Evaluation of a culturally adapted reminiscence therapy intervention: Improving mood, family and community connectedness in Spanish- and Vietnamese-speaking older adults.

Reminiscence therapy (RT) is an evidence-based treatment for alleviating depression and improving life satisfaction among elders, yet less is known about its efficacy in diverse ethnic groups. We report on the evaluation of a cultural adaptation of the RT intervention that combines reminiscence with three innovative elements: including family members in RT; conducting community events for participants to present their artwork and life-story books created during the intervention; and using ethnically matched bilingual community workers. The 12-week intervention with pre- and post-test assessments was completed by 73 Hispanic and 92 Vietnamese elders (mean age = 75 years; 62% female; mostly foreign-born, with limited English proficiency). Paired t-tests indicated statistically significant improvement in depression, loneliness, and life satisfaction. Sixty-two percent of participants noted improved relationships with family/friends through improved communication and shared understanding of the participant's life story. Fifty percent of respondents participated in a community event and the qualitative comments noted improved connection with their community through listening to others' life experiences and sharing their own. Participant perceptions of ethnically matched community workers were positive, but several indicated they could work with someone from a different ethnic background. Similar to general RT findings, the culturally adapted RT intervention demonstrated improvement in depression, loneliness, and life satisfaction among elders from two different ethnic backgrounds. Implications for future projects are discussed based on the findings and experience of conducting this intervention.

Service Utilization, Self-Efficacy, Positive Attitude and Well-Being Among Asian American Family Caregivers of Persons with Serious Mental Illnesses.

The well-being of the family caregivers of people with serious mental illnesses (SMIs) is a crucial success factor in the recovery of the afflicted family member. This cross-sectional quantitative study examined the associations between the use of formal mental health services, self-efficacy, and positive attitudes and their effects on the well-being of Asian American family caregivers of people with SMIs. Using convenience and snowball sampling, 116 Asian American family caregivers of people with SMIs in Northern California were recruited for this study. We found that formal mental health service utilization predicted an enhanced sense of self-efficacy. Higher levels of self-efficacy were related to attitudes being more positive, and these positive attitudes contributed to enhanced overall well-being. These findings suggest that mental health professionals should develop culturally competent and tailored services for Asian American family caregivers to support self-efficacy, which is fundamental to maintaining positive attitudes and promoting wellness.

Exploring caregiving-related experiences among Chinese American and European American family caregivers of persons with mental illness.

Family caregivers (FCs) of people with mental illness (PMI) experience caregiving-related distress. These challenges tend to be greater for Asian American families due to acculturative stress and structural barriers to services. However, little is known about caregiving-related experiences among FCs of PMI within a cultural context. By using an exploratory approach, we examined the experience of caregiver distress and the influence of cultural values on caregiving in European American and Chinese American FCs. In collaboration with community-based agencies, a combination of convenience and snowball sampling methods were used to recruit Chinese American and European American caregivers who co-reside with PMIs. Two focus groups with each ethnic group with 57 participants (30 Chinese and 27 European American) were conducted. Thematic analysis indicates that FCs experience intense emotions, health/mental health problems, and a negative impact on their personal/social lives. Whereas Chinese American FCs reported shame, lack of knowledge, and over-protectiveness of PMIs, European American FCs reported the need for advocacy on behalf of the PMI. Findings indicate a need for: 1) greater awareness of the caregiving experience on wellbeing of FCs; 2) an understanding of how cultural values may influence caregiver experience; and 3) developing culturally relevant prevention and intervention services that can support FCs from diverse cultural contexts.

Mental Health and Stress Among South Asians.

Addressing mental illness requires a culturally sensitive approach. As detailed in this literature review, treating mental illness in the South Asian immigrant community necessitates a thorough understanding of the South Asian conceptualization of mental illness. Past research, though limited, has described the different reasons the South Asian community attributes to causing mental illness, as well as the stigma associated with acknowledging the disease. Acculturation of the community also plays a significant role in cultural acceptability and the receipt of quality care. Lessons from local organizations can be applied at the national level to promote cultural responsiveness in treating mental illness in the South Asian immigrant community.

Vietnamese-American family caregivers of persons with mental illness: Exploring caregiving experience in cultural context.

While involvement of family caregivers can play an important role in the recovery process of persons with serious mental illness (SMI), family caregivers often endure poor health and mental health issues due to caregiving-related distress. These challenges may be exacerbated for Vietnamese American families due to cultural values (e.g., familism and stigma). This qualitative exploratory study examined how Vietnamese American family caregivers of persons with SMI describe their caregiving experience. Using convenience and snowball sampling, the study recruited 21 participants who took part in two Vietnamese-language focus groups. Key findings of the study addressed three themes: (1) the influence of cultural and religious values on caregiving and mental health; (2) the negative impact of caregiving on caregivers' wellbeing; and (3) the stigma attached to mental illness. The study offers useful insights to assist mental health practitioners in tailoring culturally appropriate and effective services for Vietnamese caregivers.

Perspectives on enhancing international practical training of students in health and social care study programs - A qualitative descriptive case study.

BACKGROUND: Internationalization of practical training in health and social care study programs is an important aspect of higher education. However, field mentors' and classroom teachers' competence in guiding culturally diverse students varies widely in European countries, and the majority does not have enough training in guiding foreign students. OBJECTIVES: This study aimed to examine which factors enhance the efficacy of international practical placement experiences in health and social care study programs. DESIGN: A qualitative descriptive case study design was used. SETTINGS: The study was conducted at six higher education institutions-two in Finland and one in Croatia, Estonia, the Netherlands and Slovenia. PARTICIPANTS: A convenience sample of 14 mentors, 15 teachers and 14 students with international experiences from six higher education institutions which are part of the Bologna Process was recruited. METHODS: The data were collected from six focus groups using a semi-structured questionnaire based on a literature review. Each higher education institution conducted one group interview that was tape-recorded, transcribed and analysed for themes. RESULTS: Participants made several recommendations for enhancing the practical placement experience of students, teachers, and mentors. Most recommendations dealt with practical supervision of students. Three major themes noted were: 'Attitudes towards internationalization of practical placements', 'Factors impacting the international placement experience', and 'Pedagogical methods used and structural support available for internationalization.' CONCLUSIONS: The study highlights the need for strengthening the multicultural knowledge and skills of mentors and teachers. The findings provide practical guidelines for improving the international placement experience across health and social care fields.

Late Life Immigration and Quality of Life among Asian Indian Older Adults.

Late-life immigration among seniors for purposes of family reunification is a growing phenomenon in developed countries. Using the World Health Organization's Quality of Life instrument short form (WHOQOL-BREF) and other psychosocial measures related to the political/legal context of immigration, and personal and environmental autonomy (mastery, immigration status, access to transportation, and language barrier), this study examined quality of life (QoL) in Asian Indian seniors (N = 109), who immigrated to the United States to reunite with their adult children. The sample scores on Overall QoL and QoL domains (physical and psychological health, social relationships, and environment) were similar to established norms. Although all QoL domains correlated significantly with Overall QoL at the bivariate level, multivariate analysis showed that only environmental domain contributed significantly to Overall QoL. Linear regressions indicated: Mastery contributed significantly to Overall QoL and all QoL domains; access to transport contributed to Overall QoL, physical health, and environmental QoL; immigration status (a proxy for political/legal context) contributed to environmental QoL whereas language barrier contributed to none. Implications for improving perceptions of QoL, mastery, access to transport and other services are discussed.

Health Promotion Practice and Interprofessional Education in Aging: Senior Wellness Fairs.

Senior wellness fairs (SWFs) offer a unique opportunity for community health promotion and interprofessional education (IPE). The authors describe and evaluate the impact of a 3-year, university-community SWF collaboration on interprofessional competencies among students across multiple professional programs. Participation in the SWF enhanced student knowledge and skills in providing health promotion information to older adults in an interprofessional, collaborative setting as indicated by mean scores on the Perceived Learning Outcomes Survey, an instrument developed for this project. Open-ended data highlighted aspects of the SWF that students found most useful (interaction with seniors, community resources, interprofessional learning, and self-awareness) and most challenging (communication barriers, limited opportunity for interaction, and physical environment). Pre- and posttest scores on the Multidisciplinary SWF Practice Learning Quiz, another instrument developed for this project, illustrated improvement in student understanding of other professions and the importance of interprofessional cooperation to promote and maintain healthy aging. Implications and suggestions for structuring learning opportunities that combine community health promotion practice and interprofessional learning are discussed.

Expectations of filial obligation and their impact on preferences for future living arrangements of middle-aged and older Asian Indian immigrants.

Filial obligation, described as culturally-defined rights and duties that prescribe how family members are expected to care for and provide support to each other, is an important variable that influences older immigrants' preferences for living and care arrangements. This exploratory study examined variables associated with expectations of filial obligation among middle-aged and older, Asian Indian, first generation immigrants and explored the relationship between variations in expectations of filial obligation and expressed preferences for future living arrangements. Data were collected through telephone surveys of 226 English-speaking immigrants in Atlanta, GA. Although no significant relationships were observed between filial obligation expectations and length of residence in the U.S., respondents indicated a variety of preferred future living arrangements. Contrary to current living arrangement patterns found among older immigrants, very few respondents preferred to move in with their children. The most popular preference was to "move closer to children," followed by "moving to a retirement community" with the majority preferring a retirement community geared to Asian Indians. Other preferences included "not moving" and "returning to India." Variations in expectations of filial obligation, length of residence in the U.S., and self-rated health were significantly associated with these preferences. Implications are discussed for building capacity within ethnic communities to address living arrangement preferences and their repercussions for caregiving in ethnic families and in communities.

Causal attributions of dementia among Korean American immigrants.

To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.

What do Korean American immigrants know about Alzheimer's disease (AD)? The impact of acculturation and exposure to the disease on AD knowledge.

OBJECTIVE: The present study examined knowledge of Alzheimer's disease (AD) and factors related to the disease knowledge among Korean American immigrants. METHODS: Two-hundred and nine middle-aged and older Korean American immigrants completed a self-administered questionnaire. RESULTS: Korean American immigrants had strong stigma about AD and interpreted the disease as a form of insanity. They considered memory loss and AD as a part of the aging process. They seriously lacked knowledge about the treatment, diagnosis and cause of AD. Those who were less acculturated and less exposed to AD were likely to have poorer AD knowledge. CONCLUSIONS: There is a need to expand AD education efforts among Korean American immigrants because the views of stigmatization and normalization of AD combined with certain Asian cultural norms can be barriers to early recognition and intervention. Our study suggests knowledge areas of concentration in AD education and a segment of the population that AD education should target. Further research on symptom knowledge by the disease stages and causal beliefs is needed to better understand the existing views about AD in Korean American immigrants.

Limited English proficiency, social network characteristics, and depressive symptoms among older immigrants.

OBJECTIVES: The purpose of the study was to examine differences in social network characteristics and their relationship to depressive symptoms among two groups of older Asian Indian immigrants: those with limited English proficiency and those proficient in English. METHODS: Telephone surveys were conducted with 226 English-speaking (Sample 1) and 114 Gujarati-speaking (Sample 2) immigrants in Atlanta. RESULTS: The samples differed significantly in demographics and patterns of social integration. Sample 2 had shorter residence in the United States, a more traditional ethnic identity, greater reliance on family for social activities, greater participation in religious events, lower likelihood of having good friends nearby, and less frequent interactions with friends. Rates of depressive symptoms did not differ, and network composition was unrelated to symptoms. For both samples, poorer health and a more traditional ethnic identity were related to depressive symptoms. Quality of relationship with children was predictive of symptoms for Sample 2. DISCUSSION: I found no differences in depressive symptoms despite differing social network structures. This may be due to the differing expectations of social ties among older immigrants. Interventions to improve well-being should focus on issues that generate acculturative stress. Cognitive and social support interventions may help individuals develop the adaptive coping strategies needed to live in a different culture.

Aging services or services to the aging?focus of a university-community curriculum development partnership to increase awareness of aging issues in social work practice.

This paper describes a partnership between social work faculty and community practitioners to develop gerontological curricula to increase awareness of aging issues among social work students. We describe steps taken to identify learning needs of students by examining gaps in the core curriculum and surveying community-based agencies that serve older persons who face a variety of problems. We also describe a unique field education assignment designed to increase awareness of how well community service agencies meet the needs of older clients and provide quantitative and qualitative data on students' overall learning experiences. The project highlights the role of community partners in developing relevant curricula for future social work practitioners.

The revised CES-D scale for caregivers of the elderly in India.

The purpose of this article is to empirically determine the factor structure of the original Radloff's (1977) Center for Epidemiological Studies-Depression Scale (CES-D), on Indian caregivers of the elderly population. The CES-D was administered to 255 caregivers via face to face interviews. The confirmatory factor analysis results did not support the original four-factor theoretical structure, but did suggest a three-factor model. In addition the three-factor version showed high internal consistency among the sub scales. The results of the present study indicate that the revised CES-D scale reflects the difference in the manifestation of depression in caregivers of the elderly in the Indian community in Allahabad, India. This scale should be validated further by replication. Implications for future research are presented.

Health behaviors, chronic disease prevalence and self-rated health of older Asian Indian immigrants in the U.S.

The purpose of this study was to examine the correlates of healthy behaviors and self-rated health in middle-aged and older Asian Indian immigrants in the U.S. Asian Indian men (n=162) and women (n=64), 50 years of age or older completed a telephone survey which collected information regarding demographics, behavioral risk factors, acculturation, perceived control, quality of social support, depression, body mass index, chronic disease prevalence, and self-rated health. Participants' average length of residence in the U.S. was 25 years, 52% were normal weight, 41% were vegetarians, 55% incorporated aerobic activity into daily lifestyle, and only 5% smoked. Hypertension and diabetes were most common chronic diseases (31 and 18%, respectively). Younger age, longer length of residence and a bicultural or more American ethnic identity were associated with greater participation in physical activity. Likewise, higher income, a bicultural or more American ethnic identity and depression were associated with higher fat intake. Poor self-rated health was associated with older age, female gender, BMI>25, satisfaction with social support, and greater number of chronic disease conditions. A multitude of factors influence the practice of healthy behaviors and the perceived health of Asian Indian immigrants, which should be addressed when developing culturally appropriate health promotion interventions.

Prevalence of metabolic syndrome risk factors among young adult Asian Indians.

Metabolic syndrome has a high prevalence within the U.S population. Asian Indians have a greater prevalence of the chronic diseases associated with this syndrome compared to Caucasians. This study aimed to determine the prevalence of risk factors of metabolic syndrome in young adult Asian Indians. Behavioral risk factors, dietary intake, and anthropometric measurements were assessed on all study participants (n=50). The mean BMI was 23.2 and 20.4, waist circumference was 87 and 79 cm, and percent body fat was 16 and 26% for males and females, respectively. Macronutrient contributions to the total energy intake were: carbohydrate 55% for males and females, protein 14 and 12% for males and females respectively, and total fat 31 and 33% for males and females, respectively. Using the definition of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III, ATP III), these Asian Indians did not appear to be at high risk for developing metabolic syndrome. However, using the newly proposed recommendations for Asian Indians, the results suggest that this group may be at risk for developing metabolic syndrome.

Resources predicting positive and negative affect during the experience of stress: a study of older Asian Indian immigrants in the United States.

PURPOSE: Using the life stress model of psychological well-being, in this study we examined risks and resources predicting the occurrence of both positive and negative affect among older Asian Indian immigrants who experienced stressful life events. DESIGN AND METHODS: We collected data through a telephone survey of 226 respondents (aged 50 years and older) in the Southeastern United States. We used hierarchical, negative binomial regression analyses to examine correlates of positive and negative affect. RESULTS: Different coping resources influenced positive and negative affect when stressful life events were controlled for. Being female was a common risk factor for poorer positive and increased negative affect. Satisfaction with friendships and a cultural or ethnic identity that is either bicultural or more American were predictive of greater positive affect. Greater religiosity and increased mastery were resources predicting less negative affect. IMPLICATIONS: Cognitive and structural interventions that increase opportunities for social integration, increasing mastery, and addressing spiritual concerns are discussed as ways of coping with stress to improve the well-being of individuals in this immigrant community.

Strain experienced by caregivers of dementia patients receiving palliative care: findings from the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program.

BACKGROUND: Programs that provide palliative care to individuals with dementia, which is a progressive terminal illness, are likely to encounter different issues (e.g., management of problem behaviors, caregiver strain extending over years) from those typically addressed by hospice programs. Little research is available on palliative care for individuals with dementia who live in the community. OBJECTIVE: This study examines predictors of types of strain experienced by caregivers of community-dwelling patients with dementia enrolled in a unique demonstration program titled Palliative Excellence in Alzheimer Care Efforts (PEACE), which moved palliative care "upstream," integrating palliative care into the primary care of patients with dementia. DESIGN: Data were collected through structured, face-to-face interviews with 150 community-dwelling, predominantly African American patient-caregiver dyads who were enrolled in the PEACE program. MEASUREMENTS: Established measures, including the Caregiver Strain Index, the Revised Memory and Behavior Problems Checklist, and the Katz Index of Activities of Daily Living, were used in addition to other measures assessing caregiver, patient, and situational characteristics. RESULTS: Factor analysis of the Caregiver Strain Index revealed three dimensions of strain (role, personal, and emotional) related to caregiving. Using a stress process model, regression analyses examined stressors and resources related to patient, caregiver, and support system characteristics in predicting these three dimensions of strain among caregivers. Patient problem behaviors predicted all types of caregiver strain. Perceived lack of support from the health care team predicted personal and emotional strain, whereas higher income, surprisingly, predicted role strain. Patient functional limitations predicted personal and role strain. CONCLUSIONS: Findings suggest that effective palliative care programs for patients with dementia need to understand and address the various sources and types of caregiver strain; provide adequate support to caregivers for the management of problem behaviors; provide counseling to help cope with the emotional reactions to the cognitive and behavioral changes associated with dementia progression; facilitate communication with the health care team; and broker access to community and other resources for assistance with functional limitations. Further research examining changes in strain over time will provide useful insights on the delivery of care and services for patients with dementia and their families in a palliative care framework.

Assessing the effectiveness of a walking program on physical function of residents living in an assisted living facility.

The purpose of this study was to assess the effectiveness of a resident-led walking program at an assisted living facility (ALF). Seventeen women (mean age 80, range 62-99) agreed to participate in a "walking club." Pre and post measurements included the Tinetti Performance-Oriented Assessment of Mobility Problems in Elderly Patients, the Functional Reach Test, and the Barthel Index to measure independence in activities of daily living (ADLs). Participants set their own goals for walking distance and frequency, with the assistance of the lead researcher if requested. Distances ranged from 75 ft to over 1 mile. At the end of the 9-week intervention, there was a significant increase in all of the pre-test measurements. In addition, post-test assessment included individual interviews with participants about their experiences with the physical activity program. Four positive themes about the walking program emerged: (a) as a pleasurable activity, (b) as a way to manage current health problems, (c) as a way to continue life-long activity, and (d) because of perceived physical and psychological benefits from the activity. The participants planned to continue the walking program. The results of this pilot study suggest that a walking program can be instituted in an assisted living facility with minimal staff effort and significant benefit to residents.

The incremental effect of dementia-related problem behaviors on the time to nursing home placement in poor, frail, demented older people.

OBJECTIVES: To examine the incremental effect of dementia-related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people. DESIGN: Client assessments were reviewed retrospectively for clinical, functional, and cognitive information, particularly the presence of DRPBs and the time during enrollment at which they occurred. SETTING: The Georgia Community Care Services Program (CCSP), a Medicaid 1915-C home and community-based services program (HCBS). PARTICIPANTS: A random sample of demented clients (n = 204) discharged during fiscal year 1996 from four CCSP regions. MEASUREMENTS: The risk of and time to nursing home placement. Cox proportional hazards models and an extended Cox model with a time-varying covariate for the presence of DRPBs were used to evaluate the risk factors associated with NHP in demented older people. Kaplan-Meier survival curves were used to estimate the time to NHP for several risk groups. RESULTS: In demented older people in a HCBS program, having a DRPB was found to increase the hazard rate of NHP. Having a problem behavior shortened average median survival in the community by approximately 2 years. CONCLUSIONS: DRPBs in demented older people shorten the time to NHP. Exploration of effective interventions is warranted.