不同种族和族裔的地理环境对痴呆症护理经验和健康的影响。
Dementia Caregiving Experiences and Health Across Geographic Contexts by Race and Ethnicity.
机构信息
Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas, USA.
Population Studies Center, Institute for Social Research and School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
J Gerontol B Psychol Sci Soc Sci. 2023 Mar 13;78(Suppl 1):S48-S58. doi: 10.1093/geronb/gbac182.
OBJECTIVES
Few studies have examined how the intersectionality of geographic context and race/ethnicity influences dementia caregiving. Our objectives were to determine whether caregiver experiences and health (a) differed across metro and nonmetro areas and (b) differed by caregiver race/ethnicity and geography.
METHODS
We used data from the 2017 National Health and Aging Trends Study and National Study of Caregiving. The sample included caregivers (n = 808) of care recipients ages 65 and older with "probable" dementia (n = 482). The geographic context was defined as the care recipient's residence in metro or nonmetro counties. Outcomes included caregiving experiences (care situation, burden, and gains) and health (self-rated anxiety, depression symptoms, and chronic health conditions).
RESULTS
Bivariate analyses indicated that nonmetro dementia caregivers were less racially/ethnically diverse (82.7% White, non-Hispanic) and more were spouses/partners (20.2%) than their metro counterparts (66.6% White, non-Hispanic; 13.3% spouses/partners). Among racial/ethnic minority dementia caregivers, nonmetro context was associated with more chronic conditions (p < .01), providing less care (p < .01), and not coresiding with care recipients (p < .001). Multivariate analyses demonstrated that nonmetro minority dementia caregivers had 3.11 times higher odds (95% confidence interval [CI] = 1.11-9.00) of reporting anxiety in comparison to metro minority dementia caregivers.
DISCUSSION
Geographic context shapes dementia caregiving experiences and caregiver health differently across racial/ethnic groups. Findings are consistent with previous studies that have shown that feelings of uncertainty, helplessness, guilt, and distress are more prevalent among people providing caregiving from a distance. Despite higher rates of dementia and dementia-related mortality in nonmetro areas, findings suggest both positive and negative aspects of caregiving among White and racial/ethnic minority caregivers.
目的
鲜有研究探究地理背景与种族/民族的交叉性如何影响痴呆症的照护情况。我们的目的是确定照护者的经历和健康状况是否：(a)在大都市和非大都市地区有所不同；(b)因照护者的种族/民族和地理位置而异。
方法
我们使用了 2017 年国家健康老龄化趋势研究和国家照护研究的数据。样本包括年龄在 65 岁及以上、患有“可能”痴呆症的被照护者的照护者（n=808），其中有 482 名被照护者患有“可能”痴呆症。地理背景定义为被照护者居住在大都市或非大都市县的情况。结果包括照护经历（照护状况、负担和获益）和健康状况（自我评估的焦虑、抑郁症状和慢性健康状况）。
结果
双变量分析表明，非大都市地区的痴呆症照护者在种族/民族方面的多样性较低（82.7%为白人，非西班牙裔），配偶/伴侣的比例较高（20.2%），而大都市地区的相应比例为 66.6%（白人，非西班牙裔；13.3%为配偶/伴侣）。在少数族裔痴呆症照护者中，非大都市地区与更多的慢性疾病（p<0.01）、较少的照护（p<0.01）以及与被照护者不同住（p<0.001）有关。多变量分析表明，与大都市地区的少数族裔痴呆症照护者相比，非大都市地区的少数族裔痴呆症照护者报告焦虑的可能性高出 3.11 倍（95%置信区间[CI]：1.11-9.00）。
讨论
地理背景以不同的方式影响不同种族/民族群体的痴呆症照护经历和照护者的健康状况。这些发现与之前的研究一致，即从远处提供照护的人更容易感到不确定、无助、内疚和苦恼。尽管非大都市地区的痴呆症和与痴呆症相关的死亡率较高，但这些发现表明，白人和少数族裔照护者在提供照护方面既有积极的方面，也有消极的方面。
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