Caregiving for Elders in the Filipino American Family - Dissertation Example

? Care-giving for the Elders in the Filipino American Family Introduction There’s a dearth of literature on studies of care for the elderly in Filipino American families in the United States. There are studies centred on women’s caregiving role for their elderly parents. Jones (qtd. Kataoka-Yahiro, Ceria and Yoder 111) examined the cultural influences in caregiving role in Filipino American women and found that Filipino culture of respect and honor were central components in providing elderly care. Paying respect was associated with gratitude, indebtedness, obligation, or paying back to a loved elder. The following are article reviews and critiques on articles regarding care giving for the elderly in Filipino American families. Some articles dealt with studies on the situational lives, including problems and challenges of the elders of Filipino American ancestry. The studies were conducted on Filipino Americans who migrated to the United States in the nineteenth and twentieth centuries, and on how they have come to lived with their second and third generation offspring. 1. “Grandparent Caregiving Role in Filipino American Families,” by Kataoka-Yahiro, Merle, C. Ceria and M. Yoder Studies on role involvement, role integration, and perceived health were conducted specifically in Chinese and Filipino American women who cared for their elders. The study was conducted by Jones, Jaceldo, Lee, Zhang, and Meleis (qtd. in Kataoka-Yahiro, Ceria and Yoder 111) who found that role integration was positively related with perceived health in Filipino group but not in Chinese women. Role satisfaction was significantly present, while there was a correlation between role satisfaction and psychological well-being for the Filipino caregivers. Total role stress was also linked significantly with overall health for both the Chinese and Filipino caregivers. The researchers found the lack of adequate theories to explain the behaviour of a specific group of people a limitation to their research, so what they did was to provide an inductive approach in exploring ‘how a group of people define their reality’. The study aimed to investigate and find existing problems for Filipino American grandparent caregivers and to explain these problems. The study focused on six Filipino American grandparents and the relevant issues related with the caregiving provided by them to their grandchildren. Therefore, this study focused on the caregiving role provided by grandparents to their grandchildren, instead of the young or the grandchildren providing care for their grandparents. The study acquired the information from Filipino American grandparents who cared for their grandchildren, with time spend for care giving ranging from 30 hours to 80 hours per week. The grandparents were native born in the Philippines and immigrated to the United States. They lived in a three generation household and their ages ranged from 58 to 69 years old. Their stay in the U.S. ranged from three to 41 years and had been retired and unemployed. They were biological grandparents to their grandchildren and had two to eight grandchildren under their care. The study used three methods for data collection: 1) a demographic information sheet, b) a focus group, and c) field notes. The researchers used a qualitative thematic analysis to analyse the narrative date and know the themes in the information. The study found that the grandchildren were more acculturated than their grandparents, which contributed to the difficulty in disciplining the children. The grandparents were having health problems such as asthma, diabetes, hypertension, coronary heart disease problems, and their care giving roles contributed to the uncontrolled enhancement of their sicknesses. The results of the study revealed that Filipino American grandparents had the same experience with other grandparents in their caregiving role with their children. The experience however was positive as the grandparents were caring for their grandchildren even if they experienced difficulties and suffered in the process. They felt joy in doing their demanding job. 2. “Filipino Arts among Elders in Institutionalized Care Setting,” by Guzman et al. This study explored the traditional Filipino arts (TFA) as the Filipino elder’s way of fighting depression. The sample used were three Filipino elders enrolled in an institutionalized care setting, who were able to help or take care of themselves with the use of traditional Filipino arts. Guzman and associates noted that Filipinos in institutionalized care setting were fighting depression and a decrease of self-esteem, helplessness and hopelessness. Depression results in lack of interest in life, loneliness, self-criticism, insomnia and inability to focus on daily activities. It made use of TFA as a recreational therapy and posed a great challenge for nurses in developing recreational therapy as a form of healing. The respondents were taken from a purposive sampling, which means the participants were not representative of a population and the purpose was to identify the research value and authenticity. The sample consisted of Filipinos, 61-86 years old, and admitted in a community-based institutionalized group home. The study was conducted through visitations in the group home and interviews with the participants. The respondents were encouraged to speak and be open during interviews as the interviewers listened with genuine interest, solicited the interest of the Filipino elderly, and provided random questions. This study reflected two major themes, depression and (lack of) self-esteem, as the primary feelings the participants suffered. Their immediate family could not take care of them since their family members were busy with their respective careers, and so they had to seek community-based help. Aging brings out negative feelings about life, and the elderly feels more depressed, abandoned and useless, since they think and realize they have no one to turn to except other people. Filipinos turn to institutionalized nursing for healthcare and have to adapt to the western way of life. But the researchers also realized the Filipino elders were not completely lost; they still had a sense of self-worth, hope for life and the future, and wanting to improve their conditions. This self-worth is felt when they know there are others who don’t give up on them. By becoming busy with the traditional Filipino arts, the Filipinos felt happy for this new experience in life, and so they wanted to improve their basic skill. The study provided significant and insightful information about Filipinos enrolled in an institutionalized care setting and the way they adapt and deal with their situation. Aging brought them depression. Not being cared of by their own families brought more negative feeling, but when they started learning new skill, such as the one that is near their heart, the traditional Filipino art, a new life and a new hope were brought before them, even as they were fighting depression. 3. “Ethnic Disparities in Hospice Use among Asian-American and Pacific Islander Patients Dying with Cancer,” by Ngo-Metzger, Phillips and McCarthy In a study of Asian Americans and Pacific Islanders (AAPI), where Filipino Americans are a significant part of this group, it was found that Filipino Americans had a longer median length of stay than white patients. But Filipino Americans were less likely than whites to enrol in hospice and would still prefer the traditional setting of care provided by their families. Filipino Americans as a sub-group of (AAPIs) are rapidly growing but have the lowest hospice use. AAPIs constitute about 5% of the U.S. population, but they are only less than 2% of the hospice population. The study used a database in finding information on patients aged 65 and older from what is known as the SEER (Surveillance, Epidemiology and End Results) of the National Cancer Institute. This is an epidemiological surveillance system popularized in 1973 to find records of cancer incidence and mortality for designated population-based cancer registries. SEER was able to capture the data about Filipino Americans. SEER did not only collect information about patients’ conditions, their sicknesses, inceptions, etc., it also recorded the feelings and sentiments of Filipino Americans who said in various instances and recorded by interviewers, that they wanted the traditional way in their end-of-life situation. 4. “Acculturation Stress and Depression among Asian Immigrant Elders,” by Ada Mui and Suk-Young Kang The study discusses the relationship of acculturation stress and depressive symptoms amongst six Asian immigrant elders – Chinese, Koran, Indian, Filipino, Vietnamese, and Japanese. The study found that about 40 percent of the immigrant elders were depressed. The researchers conducted a multiple regression analyses with a finding that a acculturation stress was caused by the elders’ feeling of a cultural gap between themselves and their offspring was related with high depression levels. Other related depression predictors were poor perceived health, stressful life, involvement in religious matters, help received from their children, and their long stint in the U.S. The study is a response to the increasing late-life suicides due to depression and the elderly of the ethnic minority group are no exception. Depression could occur frequently in Filipino American elders since most of them have limited resources and are adjusting to acculturation and family disruption. Acculturation is defined as ‘a process by which one cultural group adopts the beliefs and practices of a host culture’ (Mills and Henretta qtd. in Mui and Kang 244). Studies have pointed to an association between acculturation and depression. They need social support as much as they need help from their adult children who have been acculturated in the U.S. way of life. The study researched Asian Americans; one group was Filipino Americans aged 65 years and older. Twelve family value questions measured elders’ expectations about extended family, nuclear family, family care, marriage, divorce, gender roles, and life arrangement. The study supported the authors’ research question that higher acculturation stress is connected with higher depression levels among the different groups, particularly Filipino Americans. Asian Americans are also not homogenous. It was noted that depression is a risk factor associated with suicide and can be undetected or misdiagnosed on ethnic minority elders. 5. “Preparing Students for Culturally Competent Practice among Ethnic Minority Elders,” by Colette Browne and Noreen Mokuau This study is a university-community collaborative project on racial and ethnic disparities in health and health is care is distributed among aging adults. It is a project of students in gerontology which emphasized cultural competency as an important preparation for social work students for work with ethnic minority elders and how they could improve their work with older minority populations. Cultural competencies of three specific populations were described, namely, Japanese, Filipino, and Native Hawaiians. Health services in the U.S. should be designed to respond diversity because of the increasingly older ethnic minority population. In the Healthy People 20 report, it identified the goals and strategies to address disparities among racial and ethnic minorities, most importantly, the elderly (Brooks qtd. in Browne and Mokuau 307). Filipinos are a subgroup of Asian Americans and Pacific Islanders. There is diversity in this group. Health utilization is also difficult for health workers and policy makers to implement. Filipino Americans and the rest of the group are affected by cardiovascular disease, cancer, hepatitis B, tuberculosis and many other diseases that they must have easy access to government health care programs. Poor health care is associated with poverty, and for Filipino Americans 65 years and older, poverty rate was significant. This subgroup has low health care utilization with respect to knowledge of services, preventive care, and hospitalization rates. The results are life expectancy and mortality rates. There is prevalence of chronic diseases and poor health practices. Filipino Americans could not fully rely from their adult children as they are also busy and could not provide the necessary health care. Cultural competence can be used as a strategy to fight health disparities (Brach and Fraser qtd. in Browne and Mokuau 310). Cultural competence can also be used to promote social justice; social justice is defined here as the condition where there is respect for human dignity, care for self-determination, and ensuring that members of society acquire the same basic rights and opportunities. Older minorities must have equitable access, service utilization, and improved health. This study recommended that there is a need for ongoing education and training of professionals in gerontology to help narrow the gap on health disparities and cultural competence. Social workers are the nation’s professionals who work for the growing elderly population of diverse ethnic background. The education and training of this kind of professionals who are charge to address the unique characteristics and needs of multicultural elders, like the Filipino Americans, Japanese Americans, and other Asian Americans, are important in potentially changing the health disparities. The study emphasized geriatric/gerontology social work in Hawaii as important milestone in bringing such step to fruition to help ethnic minority elders who need immediate and continuous health support. 6. “Utilization of Alzheimer’s Disease Community Resources by Asian-Americans in California,” by Tiffany Chow, Leslie Ross, Parick Fox, Jeffrey Cummings and Keh-Ming Lin Alzheimer’s disease is prevalent among Asian Americans and a subgroup of this is composed of Filipino Americans who cannot be cared alone by their family. They need the care and support of community-based healthcare resources. Most Asian Americans are not enrolled in community-based care for AD patients. Asian-Pacific Islander groups are the fastest growing ethnic population in the United States. These groups are composed of Chinese, Japanese, Korean, Filipinos and Pacific Islanders. Along with the growth in population is the increase in the number of patients with dementia. Alzheimer’s disease is the most common cause of dementia. In caring for patients with AD, patients and their families most usually need assistance from the communities in which they life. Psychosocial and financial stressors are some of the problems that families have to deal with, spanning a mean of up to thirteen years. Filipino American elders with dementia have to go to dementia support resources such as caregiver support groups, day care centers, and other home health services. The California’s Alzheimer’s Disease Diagnosis and Treatment Centers (ADDTCs) have reported that Alzheimer centers are underutilized by Asian ethnic minority groups (Hart et al. qtd. in Chow et al. 839). Nine AADTCs have been established by the California Department of Health Services to offer comprehensive assessment, diagnosis, treatment, and other resources for persons affected with AD and Asian Americans, particularly Filipino Americans. The findings stated that there had been low enrolment for Filipino Americans with AD although it was reported that there was an increased prevalence in Filipinos with AD as reported by neurologists and clinicians. These groups were of low income levels. Filipino patients and caregivers had also been referred for financial assistance. Reason for seeking dementia evaluation was loss of memory. Family members and physicians were the most common sources of referral, but families usually needed support. It was reported that the families preferred to take care of their loved ones with AD rather than enrol them in AD centers. 7. “Filipino American Grandparent Caregivers’ Roles, Acculturation, and Perceived Health Status,” by Merle R. Kataoka- Yahiro This has relation with another article by Kataoka-Yahiro, Ceria and Yoder entitled “Grandparent Caregiving Role in Filipino American Families”, but this one centred on grandparent caregivers’ roles, acculturation, and perceived health status. Filipino American grandparents extensively take care of their grandchildren, and when it’s time for them to be cared for by their grandchildren, more problems and challenges occur. Many of these Filipinos migrated to the United States in the twentieth century and the number of migration grew after the promulgation of the U.S. Immigration and Nationality Act of 1965 (Pido qtd. in Kataoka- Yahiro 24). From this study, three themes came out in which grandparents took on responsibilities of caring for their grandchildren as a result of cultural beliefs and norms. The themes are “pakikisama” (family unity and closeness), “utang na loog (indebtedness or obligation in relationships), and “authoritarianism” (respecting and valuing elders). The findings were that role integration resulted in physical health outcomes, role stress had negative effect on physical health, and role satisfaction positively impacted on psychological well-being. Role integration was used as a framework and acculturation was calculated with respect with years lived in the United States. The higher role satisfaction was associated significantly with health status and role occupancy. The grandparents performed a number of roles, but the highest mean was on mother/father, grandparent, and caregiver role involvement. The conclusion was grandparents needed support of health care professionals to promote role satisfaction so grandparents can maintain their health as caregivers because time will come that they will need care themselves in the near future. 8. “Filipino Elderly’s Sense of Reminiscence, Living Disposition, and End-of-Life Views,” b y Allan de Guzman, Vincent Chua, Claudine Claudio, Carlo Consignado, Dianne Consolacion and Trisha Cordero This study was applied with a phenomenological design in discovering and characterizing the essence behind the life experiences and disposition of the Filipino elderly aged 65 and above. The main purpose is to provide a clear description of the relation of reminiscence, living disposition, and end-of-life views of a group of Filipino elderly. The Filipino elderly have their own understanding of their lives which is different from the societal view that states that geriatrics is a period of decline. The study found that geriatrics represent three dimensions of elderly’s lived experiences, such as, reminiscence, living disposition, and end-of-life. Filipinos, wherever they may be, express these three dispositions in various ways. According to Butler (qtd. in Guzman et al.611), life review is significant in old age. Life review is a naturally occurring process of thinking on what one has lived in the past: reminiscence allows a human being to express a mental process since he/she has to come to terms with his/her life as it is about to come to an end (Pot et al. qtd. in Guzman, Chua, et al. 610). The elderly has to accept negative events, outcomes of past events, or discover the link between the past and the present. Filipinos are perceived religious and with closely-knit families. Their culture and religion significantly affect in their understanding of end-of-life perceptions, thus, the role of reminiscence and life disposition have always to be considered. Care for the elderly Filipinos, wherever they may be in many parts of the world, have also to consider this. Most people prefer to spend the remaining part of their lives at home (Fleischer et al. qtd. in Guzman, Chua, et al. 610). Filipinos are no different. In the United States, they want to be around their families when end-of-life situations come nearer. 9. “Dying Away from Home: Quandaries of Migration for Elders in Two Ethnic Groups,” by Gay Becker This study focused on two ethnic groups in the United States, Cambodian Americans and Filipino Americans. How they view their homeland in their old age and how their views affect their perception of end-of-life situations are examined in this study using a multiple theoretical framework which delved on transnationality, place, ethnic identity, and cultural phenomenology. Becker interviewed 126 respondents (48 Cambodian Americans and 78 Filipino Americans) using open-ended and semi-structured interviews. Like the other articles reviewed in this paper, most participants want to return to their home country to die but there is always the absence of the family, coupled with memories of the homeland, and the availability of traditional practices in their adoptive country. This situation allowed them to strive more to create continuity in their lives. They want to bring closure to unresolved conflicts in their lifetime, but family support is most needed. The elder’s desire is to be reciprocated for the things they had done to their loved ones, particularly in bringing their loved ones to the United States, in providing them good life. The most important thing that the elders want is their desire to complete their lives, i.e. in the presence of their loved ones. 10. “Chronic Illness Self-Care and the Family Lives of Older Adults: A Synthetic Review Across Four Ethnic Groups,” by Mary Gallant, Glenna Spitze and Joshua Grove The purpose of this study is to relate the literature on family and social ties among the ethnic minority elderly with the literature on elders’ chronic illness self care. This can lead to the understanding of social influences on self-care behaviour, and provide culturally appropriate interventions. The paper examines demographic and prevalence of chronic illness among African Americans, Latinos, Asian-Americans and American Indians in the United States. Majority of older adults who belong to minority ethnic groups have been living with chronic illness, although there are disparities in chronic illness prevalence across these groups. It is also these groups that experience greater complications and higher death rates as a result of the chronic illnesses (NCHS; Harris qtd. in Gallant, Spitze and Grove 21). Most older people of ethnic minority do not want to go to hospitals or clinics for treatment, instead they resort to self-care. Self-care behaviour is defined as “the range of health and illness behaviours undertaken by individuals on behalf of their own health” (Dean 1992 qtd. in Gallant et al. 22). Asian Americans are a highly diverse group, with various subgroups, and one of them are the Filipino Americans who have varied immigration histories. Asian American elderly have lower rates of chronic illnesses, with heart disease and arthritis also relative low. There is evidence that Asian Americans have strong patterns of filial piety and responsibility to elders; but this is changing, and the causes are still not clear. The study recommended that in order to address health disparities in the results of chronic illness is to improve self-care behaviours. DISCUSSION The ten studies have almost similar themes relative to care giving for the elders in Filipino American families. The study by Kataoka-Yahiro explored the culture of this particular caregiving role of grandparents and its effect on their health. It is the grandparents who provided care for their grandchildren, and although it had negative effects on their health, the grandparents found joy in caring for their children. A major theme of the study was “natural role expectation”, and the sub themes were pakikisama (family unity and closeness), utang na loob (mutual reciprocity or give and take), and authoritarianism (being responsible role models). The grandparents’ role as caregivers contributed to stress, sleep deprivation, and back problems. The study by Guzman and associates on regarding traditional Filipino arts as a way of fighting depression is an eye opener for researchers. TFA is a recreational therapy used in fighting depression. The study emphasized that recreational therapies helped in the Filipino elders’ adapting a hopeful behaviour and ‘capability to play the role of psychological crutch’ (Guzman et al. 249). The third study had a sad note which is also found in the other studies: Filipino Americans were left to hospice care without family, or, they only had a few visits from family members before their end of life. This is contrary to the traditional Filipino end-of-life situation where a dying Filipino is surrounded by family members in their own home. The study by Ada Mui and Suk-Young Kang focused on acculturation which affects physical, psychological, financial, spiritual, and other dimensions of a person’s life. It is stressful for immigrant elders, particularly Filipino Americans in the United States. They have no income, and have low education and English proficiency to assist them in their situation in the U.S. The study by Browne and Mokuau examined the profile of Asian Americans and Native Hawaiians; reviewed the scope and parameters of cultural competence; described social work project and the project of graduate social work students in cultural competency with ethnic minority elders; and the development of practice standards for cultural competence. The other studies focused on the problems and challenges of caring for the Filipino American elders. The themes were culture, religious beliefs, and remembering/returning to their homeland. Works Cited Becker, Gay. “Dying Away from Home: Quandaries of Migration for Elders in Two Ethnic Groups.” The Journals of Gerontology, 57B (2002): S-79-S95. The Gerontological Society of America. Web. 19 November 2012. Browne, Colette and Noreen Mokuau. “Preparing Students for Culturally Competent Practice among Ethnic Minority Elders.” Educational Gerontology, 34, 306-327 (2008). Taylor & Francis Group, LLC. Web. 19 November 2012. Chow, Tiffany, Leslie Ross, Parick Fox, Jeffrey Cummings and Keh-Ming Lin. “Utilization of Alzheimer’s Disease Community Resources by Asian-Americans in California.” International Journal of Geriatric Psychiatry, 15, 838-847 (2000), John Wiley & Sons. Web. 19 November 2012. Guzman, Allan de, James Cyril Satuito, Miko Anne Satumba, Diego Rey Segui, Faith Serquina, Lawrence Serrano and Madely Sevilla. “Filipino Arts among Elders in Institutionalized Care Setting.” Educational Gerontology, 37 (2011): 248-261. Routledge. Web. 17 November 2012. Guzman, Allan de, Vincent Chua III, Claudine Patricia Claudio, Carlo Consignado, Dianne Karen Consolacion and Trisha Gabrielle Cordero. “Filipino Elderly’s Sense of Reminiscence, Living Disposition, and End-of-Life Views.” Educational Gerontology, 35, 610-633 (2009), Taylor & Francis Group, LLC. Web. 12 November 2012. Kataoka-Yahiro, Merle. “Filipino American Grandparent Caregivers’ Roles, Acculturation, and Perceived Health Status.” Journal of Cultural Diversity, 17.1 (2010): 24-33. Academic Search Premier. Web. 19 November 2012. Kataoka-Yahiro, Merle, C. Ceria and M. Yoder. “Grandparent Caregiving Role in Filipino American Families.” Journal of Cultural Diversity. 11.3 (2004): 110-116. Academic Search Premier. Web. 16 November 2012. Mui, Ada and Suk-Young Kang. “Acculturation Stress and Depression among Asian Immigrant Elders.” Social Work, 51.3 (2006): 243-255. Web. 18 November 2012. Ngo-Metzger, Quyen, Russell Phillips and Ellen McCarthy. “Ethnic Disparities in Hospice Use among Asian-American and Pacific Islander Patients Dying with Cancer.” JAGS 56 (2008): 139-144. Web. 18 November 2012. Read More