景、压力源和资源后,种族差异对照顾相关影响的影响。
与白人照顾者相比,黑人每周提供的照顾时间超过 40 小时的比例更高(54.3%比 38.6%),照顾生活在联邦贫困线以下(31.7%比 11.9%)或有医疗补助资格(42.2%比 11.8%)的痴呆症老年患者的比例更高。黑人照顾者更常使用支持性服务(32.9%比 24.8%)。在完全调整的回归模型中,黑人照顾者更有可能报告获益,而不太可能报告情绪困难,这与白人不同。无论种族如何,服务利用并不能减轻照顾相关的情绪困难或参与限制。
研究结果突出了照顾方面的差异和经验方面的意外差异,并表明需要确定支持措施,例如带薪家庭休假和基于信仰和社区的计划,以更好地支持居住在社区中的低收入老年人及其家庭和无薪照顾者。