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Objectives. The objectives of this study were to examine the relationship between selected decedent and caregiver characteristics, facility-related perceptions, and emotional and physical health of 434 informal caregivers (94% family) of recently deceased residents of residential care/assisted living facilities and nursing homes. We also examined potential mediating effects of social support (informal, staff, and spiritual). Methods. We analyzed data using linear mixed models. Results. Among caregivers, younger age, female gender, more education, financial burden, other dependents, poorer perceptions of care, and more care involvement were associated with more emotional strain. More staff support also was associated with more emotional strain and partially mediated the relationship between having a trusted staff member and emotional strain. Characteristics associated with poorer physical health included unemployment, financial burden, poorer physician communication, and trusted staff member. Informal social support was directly related to better physical health and mediated the relationships between physical health and both physician communication and financial burden. Discussion. Many characteristics related to end-of-life caregiving outcomes in long-term care are consistent with community-based studies, suggesting that end-of-life caregiving outcomes in long-term care are not markedly different than in other settings. However, the role of staff support may either facilitate or complicate emotional strain and merits additional study. Key Words: End of life--Long-term care facilities--Social support--Emotional and physical health.

Objectives. Our objective in this study was to explore the effects of caregiver characteristics on cultural reasons given for providing care to dependent elderly family members. Methods. The sample included 48 African American and 121 White caregivers. Using multivariate analyses, we used caregiver characteristics (e.g., race, gender, education) to predict scores on the Cultural Justifications for Caregiving Scale (CJCS). Results. Confirmatory factor analysis showed that the CJCS was appropriate for both African American and White caregivers. African Americans had stronger cultural reasons for providing care than Whites, education levels were inversely related to CJCS scores, and the influences of gender and age on cultural reasons were moderated by race. Compared to females, African American males had lower CJCS scores, whereas White males had higher CJCS scores. Younger as compared to older White caregivers had higher CJCS scores. Discussion. This study supports the long-standing cultural tradition of African American families providing care to dependent elders. Cultural reasons for caregiving need to be interpreted within the context of race and gender socialization. Social roles, such as husband or wife, son or daughter, can also help determine how individuals within a particular cultural group experience cultural expectations and obligations. Information from this study can inform culturally appropriate caregiving interventions.

Objectives. The purposes of this study were to longitudinally examine the health outcomes of 107 African American caregivers who provided care to their elderly dependent family members and to determine the role of culture in predicting health outcomes. Methods. With use of the stress and coping model of Pearlin and colleagues (1990) as a guide, the direct effects of background characteristics and stressors and the direct and mediating effects of resources (including culture) on two caregiver health outcomes (i.e., psychosocial health and physical functioning) were analyzed with hierarchical multiple regression analyses. Results. Similar to other studies, we found that combinations of caregiver background characteristics, stressors, and resources at wave 1 had direct effects on African American caregivers' health outcomes at wave 3. Unlike previous studies, where culture was not measured, we found that cultural beliefs and values did help to explain health outcomes for African American caregivers. Specifically, culture justifications for caregiving, baseline psychosocial health, and caregiving mastery predicted wave 3 psychosocial health. Caregiver education, number of morbidities, and physical functioning at wave 1 were associated with physical functioning at wave 3. Discussion. The findings from this study have implications for future studies, particularly in regard to cultural beliefs and values among African American caregivers.

Purpose: This study examined connections (linking, compensatory, or none) between three systems of social support (informal, church, and formal). Predictors of each system were also examined. Design and Methods: A community sample of 187 caregivers who provided care to older African American participants in the Duke Established Populations for Epidemiological Studies of the Elderly was used. Multiple regression analyses were used to examine relationships between systems of social support as well as to determine predictors of each social support system. Results: Findings provide evidence for linking connections between systems of support: Informal and formal supports were linked, and church support and formal support were linked. The relationship of need as positively related to social support was limited to the care recipients number of instrumental activities of daily living limitations being associated with formal support. Level of education was also associated with use of formal support. Implications: Cohesive family networks and network size are important factors that help determine what support caregivers receive. African American caregivers may be at risk for negative health outcomes because they are less likely to use formal support as care recipients' activities of daily living limitations increase. Key Words: Formal support, Church support, Informal support

Using a contextual approach, this study examined predictors of emotional distress among 187 African American caregivers to dependent elders. The results show that almost 20% of the caregivers were emotionally distressed which is indicated by having a t-score of 63 or more on two of the nine sub-scales of the Brief Symptom Inventory (BSI) or by having a t-score of 63 or more on the Global Severity Index (a global measure of the BSI) (Derogatis & Spencer, 1982). The results also show that caregivers who were distressed received less social support, were in poor physical health, and experienced more caregiving role strain than caregivers who were not distressed.

Objectives. This study identified different types of caregivers who provide care to older African Americans, the types of caregiving structures created to provide care, and the factors that help predict caregiving structures. Methods. A community sample of 330 caregivers caring for 202 elderly African Americans was used. Multinomial logistic regression predicted what type of caregiving structure was created by families to provide care to older relatives. Results. Three types of caregivers were identified: 187 primary caregivers, who were connected to 79 secondary caregivers and 49 tertiary caregivers. Fifteen tertiary-only caregivers who were not connected to other caregivers were identified. Five caregiving structures were found: (i) primary, secondary, and tertiary, (ii) primary and secondary, (iii) primary and tertiary, (iv) primary only, and (v) tertiary-only. Characteristics of care recipients were predictive of caregiving structures. Discussion. Different types of caregivers with distinct roles and responsibilities provided care within defined caregiving structures to older African American family members. Caregiving structures may be individualistic (only one caregiver) or collectivist (two or more caregivers). Caregiving structure is predicted by the care recipients' conditions and situations, but not those of the primary caregiver.