The PRECEDE-PROCEED Model and Latina Alzheimer’s Disease Caregivers
Name University
Mental Health Program Planning
February 7, 2012
The PRECEDE-PROCEED Model and Latina Alzheimer’s Disease Caregivers
Alzheimer’s disease (AD) is a progressive, debilitating neurological disease that
presents both a social and Public Health problem (Marshall & Hutchinson, 2001). AD is
the fastest growing disease in the United States, currently afflicting an estimated 5.4
million Americans. This number has doubled since 1980 and is expected to be as high as
13.5 million by 2050 (Hebert et al., 2003). The number of those suffering from AD is
expanding yearly and following the aging of the Baby Boomers; prevalence will escalate
rapidly and is expected to double by 2020, as one out of every eight baby boomers
develops this disease (California Council for the Alzheimer’s Association, 2008).
Hispanics are the fastest-growing population in the United States. During the first
half of the 21st century, the number of Hispanic elders with AD and related dementias
could increase more than six-fold, from fewer than 200,000 today to as many as 1.3
million by 2050 (Alzheimer’s Association, 2012). Researchers are beginning to discover
the impact of AD on the Hispanic community and it is reported that Hispanics are about
1.5 more times more likely to develop Alzheimer’s disease than whites (Alzheimer’s
Association, 2012).
80% of care provided at home is delivered by family caregivers; fewer than 10
percent of older adults receive all of their care from paid workers (Alzheimer’s
Association, 2011). In 2010, 14.9 million family and other unpaid caregivers of people
with AD and other dementias provided an estimated 17 billion hours of unpaid care
which h ad an estimated economic value of $202.6 billion (Alzheimer’s Association,
2011). The strong cultural value of family responsibility is a strength of Hispanic/Latino
communities and studies have demonstrated the high sense of filial responsibility for
elders, particularly among Hispanic daughters (Mausbach, et al., 2004). Other research
shows that Hispanic families tend to have high acceptance of cognitive impairment and
dementia and view these diseases as a normal part of aging to be managed within the
family (Alzheimer’s Association, 2004). Hispanic/Latino families, particularly daughters
and other female relatives, provide a disproportionate share of AD care; including more
care for longer periods of time at higher levels of AD impairment than non-Hispanic
caregivers (Alzheimer’s Association, 2004).
Phase 1—Quality of Life Diagnosis
Caregivers of patients with AD suffer from increased rates of depression, physical
illness, social isolation, health care utilization, anxiety problems, and anger, as well as
decreased quality of life, and emotional strain (Alzheimer’s Association, 2011; Mausbach
et al., 2004). The research on Hispanic caregivers is lacking but the findings of one study
suggest that in reality, Hispanic caregivers can suffer similar negative effects as their
non-minority counterparts which are manifested in physical symptoms (i.e. hypertension,
emotional problems, and heart ailments), depression, and stress (Cox & Monk, 1993).
Hispanic culture is characterized by values that shape behaviors and give
substance to the development of individual identity (Cox & Monk, 1993). The belief in
spirituality emphasizes dignity and encourages appropriate respectful behaviors and a
high acceptance of fate (Cox & Monk, 1993). These cultural values also influence the
care of elderly people (Alzheimer’s Association, 2004). A research study on older
Mexican-Americans found that personal beliefs, language proficiency, and economic
status were the most frequently perceived barriers to health care (Alzheimer’s
Association, 2004).
Education appears to have some protective effect against the ravages of AD
(Marshall & Hutchinson, 2001). Hispanics have the lowest education levels of any group
in the United States and 1 in 10 Hispanic seniors have no formal education (Alzheimer’s
Association, 2004). Over half of this population has 8 years of schooling or less
(Alzheimer’s Association, 2004).
Phase 2—Epidemiological Diagnosis
The physical and emotional impact of caregiving on Alzheimer and other
dementia caregivers is estimated to result in $7.9 billion in increased healthcare costs in
the United States (Alzheimer’s Association, 2011). Research shows that 27% of Hispanic
caregivers indicate their health is fair or poor compared to 15% for white caregivers and
15% for Asian-Americans (National Alliance for Caregiving and AARP, 2009). In
addition to caregiver’s perceived poor health, it has also been reported that caring for
persons with dementia impacts a person's immune system for up to 3 years after their
caregiving experience ends which increases their chances of developing a chronic illness
themselves (Family Caregiver Alliance, 2011).
In regards to mental health, 40% to 70% of family caregivers have clinically
significant symptoms of depression with about a quarter to half of these caregivers
meeting the diagnostic criteria for major depression (Alzheimer’s Association, 2011). In
addition to health issues, reports show there is a correlation between a caregiver's health
and income. When viewing the data on caregivers who have less than $30,000 in annual
household income, 34% report fair or poor health as compared with 3% of caregivers
with $100,000 or more (Family Caregiver Alliance, 2011). The same pattern is also found
with a caregiver's level of education (Family Caregiver Alliance, 2011).
Phase 3—Behavioral and Environmental Diagnosis
In this phase you will describe the behaviors that impact depression,
compromised immune systems or overall poor health (pick one). Describe these
behavioral risk factors and their distribution.
In Phase 4 you will categorize the influences on the behavior into predisposing,
enabling and reinforcing factors.
Phase 6— Implementation
In regards to the Latino caregiving community, it is important to facilitate the
development of culturally relevant and meaningful interventions. Outcome goals for
using a multi-component intervention such as Resources for Enhancing Alzheimer’s
Caregiver Health (REACH) include decreasing depressive symptoms, stress, and anger,
and improving overall quality of life, self-care, social support, and care giving abilities.
References
Alzheimer’s Association. (2012). Latinos and Alzheimer’s. Retrieved from
http://www.alz.org/espanol/about/latinos_and_alzheimers.asp.
Alzheimer’s Association. (2011). Alzheimer’s Disease Facts and Figures, Alzheimer’s &
Dementia: 7(2).
Alzheimer’s Association. (2004). Hispanic/Latinos and Alzheimer’s disease, 2004.
Retrieved from www.alz.org/national/documents/report_hispanic.pdf.
California Council of the Alzheimer’s Association. (2008). Guideline for Alzheimer’s
disease management. Retrieved from http://www.caalz.org/guidelines.html.
Coon, D.W., Rubert, M., Solano, N., Mausbach, B., Kraemer, H., Arguelles, T.,
Haley, W.E., Thompson, L.W., & Gallagher-Thompson, D. (2004). Well-being,
Appraisal, and coping in Latina and Caucasian female dementia caregivers:
Findings from the REACH study. Aging & Mental Health. 8(4): 330-345.
Cox, C., & Monk, A. (1993). Hispanic culture and family care of Alzheimer’s patients.
Health & Social Work, 18(2): 92-100.
Family Caregiver Alliance: National Center on Caregiving. (2011). Caregiver Statistics.
Retrieved from
http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=439.
Gelman, C.R. (2010). “La lucha”: The experiences of Latino family caregivers of patients
with Alzheimer’s disease. Clinical Gerontologist. 33(3): 181-193.
Hebert, L. E., Scherr, P. A., Bienias, J. L., Bennett, D. A., & Evans, D. A. (2003).
Alzheimer’s disease in the U.S. population: Prevalence estimates using the 2000
Census. Archives of Neurology. 60(8): 1119-1122.
Marshall, M. J., & Hutchinson, S. A. (2001). A critique of research on the use of
activities with persons with Alzheimer’s disease: A systematic literature
Review. Journal of Advanced Nursing. 35(4): 488-496.
Mausbach, B.T., Coon, D.W., Depp, C., Rabinowitz, Y.G., Wilson-Arias, E.,
Kraemer, H.C., Thompson, L.W., Lane, G., & Gallagher-Thompson, D. (2004).
Ethnicity and time to institutionalization of Dementia patients: A comparison of
Latina and Caucasian female family caregivers. Journal of the American
Geriatrics Society. 52(7): 1077-1084.
National Alliance for Caregiving and AARP. (2009). Caregiving in the U.S. Bethesda,
MD: National Alliance for Caregiving and Washington, DC: AARP.
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