Comparing the Experiences of Black and White Caregivers of Dementia Patients

Caregivers' capacities to cope with dementia patients are severely challenged as impairment levels and demands for care concomitantly increase. With deterioration occurring in several spheres of functioning, needs for supervision and assistance continually expand. These needs, coupled with the fact that the caregiver is forced to helplessly watch the gradual changes in the relative, can contribute to inordinate strain as usual coping mechanisms become overwhelmed. Depression, anxiety, isolation, physical symptoms, strains in relationships, and restricted activity levels have been cited as among the stressful effects of caregiving (Anthony-Bergstone, Zarit, & Gatz, 1988; Diemling & Bass, 1986; Gallagher, Rose, Rivera, Lovett, & Thompson, 1989; Poulschock & Diemling, 1984). Despite these consequences, most relative caregivers of dementia patients attempt to manage without any formal assistance as long as possible, using fewer services than those who care for nondemented relatives (Birkel & Jones, 1989). The ability of these caregivers to cope has been at least partially attributed to strong informal support systems and to their own feelings of competency (Morris, Morris, & Britton, 1988; Niederehe & Fruge, 1984). Further, when caregivers do turn to formal services, they commonly seek help with improving their coping skills, meeting the elder's needs, responding to family issues, handling relationship concerns, eliciting formal and informal supports, and resolving feelings of inadequacy and guilt (Smith, Smith, & Toseland, 1991). However, findings on the caregiving experience and outcomes are based primarily on studies of white, nonminority individuals. Because culture can play a major role in influencing responses and behaviors, it may also affect the nature of the caregiving process. To develop sensitive and appropriate interventions, it is essential to examine how caregiving may vary among ethnic groups. The study described in this article examined care-giving among black and nonminority white individuals caring for a relative with Alzheimer's disease. By basing the research on a model that depicts the factors contributing to caregiver stress, the study sought to identify the relevance of these factors to each group and, consequently, the ways in which the groups may vary. Methodology The conceptual model providing the framework for this study perceives caregiver stress as a function of four domains: background or context, stressors, stress mediators, and outcomes (Pearlin, Mullan, Semple, & Skaff, 1990). Stressors may be both the patient status and demands on the caregiver, and stress mediators are caregiver supports and coping abilities. The outcomes are those used in other research that have been found to be strong indicators of stress: restrictions on the caregiver's activities, strains in social relationships, and depressive symptoms (Diemling & Bass, 1986). Particular attention was given to the roles of caregiver supports and coping abilities in that each could be amenable to strengthening through appropriate interventions. An underlying research question was to determine if the roles of these mediators varied between the two ethnic groups. Furthermore, with much research attesting to the strong support systems of black elderly people (Johnson & Barer, 1990; Taylor, 1985; Taylor & Chatters, 1986), we further hypothesized that the black caregivers would be more protected against the stressful effects of caregiving than their white, nonminority peers. Sample The sample was a purposive one composed of 76 black and 88 white caregivers who had contacted the Alzheimer's Associations in Baltimore and Washington, DC. Each association offers a wide array of services, including a help line, respite care, support groups, information and referral, and caregiver education programs, and each has been actively involved in working with minority populations. …