Multi-Cultural Caregiving and Caregiver Interventions: A Look Back and a Call for Future Action

Nationally, more than a third of households are engaged in caregiving, and women comprise 66 percent of active caregivers. There are differences in estimates of caregiving prevalence among ethnic groups, at 19.7 percent for Asian Americans, 20.3 percent for African Americans, 21.0 percent for Hispanics, and 16.9 percent for whites (National Alliance for Caregiving and AARP, 2015). Caregiving involves diverse activities such as personal care, complex medical and nursing tasks, financial and instrumental assistance, and emotional and social support. With the growth of a diverse aging population (with the highest rates of growth among Hispanic, African American and Asian American older adults compared to non-Hispanic whites), higher acuity of individuals with chronic conditions, shorter hospital stays, and limited health services, the complexity and prevalence of care provided in the home is increasing (Ortman, Velkoff, and Hogan, 2014; Reinhard, Levine, and Samis, 2012). A systematic review of more than thirty years of caregiving literature on diverse populations reveals limited attention to multi-cultural issues, non-theoretical research approaches, and methodological challenges that hamper practical insight on how to better identify, engage, and address caregivers' most pressing concerns (Janevic and Connell, 2001; Dilworth-Anderson, Williams, and Gibson, 2002; Pinquart and Sorensen, 2005). This article synthesizes the multi-cultural caregiving and intervention literature to propose a research agenda that could move the field forward.Survey MethodologyThe literature on family caregiving (e.g., family, friends) for older adults of Latino, African American, Asian American, and Native American ethnicity was identified using the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo, Abstracts in Social Gerontology, Sociological Abstracts, Medline, Health Source, and JSTOR. Terms included were caregivers, informal caregivers, caregiving, family caregiving, kin and non-kin caregiving, home caregiving, aged caregiving; older adults, elderly, aged, old people, older individual, over 60; African American, blacks; Latino, Hispanic (and related national ethnic denominations); Native Americans (and related terms and tribal denominations); Asian Americans (and related national and-or ethnic denominations); race, racial, ethnicity or ethnic, cultural differences.Citations in published reviews and metaanalyses on the subject of ethnic caregiving were cross-checked for references. Inclusion criteria were English language; peer-reviewed publications published from 1980 to 2013; all study types, methods, and designs; and, U.S. or crossnational/cross-cultural with a U.S. sample component. All titles and abstracts were screened and those meeting criteria were synthesized in an evidence table and thematic analysis. Themes were identified through a well-established qualitative approach whereby main thematic categories are coded systematically in each article reviewed. The evidence table is available on the AARP website (www.aarp.org/ppi/issues/ caregiving/). Survey FindingsThis search yielded 238 articles, 218 that were descriptive or observational, and twenty involving interventions. As shown in Table 1 (this page, below), thirty-six studies focused exclusively on African Americans, forty on Latinos, twenty-five on Asian Americans, and six on Native Americans. Of the remaining 131 articles, eighty-six compared at least two ethnic groups and fortyfive compared at least three ethnic groups, commonly with Caucasian caregivers. Prominent categories by ethnic group are summarized in Table 2 (see page 41). Category I: The experience of caregiving Cultural values and family dynamics were found to shape a range of social-psychological topics such as identity, perceived burden and rewards, needs, coping, orientations and motivations to care, views of the care recipient's illness, interface with formal health services, and selfperceptions of health. …