Family Caregivers in Rural Appalachia Caring for Older Relatives with Dementia: Predictors of Service Use

Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the U.S. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, under-resourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally-relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.

Informal Supporters of Elder Abuse Victims: Who Are They and What Is Their Experience Seeking Help?

This study examined the characteristics and experiences of informal supporters of elder abuse victims, including family members, friends, and neighbors—referred to as concerned persons. The researchers utilized secondary data from a UK national elder abuse helpline to investigate the profile and help-seeking experiences (including the impact of helping) of concerned persons reporting abuse to the helpline. The researchers focused on one year of data (2017–2018), and 1623 records met inclusion criteria. Of these, 1352 were reported by a concerned person, and descriptive statistics are provided to describe this sample. The help-seeking experience was investigated using qualitative content analysis. Concerned persons were primarily female family members, often adult children of the victim and siblings of the perpetrator. They faced barriers to helping the victim, particularly in relation to formal services. Many also reported impact as a result of knowing about the abuse or helping the victim; particularly to their mental health and their relationship with the victim. Findings indicate that concerned persons often face substantial barriers and negative impact when they support elder abuse victims. There is a need to advance research on concerned persons and identify ways of effectively supporting them, given their essential role in facilitating elder abuse victims’ access to formal services.

Exploring Spirituality, Loneliness and HRQoL In Hispanic Cancer Caregivers

Providing care to an aging society in the new normal requires increased attention to the informal caregivers who support the health and well-being of older adults with chronic conditions. Hispanic caregivers carry a high caregiver-associated burden. Health disparities experienced by Hispanics, coupled with the emotional, social and physical demands of caregiving, may set an unprecedented risk for lower health-related quality of life (HRQoL). In a quantitative analysis, we investigated the relationship between spirituality, loneliness and HRQoL in Hispanic cancer caregivers using baseline data from the Support for Latinas with Breast Cancer study (N= 234 Hispanic caregivers). Findings suggested an indirect effect of spirituality on HRQoL through reduced loneliness among more spiritual caregivers, effects that were independent of age. The second study was conducted using qualitative semi-structured interviews (N= 10) with Hispanic caregivers. Interviews evaluated spirituality and HRQoL in Hispanic cancer caregivers who reported variable levels of loneliness. Five themes emerged: caregiver experience, coping strategies, loneliness, religion to gain strength or support, and spirituality to gain strength or support. Results supported the role of spirituality in promoting higher HRQoL in Hispanic cancer caregivers and elucidated pathways to intervene on HRQoL through spirituality. With Hispanics often underutilizing formal services, having an improved understanding of caregiving experiences, particularly related to spirituality, will support the development of culturally-relevant strategies and programming to promote HRQoL for Hispanic caregivers.

Social Support and Diabetes Management Among Older American Indians

We examined social support among older American Indians in relation to their diabetes management. In-depth interviews were conducted with 28 participants aged ≥ 60 years who were members of a federally-recognized tribe. We examined professionally transcribed audio recordings with a systematic text analysis approach. Main sources of social support were family/friends, clinicians/formal services, community/culture, and spiritual/God. Most of the support was instrumental in nature, including food shopping, meal preparation, and medication management. Social support had both positive and negative influences diabetes management while there were some participants who lacked support. The four main social support types were present, including instrumental, emotional, informational, appraisal support. Value orientations among American Indian families command lateral-group relational behavior rather than autonomy and independence with extended social systems fostering interdependence. A deeper understanding is needed of how social relationships can be better leveraged to aid in the effective diabetes management among older American Indians.

Research concerning the Care Planning by Care Managers in Home-Based Community Care Support Centers of Japan

The research was conducted between February 9 and 28, 2017. The care management centers were randomly selected from the national list of the centers. The data were collected by self-administered questionnaires mailed to the care managers at 500 care management centers in six prefectures in the Kinki area of Japan. The independent variables were gender, age, experience years of care managers and/or social workers, Clients’ Physical and Mental conditions (CPM), Client’s Lifestyle (CL), Physical and Mental conditions of the Caregivers (PMC), and Human and Financial resources for Clients and their Caregivers (HFCC). The dependent of variables were the categorized contents in the care planning. They included the Approach for exploring Client’s needs (AC), Coordination among Care services within the program in accordance with the needs of client (CC), Coordination among Formal services and informal supports without the program in accordance with the needs of clients (CF). We examined the relationships between the dependent and independent variables by using the Structural Equation Modeling. The results indicated that the goodness of the fit indices was acceptable, and we retained the models. In correlational analyses, AC was significantly correlated with PMC (p<.01), CPM (p<.05), and CL (p<.001). CC was significantly correlated with PMC (p<.001), CPM (p<.001), and CL (p<.01). CF was significantly correlated with PMC (p<.05), HFCC (p<.05), and CL (p<.05). In conclusion, our findings suggest that care managers should recognize that information concerning the clients’ and their caregivers’ conditions is significant in making appropriate care planning for the clients and their caregivers.

ACTIVITY OF THE FAMILY CARERS OF THE ELDERLY DURING SARS-COV-2 PANDEMIC

Article focuses on various aspects of the family carers activity in the age of pandemia. The carers activity has been divided into several categories: care activity; activity related to the health issues; occupational activity and the activity in the sphere of new technologies, especial digital tools and social media. The researches used in the article has shown that the decline of the access to the formal services (both social and medical) and the shortening of the informal, social contacts led to the increasing burden of the family carers. Thus, the care activity has been intensified, so that other forms of activities could be retrenched. Also, other restrictions and risks of that time could have impact on non-care activities of family caregivers. Pandemic time affected also the use of digital technologies in many aspects, such as searching for information, communication, contacts with formal institutions, groups of support and webinars attendance. Also labour activity opportunities has been changed that time. On the one hand, development of tele-work has given potential chance to reconciliation between working and caring duties, but on the other hand additional care burdens and difficult situation on labour market could make the labour activity of carers difficult to manage.

Do Central Banks Have a Role in Financial Inclusion?

The chapter focuses on the role of central banks in fostering financial inclusion and specifically on the potential impact of financial inclusion on financial stability and economic growth. It examines the expansion of financial inclusion, from the reliance on informal solutions to the availability of formal services, through the engagement of policy-makers who have impacted on the way the financial sector has developed to be increasingly networked, driven by digitization, and supported by digital mobile networks. It highlights Kenya’s global success in financial inclusion; Kenya is used as a case study in central bank management, financial inclusion, and its contribution to economic development. It concludes by pointing out the risks associated with the absence of countervailing policies by financial institutions which may lead to unexpected losses to the financial system, and ultimately a banking crisis.

Correlates of Support Utilization After Experiencing a Sexual Assault Among College Women and Men

Though previous research has examined survivors’ use of formal and informal services, less research has looked at whether sexual orientation, race, and different sexual assault types (e.g., coercive) are associated with seeking support services. The purpose of this study is to examine factors associated with utilizing services or support from informal sources (e.g., telling a friend) and formal sources (e.g., psychological counseling) following a sexual assault. Data were gathered in Fall and Spring of 2019–2020 from undergraduate students at a Midwestern university. Logistic regression results showed that heterosexual students had 56% lower odds of using informal supports, while females were 2.05 times more likely to have used informal supports compared to their counterparts. Students who reported more heavy drinking had 37% lower odds of using informal supports compared to their counterparts. Those who experienced physical and incapacitated sexual assault were 2.09 times and 3.60 times more likely to have used informal supports, respectively. Additionally, older students were 1.35 times more likely to have used formal supports compared to younger students, whereas heterosexual students had 67% lower odds of using formal supports compared to sexual minority students. Those with greater PTSD symptoms were 1.07 times more likely to access formal services. Finally, students with greater depressive symptoms had 8% lower odds of using formal supports. Identifying college students who are less likely to access support services following a sexual assault has important implications for targeted prevention and intervention.

Facilitators of Formal Help-Seeking for Adult Survivors of IPV in the United States: A Systematic Review

A survivor’s decision to engage with formal services for experiences of intimate partner violence (IPV) is influenced by factors at the individual, interpersonal, and sociocultural levels. Understanding factors that facilitate survivors’ choice to seek services could be beneficial to formal service providers including community agencies, health professionals, and the criminal justice system, providing guidance toward the development and implementation of accessible services for survivors of IPV. This systematic review of the literature aims to identify key factors that facilitate survivors’ formal help-seeking. Ten electronic databases were searched for key terms related to help-seeking from formal services and facilitators of formal help-seeking. Articles were included in the review if the studies were conducted in the United States, focused on adults with experiences of IPV, and discussed facilitators of formal help-seeking. A total of 1,155 studies were initially identified, and after screening, 24 were included in the review. Seven factors were identified including provider knowledge, support, accessibility, desire to provide protection and to prevent future violence, and other factors such as knoweldge of and desire for services, policy factors, and personal factors. Findings demonstrate a need for more research on the facilitators of help-seeking among East Asian, South Asian, and Middle Eastern survivors living in the United States, as well as male-identified, trans, and gender nonconforming survivors. The review also indicates a need for culturally sensitive and accessible services that support survivors and the importance of raising awareness of the services and resources available for survivors.

Why do Consumers Buy from Informal Sector Suppliers in East-Central Europe? A Case Study of Home Repair and Renovation Services

This paper seeks to explain consumers’ reasons for purchasing from informal sector suppliers so that policy initiatives can be developed to tackle the off-the-books consumer culture. The conventional assumption is that those purchasing from the informal economy are marginalised populations seeking a lower price. Here, however this assumption is evaluated critically. Reporting data from a 2019 Eurobarometer survey involving 11,171 face-to-face interviews in 11 East-Central European countries on who purchases home repairs and renovations from informal sector suppliers and why, the finding is that it is not the poorest populations who purchase such services and a lower price is the sole motive in just 20% of cases. Besides being “pulled” into the informal economy by a lower price, consumers are also “pushed” into the informal economy by the failures of formal sector provision and in addition do so for social and redistributive rationales. The policy implication is that there is not only a need to alter the cost-benefit ratio facing consumers so that they purchase formal services, but also initiatives are required to enhance the availability, speed, reliability and quality of formal sector provision and to address purchases made for social and redistributive reasons.