Intersection of multiple factors shape Korean American caregiver experience in dementia caregiving.

BACKGROUND AND OBJECTIVES: Studies have shown that cultural norms such as filial responsibility and familism operate in the Korean American caregiving context. The purpose of our study is to understand the practice of Korean American caregivers who provide care to a family member living with dementia and their dementia care support needs. MATERIALS AND METHODS: We conducted 2 focus groups and individual semi-structured interviews with a total of 20 Korean American caregivers. We used inductive thematic analysis to guide coding and generation of themes. RESULTS: Three themes were identified; 1) intersectionality in the Korean American caregiver experience, 2) complex family dynamics, and 3) dementia care barriers and caregiver support needs. Within the dyadic relationship and the family, cultural identity, generational, acculturational, and language factors shaped the caregiver experience. The need to navigate bicultural norms could lead to tensions but also provide opportunity for caregivers to consider self-care and use external supports to decrease the work of caregiving. Family was the unit of caregiving and caregiving was divided among family members based on acculturation and language fluency. Caregivers desired both medical information combined with knowledge that experienced lay support could provide. Support that reflects their cultural context was valued. DISCUSSION: Findings suggest the importance of understanding the diversity of response to strong elder care norms among Korean American caregivers and the intersection of multiple factors that influence their caregiving experience. Integrating acculturation and generational assessments may be useful as a way to tailor interventions to optimize engagement in dementia care interventions.

A review of measures of three common dementia-related behaviors: Rejection of care, aggression, and agitation.

BACKGROUND: Clustering of behavioral symptoms in dementia is common in dementia scales. However, lack of distinction may have negative treatment implications when a treatment response differs depending on classification of behaviors. Historically, rejection of care, aggression, and agitation have been lumped together. Yet, several studies have indicated these may be conceptually different behaviors. OBJECTIVE: To examine how rejection of care, aggression, and agitation are described and operationalized in existing measures of dementia-related behaviors. METHOD: We identified instruments developed to measure behavioral symptoms of dementia from two existing systematic reviews. Additionally, we conducted a literature review of peer-reviewed articles published from 1980 to 2017 to identify measures that were not captured in the two previous reviews. RESULTS: 43 instruments developed to measure behavioral symptoms of dementia were examined. Of these, 25 (58.1%) included items related to rejection of care; 32 (74.4%) included items related to aggression; and 35 (81.4%) included agitation items. Descriptions of these behaviors were highly variable across the instruments. CONCLUSIONS: The review demonstrated that rejection, aggression, and agitation are measured in most scales, yet their operationalization is highly variable, and they are not typically distinguished from each other. Future efforts should be directed at developing uniform terminology to describe dementia-related behaviors while distinguishing rejection of care, aggression, and agitation in dementia scales.

Impact of three dementia-related behaviors on caregiver depression: The role of rejection of care, aggression, and agitation.

OBJECTIVE: The relationship of specific dementia-related behaviors to caregiver depression and moderating factors is unclear. We examined the role of rejection of care, aggression, and agitation to caregiver depression and if social support and mastery independently moderated associations. METHODS: The method used was a cross-sectional, secondary analysis using baseline data from two community-based clinical trials. We examined frequency of occurrence of presenting behaviors and their combinations in persons with dementia. Multiple logistic regression analyses examined associations between nonoverlapping behavioral clusters (agitation alone, agitation + rejection, agitation + aggression, and agitation + rejection + aggression) and caregiver depression. Multiple logistic regression with interaction terms was also used to investigate whether social support or caregiver mastery moderated the relationship between behavioral symptom clusters and caregiver depression. RESULTS: Three of four symptom clusters (all three behaviors [adjusted odds ratio (AOR) = 2.22; 95% CI, 1.02-4.83], agitation + rejection of care [AOR = 2.55; 95% CI, 1.06-6.13], and agitation + aggression [AOR = 2.63; 95% CI, 1.17-5.89]) had a positive association with caregiver depression, whereas agitation alone was not significantly associated with caregiver depression. Neither social support nor mastery significantly moderated the relationship between these three behavioral clusters and caregiver depression. CONCLUSION: Caregiver depression was associated with different combinations of behaviors but not with agitation alone. These results have implications for intervention development and identifying caregivers at risk for depression. Level of social support and mastery does not appear to moderate impact on caregiver depression.

Co-Occurrence and Predictors of Three Commonly Occurring Behavioral Symptoms in Dementia: Agitation, Aggression, and Rejection of Care.

OBJECTIVE: To investigate co-occurrences of agitation, aggression, and rejection of care in community-dwelling families living with dementia. METHODS: Cross-sectional, secondary analysis from a randomized controlled trial testing a nonpharmacological intervention to reduce behavioral symptoms. We examined frequency of occurrence of presenting behaviors at baseline and their combination. Omnibus tests compared those exhibiting combinations of behaviors on contributory factors. Multinomial logistic regression analyses examined relationships of contributory factors to combinations of behaviors. RESULTS: Of 272 persons with dementia (PwDs), 41 (15%) had agitation alone (Agi), 3 (1%) had aggression alone, 5 (2%) had rejection of care alone. For behavioral combinations, 65 (24%) had agitation and aggression (Agi+Aggr), 35 (13%) had agitation and rejection (Agi+Rej), 1 (0%) had aggression and rejection, and 106 (39%) had all three behaviors (All). Four behavioral subgroups (Agi, Agi+Aggr, Agi+Rej, and All) were examined. Kruskal-Wallis tests showed that there were significant group differences in PwD cognition, functional dependence, and caregiver frustration. PwDs in Agi+Rej and All were more cognitively impaired than those in Agi and Agi+Aggr. Also, caregivers in All were more frustrated than those in Agi. In logistic regression analyses, compared with Agi, greater cognitive impairment was a significant predictor of Agi+Rej and All, but not Agi+Aggr. In contrast, greater caregiver frustration was a significant predictor of Agi+Aggr and All, but not Agi+Rej. CONCLUSIONS: We found that agitation, aggression, and rejection are common but distinct behaviors. Combinations of these behaviors have different relationships with contributory factors, suggesting the need for targeting treatment approaches to clusters.

The association between adverse childhood experiences and self-harm among South Korean children and adolescents: a cross-sectional study.

PURPOSE: Adolescent self-harm is a public health problem. Research suggests a link between adverse childhood experiences (ACEs) and self-destructive behaviors. Few studies, however, have examined the effects of ACEs on self-harm among Asian adolescents. This study explored the association between lifetime ACEs and a history of self-harm among Korean children and adolescents in elementary, middle, and high schools. METHODS: A cross-sectional, retrospective medical record review was conducted on a dataset of a national psychiatrist advisory service for school counselors who participated in the Wee Doctor Service from January 1 to December 31, 2020. The data were analyzed using multiple logistic regression to predict self-harm. RESULTS: Student cases (n=171) were referred to psychiatrists by school counselors for remote consultation. Multiple logistic regression analyses revealed that the odds of self-harm were higher among high school students (adjusted odds ratio [aOR]=4.97; 95% confidence interval [CI]=1.94-12.76), those with two or more ACEs (aOR=3.27; 95% CI=1.43-7.47), and those with depression (aOR=3.06; 95% CI=1.32-7.10). CONCLUSION: The study's findings provide compelling evidence that exposure to ACEs can increase vulnerability to self-harm among Korean students. Students with a history of ACEs and depression, as well as high school students, require increased attention during counseling. School counselors can benefit from incorporating screening assessment tools that include questions related to ACEs and depression. Establishing a systematic referral system to connect students with experts can enhance the likelihood of identifying self-harm tendencies and offering the essential support to prevent self-harm.

Therapeutic community-oriented day treatment program for Korean women with alcohol use disorder: a non-randomized pilot feasibility trial.

BACKGROUND: The prevalence of alcohol use disorder (AUD) among women in South Korea has been rising, causing public health problems. Yet women's treatment needs are mostly unmet in South Korea due to the lack of women-focused treatment programs. This study evaluated the feasibility, acceptability, and clinical outcomes of a therapeutic community (TC)-oriented day treatment program for Korean women with AUD on alcohol abstinence self-efficacy, forgiveness, and spirituality. METHODS: The current study employed a quasi-experimental, non-equivalent control group design with a pretest and posttest. Participants were assigned to 6-month TC-oriented day treatment program (n = 19) or usual treatment (n = 21). Feasibility (treatment completion rate) and acceptability (overall program satisfaction) were assessed. Alcohol abstinence was measured as a clinical outcome at baseline, 3 months, and 6 months. Repeated measures using Alcohol Abstinence Self-Efficacy (AASE), Enright Forgiveness Inventory-Korea (EFI-K), and Spiritual Assessment Scale (SAS) were also obtained from both conditions at those three time points. RESULTS: Fifteen participants (78.9%) in the intervention group successfully completed the program. The overall program satisfaction ratings were very high (4.9 ± 0.2). Continuous abstinence rates at 6 months were significantly higher in the treatment group (78.9%) than in the control group (9.5%). Results of the two-way repeated measures ANOVA indicated that statistically significant two-way (group × time) interaction effects were found for the intervention group on AASE, EFI-K, and SAS but not for the control group on any of the outcomes. CONCLUSION: The current study demonstrated the feasibility and acceptability of implementing a TC-oriented intensive day treatment program to promote recovery in Korean women with AUD. This intervention merits further investigation as a potential strategy to help address alcohol abstinence self-efficacy, forgiveness and spirituality. TRIAL REGISTRATION: KCT0006386 (Cris.nih.go.kr).

Pilot testing of a dementia literacy intervention for Korean American elders with dementia and their caregivers.

BACKGROUND AND AIM: To test the feasibility and acceptability of a dementia literacy intervention for Korean American (KA) elders with dementia and their caregivers: K-PLAN (Preparing successful aging through dementia Literacy education And Navigation). METHOD: Twenty cognitively impaired Korean elders (Clinical Dementia Rating 1+) and their caregivers participated in a pilot trial to receive the K-PLAN intervention, which consisted of 1-h dementia literacy education followed by monthly phone counseling sessions and navigation assistance for 3 months by a trained bilingual community health worker. Outcomes of interest were linkage to medical services for dementia evaluation (KA elders) and dementia literacy, social support, self-efficacy in dementia care, depression, and quality of life (caregivers). Using a one-group pre-and post-test design, all ten dyads were followed up at 12 weeks. RESULTS: The K-PLAN intervention was highly feasible and acceptable. We were able to retain all twenty participants over the study period (100% retention rate). In addition, 100% of the caregivers would recommend the program with an overall satisfaction rating of 9.7 on a 1-10-point scale. Three of the elders (30%) were linked to medical services for dementia by medical record review. The effect sizes for caregiver outcomes ranged from 0.4 to 0.7 in absolute value. CONCLUSION: Dementia literacy intervention has the potential to promote linkage to medical services for dementia evaluation and early diagnosis among linguistically isolated KA elders while improving caregiver psychological outcomes. Studies with larger sample sizes, comparison groups, and cost-effective analyses are needed to inform the application of K-PLAN in diverse community settings. RELEVANCE FOR PATIENTS: Early diagnosis of dementia can help preserve functional status. Promoting dementia literacy and linkage to health services through community-based programs such as K-PLAN may enable underserved racial/ethnic minority communities to make timely follow-up for dementia evaluation and care planning.

Mentoring in research-focused doctoral nursing programs and student perceptions of career readiness in the United States.

BACKGROUND: Research-focused doctorate nursing programs are expanding and seek to double the number of doctoral-prepared nurses by 2020. There is little empirical evidence of the contributions of mentoring to doctoral nursing students' readiness for their desired careers. PURPOSE: This study assessed characteristics and practices of nursing PhD students, the mentoring practices of their advisors, and the likelihood of self-reported career readiness. DESIGN: A nationwide descriptive, cross-sectional study of PhD students in the United States was conducted using an electronic survey platform. A sample of 380 PhD students representing 64 schools was surveyed from January to July 2016. METHODS: Descriptive statistics and ordered logistic regression were used to describe the sample and determine likelihood of career readiness by three readiness levels. FINDINGS: Results revealed greater likelihood of career readiness for students that: (1) perceived their proficiency in key scholarly skills as high, (2) were older, (3) worked a larger number of hours per week, (4) had more responsibilities outside of school, (5) had both advising and mentoring support, (6) had a co-advisor, and (7) attended a private university. CONCLUSION: Enrollment targets should be based on a faculty-to-doctoral student ratio that optimizes advising and mentoring and schools should provide mentoring guidelines and training for faculty.