Characteristics of Asian American Family Caregivers of Older Adults Compared to Caregivers of Other Racial/Ethnic Groups: BRFSS 2015-2020

By Erin Bouldin, Kyriakos S. Markides, Christina E. Miyawaki & Christopher Taylor

Asian Americans are the fastest-growing racial/ethnic group in the United States (U.S.) comprising 7.2% of the U.S. population, and many (57%) are foreign-born immigrants. The Asian American population has grown from 11.9 million to 22.4 million between 2000 and 2019 (88% growth). Despite these rising numbers, their health and healthcare needs remain understudied. Asian Americans are a highly diverse and heterogeneous group from over 50 countries and speak 100 different languages, but they share common cultural backgrounds such as collectivistic values, and family and intergenerational practices including elder caregiving. Multigeneration households are common in Asian countries and this pattern also can be found in Asian American communities in the U.S. They often provide intergenerational elder caregiving practicing the Asian cultural concept of filial piety. However, it is unknown if they continue elder caregiving in the U.S. the way they used to do in their home countries.

Using data from the Caregiver Module of the Behavioral Risk Factor Surveillance System (BRFSS) in the years 2015-2020 (unweighted N = 265,742), we examined the prevalence and characteristics of elder caregiving in community-dwelling Asian American adults (≥25 years) of different ethnic origins and compared them to other racial/ethnic groups of caregivers. We defined caregivers of older adults as those who have provided care/assistance to a friend/family member with a long-term illness/disability during the past 30 days, aged ≥25 caring for a grandparent, aged ≥45 caring for a parent/parent-in-law, or aged ≥65 caring for a spouse/partner, sibling, or other relative.

Most Asian American caregivers were aged ≥45 (82%), female (59%), married (71%) with no children (82%), college-educated (86%), retired (45%) or employed (39%) with an annual income of ≥$50,000 (56%). They feel they are in excellent/very good/good health (76%) but typically had at least one chronic condition (66%). They assisted their parent/parent-in-law (39%) or a spouse/partner (28%) for ≥2 years (49%) on an average of <20 hours/week (67%) providing personal care (63%) and household tasks (79%). But surprisingly, they provided elder caregiving the least (4%) compared to Hispanic (7%), Black (9%), White (11%), and American Indian/Alaska Native adults (13%). Nonetheless, the characteristics of the caregiving experiences were generally similar across all racial/ethnic groups. In terms of Asian American caregivers’ health compared to non-caregivers, they were fairly similar but Asian American caregivers were older and had a higher prevalence of chronic health conditions.

Because of the Asian American cultural background – elder caregiving is a normal cultural expectation – the lower prevalence of caregivers compared to other racial/ethnic groups of caregivers was a surprise. It could be that elder caregiving is something that is expected among Asian Americans and therefore, they may not identify themselves as caregivers, even though the BRFSS did not use this language directly. Like other national surveys, the BRFSS was conducted only in English and Spanish, so those with a different primary language may not have been able to take the survey as 57% of the Asian American population is foreign-born and only 50% of East and Southeast Asian immigrants are proficient in English. Foreign-born Asian Americans more often become caregivers for older relatives than their American-born counterparts (74% vs 65%). If foreign-born Asian Americans did not take the survey, this may not fully reflect the picture of Asian American caregivers.

To support and assist caregivers, we should be attentive to caregivers’ demographic, health, and cultural practices. Ethnic-specific adult day centers that provide ethnic-specific meal and activity programs may alleviate Asian American caregivers who try to adjust to U.S. lifestyles but maintain their traditional elder caregiving culture while working outside the home. Some geographic areas where different ethnic groups of immigrants reside such as California, New York, and Texas, have been offering culturally relevant social and nutrition services supported by the Older Americans Act of 1965. As the diversity of the older population continues to increase, the importance of ethnically and linguistically responsive programs is paramount. Policymakers should consider providing increased availability of and access to these programs to accommodate the needs of not only Asian Americans but also other racial/ethnic groups of caregivers so that they can continue providing adequate care for their loved ones.

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Article Details
Characteristics of Asian American Family Caregivers of Older Adults Compared to Caregivers of Other Racial/Ethnic Groups: Behavioral Risk Factor Surveillance System 2015–2020
Christina E. Miyawaki, Erin D. Bouldin, Christopher A. Taylor, Lisa C. McGuire and Kyriakos S. Markides
First published: December 20, 2022
DOI: 10.1177/07334648221146257
Journal of Applied Gerontology

About the Authors

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Christopher Taylor is an epidemiologist with the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion. His work supports CDC’s Alzheimer’s Disease Team which leads projects supporting both the Congressionally appropriated Health Brain Initiative and Building Our Largest Dementia, or BOLD, Infrastructure Act. Dr. Taylor earned a PhD in Epidemiology from the University of Pittsburgh Graduate School of Public Health where he worked on several longitudinal studies of older adult health. In addition to his work focusing on cognitive decline, dementia, and caregiver issues related to older adults, his past research has focused on traumatic brain injury as well as infectious disease-related mortality.

Erin Bouldin is an epidemiologist and health services researcher with the Salt Lake City VA Medical Center, the University of Utah’s Department of Internal Medicine, and the Centers for Disease Control and Prevention’s National Center for Chronic Disease Prevention and Health Promotion, Alzheimer’s Disease Team. Dr. Bouldin earned an MPH in epidemiology from the University of Florida and a PhD in epidemiology from the University of Washington. She completed a post-doctoral fellowship in health services research with the VA. Her research focuses on family caregiving, disability, and cognitive decline often with an emphasis on Veterans, people living in rural areas, and people from diverse racial and ethnic backgrounds.

Kyriakos S. Markides, PhD, is Annie and John Distinguished Professor of Aging at the School of Public and Population Health at the University of Texas Medical Branch in Galveston. His research has focused on aging and health among the Hispanic population of the United States as well as on other ethnic/minority populations. He is currently the Principal Investigator of the Hispanic EPESE (Established Population for the Epidemiological Study of the Elderly) and Editor of the Journal of Aging and Health which he founded in 1989.

Christina E. Miyawaki, PhD, MSW, MA is an Associate Professor at the University of Houston Graduate College of Social Work. She earned her M.A. in Gerontology from San Francisco State University, M.S.W. from the University of California, Berkeley, and Ph.D. from the University of Washington. She worked as a bilingual Geriatric Social Worker and the Program Director at a senior social service agency in Berkeley, California. Dr. Miyawaki’s overall research has centered on the health and well-being of older adults of color and their family caregivers. Trained as a bilingual geriatric social worker, Dr. Miyawaki has first-hand working experience with family caregivers and their care recipients from a variety of racial/ethnic groups. As a gerontologist, she developed a strong foundation in health disparities research, especially focusing on Asian American populations. She has investigated how Asian American family caregivers’ physical and mental challenges are associated with care recipients’ health conditions including Alzheimer’s disease and related dementias. More recently she has focused on health disparities among older Vietnamese immigrants and refugees and their family caregivers based on their culture.