WITH THE DIVERSITY IN PERCEPTION OF CAREGIVER ROLES, EDUCATING HEALTHCARE PROFESSIONALS, ENGAGING FAMILIES AND COMMUNITIES IS EVEN MORE ESSENTIAL TO PROMOTE QUALITY CARE: Session 320

Abstract Compared to few decades ago, the diversity in the elderly patient population and their caregivers has significantly increased and so has the diversity in ethnicities of healthcare providers in the geriatric psychiatry work force. Given this cultural diversity, there is an exponentially greater chance that clinical encounters will occur between individuals of different origins. Multiple studies have shown that caring for an elderly family member with health problems can be associated with negative health outcomes but our understanding of how caregivers from different cultural backgrounds are differentially affected by caregiving is limited. They all have different perceptions about caregiver burden and capacity to accommodate caregiver burden or resilience. During this session, we will use review subjective caregiver burden, prevalence, variations noticed in the subjective burden and the common factors that affect caregiver burden like nature of the illness, degree of disability, relationship of the patient with the caregiver, age and gender of the caregiver. We will go over some case scenarios where it was tough to counterbalance the health and well-being of the caregiver with the rights of the elderly patient. The session will describe the individual meaning of the stressful care situation, analyzing the abilities and resources that caregivers have to cope with the stressful situation. We often notice that the attitudes or decisions of the professional is influenced by their own cultural roots and can become an additional level of discord and complexity to a case. We will talk about the cultural diversity of the healthcare professionals, generational attitudes of the newer healthcare professionals and how that might impact the care of the elderly patient and the caregiver who come from a different generation. Learning how to communicate across different generations is enriched by engaging families and communities early on in the process. This promotes quality care for our elderly patients. Through case illustrations, we will talk about the importance of educating and engaging all parties involved so that we understand the variations in caregiving, different styles of using social support and coping styles. The sooner we understand these concepts, the easier it is to help engage for a positive change. The first case involves a patient who is an 87-year-old Caucasian male with mild neurocognitive disorder and his wife, who was the patient's primary caregiver, was unable to care for him and insisted on him being sent to a locked memory unit. Although the patient did not have significant behavioral issues and was able to perform his activities of daily living, his wife perceived the burden of caregiving to be greater than she could undertake and was insistent on long-term placement. We will talk about her perception, different healthcare professional's attitudes towards the situation and how education and training helped improve the quality of care provided to the 87 year old gentleman. The second case involves a patient who is a 75-year-old Caucasian male with Parkinson's disease and associated neurocognitive disorder whose primary caregivers are his wife and adult son. This patient had significant behavioral issues including verbal aggression, was tough to redirect, and unable to perform his activities of daily living independently. However, his wife and adult son displayed resilience in regard to caretaking of the patient prior to the patient's residence in a nursing home setting. The family was experiencing significant caregiver burden but were reluctant to institutionalize patient. We will talk about the healthcare professional's attitudes towards this situation and how education was essential in order to support family situation. We will also talk about how engaging the community early on in the illness helped this patient stay at home longer. The current health care models are advocating for informal caregivers as a cost saving measure and this indirectly supports patient autonomy, staying at home versus as opposed to being institutionalized. And once the severity of the illness increases, we get into end of life care issues. Often in cases of patients who don't have the capacity to make decisions, end of life decisions are made using advance directives or next of kin. In cases where these resources are absent the values of the healthcare professionals often plays a more prominent role in prioritizing the various factors used to make such decisions. Engaging the families sooner will also help avoid some of these complicated situations. We will end the session by forming smaller groups and talking about difficult case scenarios where the participants felt that education and engaging families would have helped improve patient care.