An analysis of stressors, mediators and health outcomes among African American caregivers of older adults with chronic illness
Watkins, Karen Yvonne
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The purpose of this investigation was to define the stress process and health outcomes of African American caregivers who provide care to older adults with chronic illness. This study sought to investigate what background characteristics of caregivers are associated with caregivers' health outcomes (physical and mental), what primary and secondary stressors affect health outcomes, and what variables mediate caregivers’ health outcomes. Guided by the stress process model (Pearlin, Mullan, Semple, & Skaff, 1990), this study examined 152 African American caregivers who provide day-to-day, specific task care and/or emotional care for African American older adults with chronic illness. All caregivers were interviewed, using a structured questionnaire, which included caregivers’ and care-recipients’ demographic information, other background characteristics (caregiving history, caregiver justifications), primary stressors (cognitive status, behavior problems, ADLS/IADLS, role overload, and loss of relationship), secondary stressors (family and work conflict), mediators (religious/spiritual coping, informal social support, and formal social support), and health outcomes (physical and mental). Univariate, bivariate, and mediation analyses were employed to analyze the outcome data of this study. Univariate analyses revealed caregivers who were older, no immediate relation with the care recipient, who were unemployed, lower income, three health problems, and who provided care for 43 + hours a week for over 121 months, showed poorer physical health outcomes. Caregivers who resided with care recipient demonstrated lower mental health outcomes. At the bivariate level increased amounts of role overload, loss of relationship with care recipient, and work conflict resulted in negative physical and mental health outcomes. Elevated levels of family conflict were a significant predictor for elevated levels of mental health, while increased amounts of caregiving justification, religious/spiritual coping, and informal social support relieved mental health outcomes. Lastly, family conflict significantly mediated the relationship between the loss of relationship and mental health outcomes. Based on the findings of this study, directions for future research were suggested, particularly for African American caregivers who provide care for older adults with chronic illness.