IMPACT OF CARING FOR ALZHEIMER’S DISEASE CLIENTS ON FILIPINO
CAREGIVERS’ STRESS LEVEL AND PSYCHOLOGICAL WELL-BEING
A Thesis Presented to
The Faculty of the Department of Psychology/Gerontology
Northeastern Illinois University
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In Partial Fulfillment
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of the Requirements for the Degree
Master of Arts
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in Gerontology
by
Nelson Fababaer
August 2017
ProQuest Number: 10615875
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ABSTRACT
The purpose of this study was to examine the impact of caring for Alzheimer’s disease clients on
paid Filipino caregivers’ stress level, psychological well-being, and quality of life in order to
make recommendation regarding ways to design and develop strategies on how to assist Filipino
caregivers cope with the stress of caregiving. Forty five participants were recruited from three
nursing home and assisted living facilities in the Chicago area, of which 24 were caregivers of
AD care recipients and the remaining 21 were caregivers of older adults with a physical
disability (PD) (control group). Participants completed a survey which included quantitative
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measures and qualitative open-ended interview questions designed to allow the caregiver to share
some of the challenges and difficulties they experienced in providing care to a person with
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Alzheimer’s disease. The quantitative parts of this research used Kingston Caregiver Stress Scale
(KCSS), Psychological Well-Being Scale (PWBS), and SF-12 quality of life (QOL) scale to
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assess the general mental health status of the caregivers. The quantitative results revealed that
there were significant differences of stress levels between AD and PD caregivers but no
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significant differences were found on PWB and QOL scores. The same is true when age group
comparisons were tested; two of the three outcomes showed significant mean differences
between stress of caregiver and PWB score. Analysis of the qualitative data found that the
caregivers wanted more social support, sufficient information about Alzheimer’s disease, days
off, and additional seminars/workshops to combat the negative impact of dementia caregiving.
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ACKNOWLEDGEMENTS
It is a pleasure to take advantage of this opportunity to thank those who made this research
possible. I would like to thank my thesis committee, Dr. Ben Inventor and Dr. Jin Kim, for their
professional expertise, knowledge of dementia caregiving and for helping me reorganized some
of my ideas while still focusing on my primary objectives. I would also like to express my
sincerest gratitude to my thesis advisor, Dr. Lisa Hollis Sawyer for her expertise in guiding the
research process, her skillful assistance in identifying areas of my paper for revision, and for the
untiring support she shown me during the entire process.
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My family was also instrumental and a vital support during this research process. I would
like to thank my wife Eden, for her moral and spiritual support especially for her understanding
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as well as my two sons John Paul and Chris, for sharing their skills in using word processing
programs and for being supportive as well.
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Finally, I would like to thank all my friends in the religious congregations and the Filipino
Community of San Barnaba Church in Florence, Italy for their consistent prayers and continued
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spiritual support for my whole family.
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TABLE OF CONTENTS
ABSTRACT………………………………………………………………………………….iii
ACKNOWLEDGEMENTS………………………………………………………………….iv
TABLE OF CONTENTS…………………………………………………………………….v
LIST OF TABLES………………………………………………………………………....viii
CHAPTER I INTRODUCTION ............................................................................................. .1
Problem Statement……………………………………………………………………………2
Purpose of the Study………………………………………………………………………….3
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Literature Review ..................................................................................................................... 4
Who are the Caregivers?...........................................................................................................4
Negative Effects Associated with Caregiving………………………………………………..6
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Statistical and Cultural Information on Filipino Caregivers………………………………….8
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Significance of Filipino Caregivers ..........................................................................................11
Hypotheses Explored in this Study ......................................................................................... .13
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CHAPTER II METHOD……………………………………………………………………..14
Participants .............................................................................................................................. 14
Materials .................................................................................................................................. 14
Procedure ................................................................................................................................. 17
CHAPTER III RESULTS……………………………………………………………………18
Hypothesis One: Comparison of Mean Stress Scores between AD and PD of Caregivers…19
Hypothesis Two: Comparison of Mean PWB Scores between AD and PD of Caregivers…19
Hypothesis Three: Comparison of Mean QOL Scores between AD and PD of Caregivers..19
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Hypothesis Four: Comparison of Mean Stress Scores between Male and Female Caregivers.20
Hypothesis Five: Comparison of Mean Stress Scores between Older and Younger Caregivers
………………………………………………………………………………………………...20
Hypothesis Six: Comparison of Mean Stress Scores between Married and Other Marital
Status ....................................................................................................................................... .20
Hypothesis Seven: Comparison of Mean Stress Scores between Caregivers Who Speak the
Same Language as Their Care Recipients and Those Who Do Not .........................................21
Quantitative Post-hoc Analyses – Significant Results ............................................................. 21
Additional Qualitative Findings ............................................................................................... 21
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CHAPTER IV DISCUSSION………………………………………………………………..24
Caregivers’ Type of Care and Self-reported Stress Reaction/Mental Health Reactions ...........24
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Caregivers’ Gender and Self-reported Stress Reaction ............................................................ 26
Caregiver’s Age and Self-reported Stress Reaction ................................................................. 27
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Caregivers’ Marital Status and Self-reported Stress Reaction ................................................. 28
Caregivers’ Language Correspondence and Self-reported Stress/QOL Reactions…………...29
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Limitations and Future Research Suggestions ......................................................................... 29
Conclusion............................................................................................................................... 30
REFERENCES ........................................................................................................................ 31
Table 1 Participant Demographic Data .................................................................................... 44
Appendix A Study Recruitment Flyer………………………………………………………...45
Appendix B Informed Consent Form ....................................................................................... 46
Appendix C Personal Demographic Survey..............................................................................49
Appendix D Open-ended Interview Questions……………………………………………….50
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Appendix E Kingston Caregiver Stress Scale (KCSS) .......................................................... 51
Appendix F Psychological Well-Being Scale (PWBS)/Affect Balance Scale (ABS) ........... 53
Appendix G SF-12 Questionnaire .......................................................................................... 54
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LISTS OF TABLES
Table 1 Participant Demographic Data ............................................................................... 44
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1
CHAPTER 1
INTRODUCTION
Alzheimer’s Disease (AD) is ranked 6th causes of death in the US, and it is also the
5th leading causes of death for people age 65 years and older (Alzheimer's Association, 2011).
This brain disorder affects memory, judgment, communication, and the ability of a person to
perform the activities of daily living (ADLs) (Alzheimer's Association, 2011). Statistics indicate
that 5.4 million Americans have AD, and about 67% (3.2 million) of them were women
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(Alzheimer's Association, 2012). The number of AD cases in the U.S. has been steadily growing,
and experts believe that new diagnoses are inevitable in the years to come (Vincent & Velkoff,
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2010). In fact, they projected that within three decades, or by 2050 the rate of growth of the
disease will increase (Alzheimer's Association, 2015). There are preventive measures to slow
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down the progress but no medical treatments are available to control or cure AD. This disease
will have a negative impact on states' health care systems, and to the families and caregivers’
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health (Alzheimer's Association, 2013; OED Online, 2012; Schulz, Visintainer, & Williamson,
1990).
Based on the report on Alzheimer's Association (2015), the estimated financial cost of
caring for those with AD and other forms of dementias is $226 billion. Nearly 50% of the
amount is spent by the Medicare patients. Experts predict that by 2050, the ratio will become one
in every three dollars or roughly 33%. In short, unless something is done before 2050, the cost of
Alzheimer's will reach more than $1.1 trillion. The costs to Medicare will increase over 400% or
$589 billion (Alzheimer’s Association, 2015). This tremendous amount will have negative
consequences on the ability of the government to support family caregivers in their caregiving
roles and responsibility.
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There are many factors that influence or affect caregivers’ ability to provide care to
someone with AD. One of the factors is the gender and caregiving role differences. Based on the
data from Institute on Aging (2016), 75 % of caregivers are female and all of them spend more
time providing care than males. Some other studies emphasized that 36% of the most
complicated and difficult tasks such as bathing, toileting, and dressing are performed by female
caregivers compared to 24% of their male counterparts (National Alliance for Caregiving and
AARP, 2009). The other issue that a caregiver’s face is the language barrier, which is crucial in
safe and quality health care (Schyve, 2007). A caregiver who can speak the same language as
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their care recipients will not only enhance the caregiver-patient relationship but will also result in
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better healthcare outcomes (Wynia et al., 2010).
Finally, is the ability of caregivers on how to manage and cope with the stress of
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caregiving. Prior studies indicate that male caregivers used their intellectual capacity in coping
with the negative impact of caregiving whereas female caregivers concentrate more on the
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quality of job performance and emotional support (Ducharme et al., 2011). In addition, male
caregivers are more likely to seek professional help and rely on support services than their
female counterparts (Brown et al., 2007). Past research also argued that male coping strategies
are not the same from female and that male consider caregiver’s role differently.
Problem Statement
Previous and current studies have argued that family caregiving is certainly a stressful and
deleterious job especially when caring for someone with or other forms of dementia
(Alzheimer’s Association, 2011, 2012, 2013, 2015, 2016; Schulz & Sherwood, 2008). As
dementia progresses, both the care recipient and the caregiver are at higher risk for depression
and other chronic diseases (Amirkhanyan & Wolf, 2003; Dupuis & Smale, 2004). In fact, Schulz
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and Beach (1999) emphasized that stressed caregivers experienced a 63% greater risk of
mortality when compared to non-caregivers.
Family caregivers play a vital role in preserving as well as in enhancing the quality of life
of the care recipient (Brodaty et al., 2009). Without caregivers, the mental health condition of
people diagnosed with AD and those with the existing condition will deteriorate quickly and
possibly be institutionalized more rapidly. Furthermore, this will also have financial effects on
families of the care recipients and a huge economic impact on the part of the U.S. government.
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Purpose of Study
Currently, little information is known about the impact of caregiving among paid Filipino
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caregivers of older adults with dementia (e.g., Dilworth-Anderson, Williams, & Gibson, 2002).
Thus, the goal of this research study was to examine the impact of caring for Alzheimer’s disease
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clients on Filipino caregivers’ stress level and psychological well- being and the rationale for this
is to find ways on how to assist Filipino caregivers' cope with the stress of caregiving.
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One of the reasons that contribute to the elevated level of stress and poor well- being of
Filipino caregiver is the current level of poverty in the Philippines (Sevilla, Punzalan, Rovira,
&Vendivel, 1997). Some Filipino caregivers have two jobs working 15 to 18 hours a day to
support the needs of their respective families in the Philippines (Kang, 1996). Filipinos have a
profound respect for older adults and proud of their caregiving role in the families (Browne,
Braun, & Arnsberg, 2006; Chang, & Ling, 2003). Most Filipinos are also obligated to care for
their parents as they aged.
This research topic is important because results of this study can be used to make a
recommendation regarding ways to design and develop strategies that could inform future studies
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on how to help Filipino caregiver reduce their level of stress, enhance their psychological well-
being, and help them improve their quality of life.
Theoretical Framework
This study used Lazarus and Folkman's (1984) Transactional Model of Stress and Coping
theory, one of the most known theoretical frameworks of stress sciences (Contrada & Baum,
2011; Smith & Kirby, 2011). Stress is a relationship between the person and the environment
that is considered demanding and burdensome (Lazurus & Folkman, 1984). The stressful
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consequences of caregiving are based on the findings of past research (Lazarus & Folkman,
1984; Skaff, Pearlin, & Mullan, 1996), and the assumption that dementia caregiving is more
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stressful than non-dementia caregiving (Pinquart & Sorensen, 2006).
Lazarus's perception of psychological stress is one of the most advanced and modern
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views of stress (Contrada & Baum, 2011). Stress happens when environmental demands exceed
one’s adaptive ability. These psychological and biological changes put someone at risk of a
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disease (Cohen, Kessler, & Gordon, 1997). Another important aspect of stress is that human
beings could handle the situation based on the availability of resources and social support. Stress
can be controlled and avoided when effective coping and adaptation is used (Lazarus &
Folkman, 1984).
Who are the Caregivers?
A caregiver can be defined as a family member, a friend or significant others who offers
support and personal assistance to their loved one (Query, 2005). They help older adults with the
activities of daily living (ADLs) and in some cases, in decision making as well (e.g., Brown et
al., 2009; Fredman, Cauley, Hochberg, Ensrud, & Doros, 2010; Schulz & Beach, 1999).
