A 9 a MNWMaleCaregiversStr ategies

The Emerging Male Caregiver: Successful Strategies for Outreach and Support: 

The Emerging Male Caregiver: Successful Strategies for Outreach and Support Maryam Navaie-Waliser, Dr.P.H. National Aging I&R/A Symposium AIRS National Conference May 5, 2004 Contact Info: maryam.navaie@vnsny.org

OVERVIEW OF PRESENTATION: 

OVERVIEW OF PRESENTATION Presentation will highlight the following topics: 1. Informal caregiving and gender: an overview of the literature 2. Summary of findings relevant to male caregivers from a recent national study of informal caregivers 3. Challenges serving male caregivers 4. Implications and recommendations for future directions in practice, research, and policy

INFORMAL CAREGIVING AND GENDER: AN OVERVIEW OF THE LITERATURE : 

INFORMAL CAREGIVING AND GENDER: AN OVERVIEW OF THE LITERATURE Compared with female caregivers, male caregivers are less likely to: be a primary caregiver care for a spouse or a parent spend many hours/wk caring for sick relatives provide hands-on care with: Activities of daily living (ADL) Instrumental activities of daily living (IADL) resist relying on formal caregivers to access caregiver education and support programs report exacerbated physical ailments associated with caregiving forgo practicing health promoting behaviors as a result of caregiving

INFORMAL CAREGIVING AND GENDER: LIMITATIONS OF THE LITERATURE : 

INFORMAL CAREGIVING AND GENDER: LIMITATIONS OF THE LITERATURE Past research has: Used small, non-representative, convenience samples of informal caregivers Focused on informal caregivers to patients with severe debilitating illnesses (i.e., Alzheimer’s) Centered mostly on either spouse caregiver or the parent-child dyad relationships Examined principally informal caregiving to elderly care recipients Compared male and female caregivers’ experiences on a narrow set of factors

A NATIONAL STUDY OF INFORMAL CAREGIVERS: 

A NATIONAL STUDY OF INFORMAL CAREGIVERS Maryam Navaie-Waliser, Dr.P.H. Aubrey Spriggs, M.A. Penny H. Feldman, Ph.D.

BACKGROUND: 

BACKGROUND Aging population  demands for dependent care likely to increase Limited access, availability, and affordability of formal care services  burden shift to informal caregivers Informal caregivers likely to continue to be responsible for the majority of care for loved ones, many living well into late stages of life

BACKGROUND (cont’d): 

BACKGROUND (cont’d) Nationally, men constitute 30% of all informal caregivers, and 36% of spouse caregivers Informal caregiving traditionally dominated by women  research and programs tend to be female-centric The activities and needs of male and female caregivers differ in important ways  implications for practice, research, and policy to incorporate male perspectives relevant to caregiving issues

STUDY PURPOSE: 

STUDY PURPOSE Using a large, nationally-representative sample of informal caregivers, compare male and female caregivers’: Sociodemographic characteristics Caregiving activities Caregiving challenges Health impacts of caregiving (physical and mental) Coping strategies

STUDY DESIGN AND SAMPLE: 

STUDY DESIGN AND SAMPLE Study Design Nationally representative cross-sectional study Random digit dialing Telephone interviews Project period: May – September 1998 Study Sample 4,874 households Inclusion criteria: 18+ years of age Provide direct unpaid care or arrange care for family or friend in year preceding the study

DATA COLLECTION: 

DATA COLLECTION Caregiver’s and care recipient’s: Sociodemographic characteristics Relational characteristics Care types provided including, ADLs, IADLs, and other complex tasks Hours of care provided per week Duration of caregiving Caregiving intensity Caregiver’s emotional and physical well-being Care recipient’s physical well-being Use of formal care services Difficulty with care provision and perceived needs

STATISTICAL ANALYSES: 

STATISTICAL ANALYSES Performed descriptive statistics, bivariate analyses and multivariate modeling Models assessed degree to which gender independently predicted: Caregiving activities Caregiving challenges Caregiving impact

STATISTICAL ANALYSES: 

STATISTICAL ANALYSES Crude and adjusted odds ratios (ORs), 95% confidence intervals (CIs) and P values were computed. Care recipient physical health Caregiving intensity Being a primary caregiver Caregiver age Caregiver race/ethnicity Caregiver marital status Caregiver employment Models adjusted for:

RESULTS: SOCIODEMOGRAPHIC AND RELATIONAL CHARACTERISTICS: 

RESULTS: SOCIODEMOGRAPHIC AND RELATIONAL CHARACTERISTICS > 65 years of age African American Married The primary caregiver Compared to female caregivers, male caregivers are: Significantly less likely to be: Significantly more likely to: have < high school diploma be employed (part-time or full-time)

RESULTS: CAREGIVER ACTIVITIES: 

RESULTS: CAREGIVER ACTIVITIES ADLs care (i.e., bathing, dressing, feeding, incontinence, ambulating) IADLs care (i.e., shopping, homework, meal preparation, telephone calls, financial management, assistant with government programs) Complex care (i.e., dressing changes, medical equipment, assistance with >2 mediations) Compared to female caregivers, male caregivers are significantly less likely to provide:

RESULTS: CAREGIVER CHALLENGES: 

RESULTS: CAREGIVER CHALLENGES Compared to female caregivers, male caregivers are significantly less likely to: report difficulty providing care have difficulty balancing caregiving with other family responsibilities have difficulty balancing caregiving with employment responsibilities give up respite activities in order to take on caregiving role

CONCLUSIONS: 

CONCLUSIONS In general, male and female informal caregivers: Provide different types of care Relate to the care recipient in different ways Engage formal and informal support systems at different levels Have distinct needs stemming from caregiving

CHALLENGES SERVING MALE CAREGIVERS: 

CHALLENGES SERVING MALE CAREGIVERS

KEY ISSUES RELEVANT TO ENGAGING MALE CAREGIVERS : 

KEY ISSUES RELEVANT TO ENGAGING MALE CAREGIVERS 1. Caregiver identification 2. Non-system barriers 3. System barriers

MALE CAREGIVER IDENTIFICATION: 

MALE CAREGIVER IDENTIFICATION Care recipients may be reluctant to identify caregivers Caregivers may not identify themselves as such (~15% of caregivers) mostly because they are unfamiliar with definition of the term caregiver or they dislike being labeled a caregiver Such “hidden” caregivers are disproportionately male and racial /ethnic minorities Identifying oneself with the term “caregiver” is a significant predictor of resource-seeking

NON-SYSTEM FACTORS AFFECTING MALE PARTICIPATION IN CAREGIVER PROGRAMS: 

NON-SYSTEM FACTORS AFFECTING MALE PARTICIPATION IN CAREGIVER PROGRAMS Gender role issues affect self-identification and participation: Males far less likely than females to participate in caregiver support/education programs Masculinity beliefs Stigma associated with men as caregivers Self-image Logistical challenges faced by men also affect participation: Long-distance caregiving (more common than for women) Balancing caregiving with employment (men more likely to be employed than women) Rural residence  social isolation (more common among men in this setting)

SYSTEM FACTORS AFFECTING MALE PARTICIPATION IN CAREGIVER PROGRAMS: 

SYSTEM FACTORS AFFECTING MALE PARTICIPATION IN CAREGIVER PROGRAMS Caregivers’ general lack of awareness about the range of available services The longitudinal nature of caregiving programs Lack of cultural and gender sensitivity in program delivery Content of programs tend to be more female friendly/focused The non-home-based mode of service delivery utilized by most programs

Slide22: 

Common Modes of Service Delivery Among Caregiver Education and Support Programs

IMPLICATIONS AND RECOMMENDATIONS: 

IMPLICATIONS AND RECOMMENDATIONS

PRACTICE IMPLICATIONS: 

PRACTICE IMPLICATIONS Enhance Marketing Strategies Lack of awareness of programs often cited as reason for non-participation among male caregivers Focus on the message “ask for help” rather than “take care of yourself” Use comforting, reassuring and empowering campaign tones with sensitivity to male gender so that messages are not female-centric Provide multiple means of contact between caregiver and program

PRACTICE IMPLICATIONS: 

PRACTICE IMPLICATIONS Enhance Program Design Use program “add-ons” rather than stand-alone Provide a wide range of services including a home-based component Schedule flexibly to accommodate caregivers’ other responsibilities (particularly among employed caregivers) Establish satellite programs in rural communities Provide respite services

RESEARCH IMPLICATIONS: 

RESEARCH IMPLICATIONS Investigate the support needs of male caregivers Evaluate the efficacy of various strategies aimed to enhance male caregiver involvement in programs Study the connection between male caregiver self-identification and self-help actions Analyze the effectiveness of large-scale, controlled gender-specific interventions on male caregiver outcomes

POLICY IMPLICATIONS: 

POLICY IMPLICATIONS Advocate for employer-sponsored support of caregiving activities Assemble and train informal caregivers in public policy advocacy techniques Support funding increases for male caregiver focused research and program development