Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers

Dolores Gallagher-Thompson, Marian Tzuang, Ladson Hinton, Paula Alvarez, Johanna Rengifo, Irene Valverde, Nancy Chen, Tara Emrani, Larry W Thompson, Dolores Gallagher-Thompson, Marian Tzuang, Ladson Hinton, Paula Alvarez, Johanna Rengifo, Irene Valverde, Nancy Chen, Tara Emrani, Larry W Thompson

Abstract

The clinical need to address stress and depression in Latino dementia caregivers (CGs) combined with low health literacy and less accurate knowledge of dementia motivated the development of a pictorial tool [called a fotonovela (FN)] to teach (a) coping skills for caregiver (CG) stress; (b) self-assessment of depression; and (c) encourage improved utilization of available resources. To test the effectiveness of the FN, 110 of 147 Latino CGs, who were randomly assigned to the Fotonovela Condition (FNC) or the Usual Information Condition (UIC), were included in the final analyses. Self-report measures were given at baseline and post intervention. Results showed that FNC CGs demonstrated significantly greater reductions in level of depressive symptoms than UIC CGs. A significant decrease in level of stress due to memory and behavioral problems exhibited by their loved ones was similar in both groups. The FNC CGs reported that the FN was more helpful and that they referred to it more often than the UIC CGs did with regard to the informational materials they were provided about dementia. In conclusion, a culturally tailored FN can be an effective tool for Latino CGs given their high unmet needs for assistance and various barriers in accessing resources.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

References

    1. Alzheimer’s Association. Seven Stages of Alzheimer’s. 2012 Available at: .
    1. Alzheimer’s Association. Minorities Contract Alzheimer’s Earlier. 2011 Available at: .
    1. Clark CM, DeCarli C, Mungas D, et al. Earlier onset of Alzheimer disease symptoms in latino individuals compared with anglo individuals. Arch Neurol. 2005;62:774–778.
    1. Tang MX, Cross P, Andrews H, et al. Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in northern Manhattan. Neurology. 2001;56:49–56.
    1. Perkins P, Annegers JF, Doody RS, Cooke N, Aday L, Vernon SW. Incidence and prevalence of dementia in a multiethnic cohort of municipal retirees. Neurology. 1997;49:44–50.
    1. Yaffe K, Haan M, Blackwell T, Cherkasova E, Whitmer Ra, West N. Metabolic syndrome and cognitive decline in elderly Latinos: findings from the Sacramento Area Latino Study of Aging study. J Am Geriatr Soc. 2007;55(5):758–762.
    1. Strachan MW, Deary IJ, Ewing FM, Frier BM. Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies. [Accessed September 26, 2014];Diabetes Care. 1997 20(3):438–445. Available at: .
    1. Leibson CL, Rocca WA, Hanson VA, et al. The risk of dementia among persons with diabetes mellitus: a population-based cohort study. [Accessed September 26, 2014];Ann N Y Acad Sci. 1997 826:422–427. Available at: .
    1. Haan MN, Mungas DM, Gonzalez HM, Ortiz TA, Acharya A, Jagust WJ. Prevalence of dementia in older latinos: the influence of type 2 diabetes mellitus, stroke and genetic factors. [Accessed September 26, 2014];J Am Geriatr Soc. 2003 51(2):169–177. Available at: .
    1. Rotkiewicz-Piorun AM, Al Snih S, Raji MA, Kuo Y-F, Markides KS. Cognitive decline in older Mexican Americans with diabetes. [Accessed September 26, 2014];J Natl Med Assoc. 2006 98(11):1840–1847. Available at: .
    1. Ayalon L, Huyck MH. Latino caregivers of relatives with Alzheimer’s disease. Clin Gerontol J Aging Ment Heal. 2001;24:93–106. Available at: .
    1. Connell CM, Gibson GD. Racial, ethnic, and cultural differences in dementia caregiving: review and analysis. Gerontologist. 1997;37:355–364.
    1. Gallagher-Thompson D, Solano N, Coon D, Areán P. Recruitment and retention of latino dementia family caregivers in intervention research: issues to face, lessons to learn. Gerontologist. 2003;43:45–51.
    1. Hinton L, Chambers D, Velásquez A, Gonzalez H, Haan M. Dementia neuropsychiatric symptom severity, help-seeking patterns, and family caregiver unmet needs in the Sacramento Area Latino Study on Aging (SALSA) Clin Gerontol. 2006;29:1–15.
    1. Ortiz F, Fitten LJ. Barriers to Healthcare Access for Cognitively Impaired Older Hispanics. Alzheimer Dis Assoc Disord. 2000;14(3):141–150.
    1. National Alliance for Caregiving and Evercare. Evercare Study Hisp Caregiving US. 2008 Nov
    1. 2014 Alzheimer’s Disease Facts and Figures. [Accessed September 26, 2014]; Available at: .
    1. Guerra-Silla MG, Gutiérrez-Robledo LM, Villalpando-Berumen JM, et al. Psychometric evaluation of a Spanish language version of the Screen for Caregiver Burden (SCB) in caregivers of patients with mixed, vascular and Alzheimer’s dementia. J Clin Nurs. 2011;20(23–24):3443–3451.
    1. Hardwood D, Baker B, Ownby R, Dura R. Delusions and hallucinations among outpatient hispanic Alzheimer’s disease patients. [Accessed November 22, 2013];Clin Gerontol. 18(1):55–59. Available at: .
    1. Chen JC, Borson S, Scanlan JM. Stage-specific prevalence of behavioral symptoms in Alzheimer’s disease in a multi-ethnic community sample. Am J Geriatr Psychiatry. 2000;8:123–133.
    1. Sink KM, Covinsky KE, Newcomer R, Yaffe K. Ethnic differences in the prevalence and pattern of dementia-related behaviors. J Am Geriatr Soc. 2004;52:1277–1283.
    1. Mangone C, Bueno AA, Allegri R, et al. Behavioral and Psychological Symptoms of Dementia in Latin America. Int Psychogeriatrics. 2000;12(S1):415–418.
    1. Hinton L, Haan M, Geller S, Mungas D. Neuropsychiatric symptoms in Latino elders with dementia or cognitive impairment without dementia and factors that modify their association with caregiver depression. Gerontologist. 2003;43:669–677.
    1. Livney MG, Clark CM, Karlawish JH, et al. Ethnoracial differences in the clinical characteristics of Alzheimer’s disease at initial presentation at an urban Alzheimer's disease center. Am J Geriatr Psychiatry. 2011;19(5):430–439.
    1. Ortiz F, Fitten LJ, Cummings JL, Hwang S, Fonseca M. Neuropsychiatric and Behavioral Symptoms in a Community Sample of Hispanics With Alzheimer’s Disease. Am J Alzheimers Dis Other Demen. 2006;21(4):263–273.
    1. Hinton L, Chambers D, Velásquez A. Making sense of behavioral disturbances in persons with dementia: Latino family caregiver attributions of neuropsychiatric inventory domains. Alzheimer Dis Assoc Disord. 2009;23(4):401–405.
    1. Valle R, Yamada AM, Barrio C. Ethnic differences in social network help-seeking strategies among Latino and Euro-Aamerican dementia caregivers. Aging Ment Health. 2004;8(6):535–543.
    1. Adams BUSCRLANRCADRC of CDCUsaMP. USCS of SWADRC of CCU. Ethnic and gender differences in distress among Anglo American, African American, Japanese American, and Mexican American spousal caregivers of persons with dementia. J Clin Geropsychology. 2002;8(4) doi:<a data-auto=“ep_link_”href=“ ”target=“_blank” id=“linkhttp:dx.doi.org10.1023A:1019627323558”title=“ ” data-title=“ ”> </a>.
    1. Pinquart M, Sörensen S. Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: a meta-analysis. [Accessed September 26, 2014];Gerontologist. 2005 45(1):90–106. Available at: .
    1. Llanque SM, Enriquez M. Interventions for Hispanic Caregivers of Patients with Dementia: A Review of the Literature. Am J Alzheimers Dis Other Demen. 2012;27:23–32.
    1. Mausbach BT, Coon DW, Depp C, et al. Ethnicity and time to institutionalization of dementia patients: a comparison of Latina and Caucasian female family caregivers. J Am Geriatr Soc. 2004;52:1077–1084.
    1. Rabinowitz Y, Mausbach B, Coon D, Thompson L, Gallagher-Thompson D. The Moderating Effect of Self-Efficacy on Intervention Response in Women Family Caregivers of Older Adults with Dementia. Am J Geriatr Psychiatry. 2006;14(8):624–649.
    1. Cabassa LJ, Molina GB, Baron M. Depression fotonovela: development of a depression literacy tool for Latinos with limited English proficiency. Health Promot Pract. 2012;13(6):747–754.
    1. Valle R, Yamada A-M, Matiella AC. Fotonovelas: A Health Literacy Tool for Educating Latino Older Adults About Dementia. Clin Gerontol J Aging Ment Heal. 2006;30:71–88.
    1. Unger JB, Molina GB, Baron M. Evaluation of Sweet Temptations, a Fotonovela for Diabetes Education. Hisp Heal Care Int. 2009;7:145–152. doi: .
    1. Turner RM, Tran C, Hinton L, Gallagher-Thompson D, Tzuang M, Tran CH, Valle RJ. Coping with dementia behavior problems: A culturally-attuned focus group study of Latino caregivers. Am J Alzheimer’s Dis Other Dementias
    1. Radloff LS. The CES-D Scale: A Self Report Depression Scale for Research in the General. Appl Psychol Meas. 1977;1:385–401.
    1. Teri L, Truax P, Logsdon R, Uomoto J, Zarit S, Vitaliano PP. Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychol Aging. 1992;7:622–631.
    1. Unger JB, Cabassa LJ, Molina GB, Contreras S, Baron M. Evaluation of a fotonovela to increase depression knowledge and reduce stigma among Hispanic adults. J Immigr Minor Health. 2013;15(2):398–406.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj