Culturally Sensitive Dementia Caregiving Models and Clinical Practice.

Family caregiving for individuals with dementia is an increasingly complex issue that affects the caregivers' and care recipients' physical, mental, and emotional health. This article presents 3 key culturally sensitive caregiver models along with clinical interventions relevant far mental health counseling professionals. ********** The role of a caregiver for a family member with dementia and the effect on caregivers' emotional and psychological states have been well researched over the past 30 years (Brody, 1985; Cooke, McNally, Mulligan, Harrison, & Newman, 2001; Daire, 2002, 2004; Fisher & Lieberman, 1994; Litwak & Szelsenyi, 1969; Meshefedjian, McCusker, Bellavance, & Baumgarten, 1998; Myers, 2003). Early research identified the key role family caregivers played in linking patients with dementia with service providers (Litwak & Szelsenyi, 1969). Additionally, research focused not only on how caregivers positively affected the lives of care receivers but also on the accompanying strain and distress these caregivers experienced (Carradice, Beail, & Shankland, 2003; Fisher & Lieberman, 1994). Family caregivers, the support they provided (or were not able to provide), and the resulting emotional strain they experienced proved to be key factors regarding whether patients with dementia were institutionalized or whether they remained in the community (Coon, Gallagher-Thompson, & Thompson, 2003). Additionally, family caregivers who were coping well were found to have a positive effect on the health of the care recipients. But, what were the emotional costs to the caregiver? Research has shown that caregiver burden varied significantly depending on the caregiver's coping skills, support system, physical condition, anxiety level, and the specificity of the stressor (Kneebone & Martin, 2003). The specific situation and the type of stressor also dictated the coping strategies implemented by the caregiver. Caregiver burden was also associated with increased mental health problems such as clinical depression, depressive symptoms, and anxiety (Carradice et al., 2003; Connell, Janevic, & Gallant, 2001; Daire, 2004). In addition, caregiver stress and burden were exacerbated as dementia symptoms progressed (Wackerbarth & Johnson, 2002). The intricate and subjective burden experienced by caregivers was influenced by several factors, such as the emotional and physical demands, the consequences of such demands, and the elements that govern them (Myers, 2003). FAMILY CAREGIVING Families of patients with dementia provided a significant amount of care in a community setting (Brody, 1985; Cooke et al., 2001; Coon et al., 2003; Fisher & Lieberman, 1996). With the cognitive and behavioral challenges associated with dementia, this proved a challenging responsibility for families. It also came with a certain degree of emotional and psychological strain. Most families were not emotionally, physically, or financially prepared to embrace the daily challenge of caring for their loved one who had been diagnosed with dementia. At some point, behavior and physiological issues warranted placing that family member in an assisted living facility (e.g., nursing home, assisted living facility, or respite care). The patient's deteriorating health condition and the severity of the caregiver's distress usually triggered the decision to institutionalize the family member with dementia (Levesque, Ducharme, & Lachance, 1999). However, it is important to note that the primary caregivers of institutionalized patients with dementia also experienced significant levels of emotional, physical, and psychological strain (Daire, 2002; LoGiudice et al., 1998). Whether it was a spouse, sibling, or child, nearly all caregivers of institutionalized parents with dementia continued to experience some level of strain or psychological distress (Levesque et al., 1999). In addition to examining the ill effects on caregivers, previous researchers paid special attention to the different individuals who provided care, which furthered the understanding of the effect of caregiving on the family system (Coon et al. …