Social engagement has many demonstrated benefits for aging non-Hispanic Whites in the U.S. This study examined data from the U.S. Health and Retirement Study to determine whether these benefits were similar among American Indians and Alaska Natives older than 50 years.
Linear regression techniques were used to examine the associations between level of social engagement, scores for memory and mental status, and self-reported health among 203 American Indian and Alaska Native elders who participated in the Health and Retirement Study and had data available between 1998 and 2010.
Level of social engagement was significantly associated with memory, mental status, and self-reported health. However, only the association of social engagement with mental status and self-reported health remained significant (p=0.04 and p=0.05, respectively) after adjusting for sociodemographic variables, number of known health conditions, and scores on the Center for Epidemiologic Studies Depression scale. Level of social engagement was not associated with patterns of decline across time in cognitive or physical health.
Higher levels of social engagement are associated with better physical and cognitive functioning in American Indian and Alaska Native elders. Future studies should examine whether this association acts through cognitive stimulation, increase in physical activity resulting from social engagement, or access to resources that support physical and cognitive health.
American Indians; Alaska Natives; elders; social engagement; cognition; memory; aging; retirement; health
Research on barriers and utilization of mental health services in older ethnic minorities has been productive. However, little is known about the characterization and beliefs about anxiety and depression symptoms among older Mexican-Americans. Exploration of these conceptualizations will lead to better detection and provision of care to this large, yet underserved group.
The present study used a mixed methods approach to explore conceptualizations of anxiety and depression in a group of rural older Mexican-Americans. Twenty-five Spanish-speaking participants (mean age 71.2) responded to flyers that solicited individuals who felt “tense or depressed.” Participants completed a structured diagnostic interview as well as self-report questionnaires about medical health, anxiety and depressive symptoms, and cognitive functioning. Qualitative interviews included questions about how participants describe, conceptualize, and cope with anxiety and depression symptoms.
Sixty-eight percent of the sample met criteria for at least one anxiety or mood disorder with high comorbidity rates. Self-reported symptoms of depression, anxiety, and somatization were below clinical ranges for all participants. Medical illness, cognitive impairment, age, education, and acculturation were not associated with distress. Qualitative analyses revealed that nearly half of the terms used by the sample to describe distress phenomena deviated from Western labels traditionally used to indicate anxious and depressive symptomatology.
Multiple methods of symptom endorsement demonstrated that older Mexican-Americans may report distress differently than detected by traditional self-report measures or common Western terminology. Understanding these additional illness conceptualizations may have implications for improving the detection of mental illness and increasing service use among this growing population.
acculturation; elderly; rural mental health; idioms of distress
A cross-cultural valid analytic definition of retirement remains elusive in gerontology despite a long tradition of research on the topic. Inadequate attention has been paid to consistently defining the key concepts used to examine retirement and to specifying its occurrence in non-Western, non-industrial societies. This paper critically reviews basic cultural tenets in the notion of retirement, and proposes a more comparatively valid definition. It then proposes a three part comparative categorization by exploring retirement in contemporary Western nations and comparing it with retirement-like practices from a range of non-Western cultures including Thai, Chinese, Ladak, Fulani, Lusi and Aymara.
comparative gerontology; conceptual bias; cross-cultural analysis; non-Western retirement; retirement
Previous studies have gauged support for implementing smoke-free multi-unit housing (MUH) policies in the United States, but none have specifically examined attitudes among racially and ethnically diverse elders living in low-income MUH. We surveyed a convenience sample of elders 62 years of age and older (n = 807) across 24 low-income housing properties in Broward County, Florida in order to assess residents’ smoking behaviors, exposure to second-hand smoke, and support for smoke-free policies. The study sample was ethnically and racially diverse with Hispanics comprising more than 61 % of the population, and 22 % identifying as Black or other races. Although close to 22 % of the sample were former smokers, only 9 % of residents reported being current smokers. The majority of residents surveyed supported no-smoking policies: 75 % support no-smoking policies for individual units; 77 % supported no-smoking policies in common areas; and, 68 % supported no-smoking policies in outdoor areas. Over 29 % of residents surveyed reported being exposed to secondhand smoke entering their units from elsewhere in their building. Residents who reported having a home smoking rule were more than twice as likely to support an indoor policy compared to residents who allowed smoking anywhere in their home (OR = 2.36; 95%CI 1.25–4.43; p ≤ 0.01), and nonsmoking residents were nearly three times as likely to support an indoor policy compared to smokers (OR = 2.89; 95%CI 1.44–5.79; p ≤ 0.01). Support for an indoor policy was not modified by age, gender, ethnicity or race. . This study demonstrates that elders living in low-income MUH properties overwhelmingly supported the implementation of smoke-free policies.
Culturally diverse; Low-income; Multi-unit housing; Elders; Smoke-free policy; Tobacco-free
Mexican Americans have demonstrated lower than what would be expected mortality rates and disease prevalence, given their overrepresentation among those living in poverty. However, Mexican Americans living along the US-Mexico border have been documented as carrying a higher burden of disease and disability that seems to contradict or at least challenge evidence in support of a “Hispanic Paradox”. The purpose of this paper is to evaluate the concept of border health as it relates to the conceptualization and measurement of health outcomes in older Mexican Americans living in the Southwest United States. Data for this study comes from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (Hispanic EPESE) wave 1 and mortality files up to wave 5. Border residence was determined using La Paz Agreement county and distance from a port of entry classifications. Statistical analysis was conducted to assess border versus non-border differences in cause of death, disability, disease prevalence and premature mortality. Adjusted regression models were used to predict cause of death, disability and disease-free life expectancy and premature mortality (i.e. occurring before life expectancy). Interaction models between border/non-border and median income were also performed. Finally, distance from the US-Mexico border was used to determine the effect of distance to the US-Mexico border in border-residing participants. The findings from this study indicate that participants in the HEPESE were more likely to be alive at Wave 5 if they resided in a border county, however more likely to transition into ADL disability status. These findings were not explained by behaviors, duration in the US or sociocultural characteristics of where they lived. Additionally, Hispanic EPESE subjects that lived in the border region were more likely to have died from old age and were less likely to be lost to follow up. Interaction models revealed significant effects for diabetes as a cause of death. Moreover, distance from a US-Mexico port of entry was significant for being alive at wave 5 for border-residing participants. Relative to non-border residing participants, border residing Mexican Americans in the Hispanic EPESE did not carry a uniformly higher burden of disease, however had a significantly greater odds of 10 year survival. These findings bring up issues of measurement and the importance of geographic location when it comes to evaluating disease burden and mortality in Mexican Americans.
Hispanics; Disability; Survival; US Mexico border; Disease prevalence
The effect of language acculturation, socioeconomic status (SES), and immigrant generation on development of diabetes among Mexican Americans was evaluated in the Hispanic Established Population for the Epidemiologic Study of the Elderly (HEPESE).
HEPESE is a longitudinal cohort study of 3,050 non-institutionalized Mexican Americans aged 65 years at baseline (1993–1994) from 5 Southwestern states. Diabetes incidence was ascertained in 4 follow-up surveys to 2004–05 by respondent self-reported physician-diagnosis of diabetes, high blood glucose, or sugar in the urine. Language of interview, immigrant generation, gender, age, education, family history of diabetes, smoking status, alcohol use, health insurance type and self-reported height and weight were assessed. High socioeconomic status (SES) was defined by high school graduation and non-Medicaid insurance. Cox's proportional hazards models were fit to evaluate the effects of language acculturation, generation and SES on incident diabetes.
845 of 3,050 (27.7%) Mexican Americans had diabetes at baseline and were younger, more educated, and more likely to have health insurance than those without diabetes. Risk of developing diabetes increased for Spanish-speaking respondents with low SES from 1st to 3rd generation (HR = 1.76, 95% CI = 1.02–3.03) and from 2nd to 3rd generation (HR = 2.15, 95% CI = 1.20–3.84). Among English-speaking, high SES participants, generation had a protective effect on developing diabetes: HR = 0.45 (95% CI = 0.22–0.91) when comparing 3rd versus 1st generation
The effect of language acculturation and immigrant generation on incident diabetes is moderated by SES status in HEPESE participants.
acculturation; diabetes; Mexican Americans
Mexico has experienced changes in its demographic and epidemiologic profile accompanied by recent changes in nutrition and income. Thus, the old and the young have experienced very different environments. Using data from the Mexican National Health Nutrition Survey 2006, we examine age and sex differences in physiological status and dysregulation and assess how socioeconomic factors associate with variability in biological indicators of health. Results indicate that young people have experienced better physical development as evidenced by their being taller and having less stunting. There is currently little under-nutrition in Mexico, but there is evidence of over-nutrition as indicated by high prevalence of overweight across the age range. Physiological dysregulation across multiple systems is higher in Mexicans than Americans across all ages. Mexicans have: higher levels of blood pressure, plasma glucose, and especially for women, dysregulated cholesterol and higher body weight. Low education is associated with both being stunted and overweight, and with adverse levels of HDL cholesterol and more physiological risk factors. Rural dwelling males are less likely to be overweight as are females living in poor states. Living in a poor state among females and having rural residence among males is associated with a higher number of high-risk factors. Overweight is a strong predictor of hypertension. Age differences in indicators of physiological development suggest that the epidemiological and demographic transitions in Mexico were accompanied by improved physical development; however, increases in nutrition may have reached a point of diminishing returns as Mexico switched from a state of under-nutrition to over-nutrition.
biomarkers; overweight; blood pressure; cholesterol; plasma glucose; education; Mexico
The first official U.S. federal poverty line was developed in the 1960s; since the mid-1990s the scientific consensus has been that it has become outdated and inaccurate. This article explains the key elements of the current federal measure that are inaccurate for older adults in general and older Latinos specifically. An alternative is described that addresses the key failings of the current measure. The alternative, the Elder Economic Security Standard™ Index (Elder Index), adapts a national methodology to the basic costs of living in California for 2007 using data from the American Community Survey, and other public data sources. The results show that the amount needed for basic economic security in California is higher than the federal poverty level in all counties, and averages about twice the federal level. Housing costs are the largest component of costs in most counties, although health care is the largest component for couples in lower housing cost counties. Among singles and couples age 65 and over in California, almost 60% of Latinos have incomes below the Elder Index compared to one-quarter of non-Latino whites. The rates are higher among renters, and older Latinos are more likely than non-Latino whites to rent. Applying the Elder Index in California documents the disproportionate rates of economic insecurity among older Latinos. The findings indicate that changes to public programs such as Social Security and Medicare that decrease benefits or increase costs will have disproportionately negative impact on the ability of most older Latinos to pay for basic needs.
poverty; older adults; California; health care costs; housing; Latinos
While deleterious consequences of smoking on health have been widely publicized, in many developing countries, smoking prevalence is high and increasing. Little is known about the dynamics underlying changes in smoking behavior. This paper examines socio-economic and demographic characteristics associated with smoking initiation and quitting in Mexico between 2002 and 2010. In addition to the influences of age, gender, education, household economic resources and location of residence, changes in marital status, living arrangements and health status are examined. Drawing data from the Mexican Family Life Survey, a rich population-based longitudinal study of individuals, smoking behavior of individuals in 2002 is compared with their behavior in 2010. Logistic models are used to examine socio-demographic and health factors that are associated with initiating and quitting smoking. There are three main findings. First, part of the relationship between education and smoking reflects the role of economic resources. Second, associations of smoking with education and economic resources differ for females and males. Third, there is considerable heterogeneity in the factors linked to smoking behavior in Mexico indicating that the smoking epidemic may be at different stages in different population subgroups. Mexico has recently implemented fiscal policies and public health campaigns aimed at reducing smoking prevalence and discouraging smoking initiation. These programs are likely to be more effective if they target particular socio-economic and demographic sub-groups.
smoking; smoking cessation; smoking onset; education; expenditure; Mexico
This study applies life-course theories of latent (direct), pathway (indirect) and conditional effects in an analysis of childhood poverty on later-life depressive symptoms among older adults in Mexico. Data are from the 2001 Mexican Health and Aging Study (MHAS), a nationally representative sample of older adults born before 1951 (n=8696). Respondents had a mean of 3.6 past-week depressive symptoms and 71 % had no household sanitation facilities before age 10; this measure served as a proxy for childhood poverty. Childhood poverty is significantly related to scores on an adapted 9-item CES-D scale in the full model (b=0.27, p<0.001). This effect is partially mediated by four adult socio-economic status measures, although decomposition analysis reveals the mediation effect to be primarily driven by educational achievement. These findings have important implications for Mexico’s rapidly aging population as well as efforts for childhood poverty reduction and gains in education.
Life-course; Childhood socio-economic status; Depressive symptoms; Mexico; Older adults
Long-term care use among older Mexican-Americans is poorly understood, despite the adverse effects on health and economic disadvantage in this vulnerable population. This study examines gender-based risk of long-term care use in 628 women and 391 men, age 70 and over in the 2000-01 and 2004-05 waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly. Logistic regression models are employed to assess the impact of the opportunity cost implications of family support (kin availability and co-residence) relative to health care needs (quality-adjusted life years (QALY) weighted scores and functional limitations) on women's risk of entry into a nursing home. A small percentage (∼5%) of men and women had entered a long-term care facility. Women had lower weights for QALY weights and greater disability than men, but on average were more likely to live with or in closer proximity to an adult child. Higher disability rates (p < .01) increased the risk of institutionalization regardless of gender because disability increases time burdens. Families with fewer adult children faced higher time burdens per child in caring for elderly parents; particularly for elderly mothers. Demographic trends suggest that the number of adult children available to share the caregiving load may decrease long-term care use.
Mexican American; long-term care; caregiving; opportunity costs
This study documents the mortality, chronic morbidity and physical functioning experiences of U.S. Hispanics, non-Hispanic whites, and non-Hispanic blacks 50 years of age and older in the United States. Hispanics are classified by nativity to better assess an important source of heterogeneity in population health within that population. Drawing on mortality and morbidity data from the National Health Interview Survey, demographic models of healthy life expectancy are used to derive estimates of life expectancy, life expectancy with and without chronic morbidity conditions, and life expectancy with and without functional limitations. The results not only highlight the mortality advantages of foreign-born Hispanics, but also document their health advantages in terms of morbidity and physical functioning beyond age 50. Nativity is a highly important factor differentiating the health and mortality experiences of Hispanics: U.S.-born Hispanics have a health profile more indicative of their minority status while foreign-born Hispanics have much more favorable mortality and health profiles. Differences in smoking across racial/ethnic/nativity groups is suggested as an important reason behind the apparent health advantages of foreign-born Hispanics relative to whites as well as relative to their U.S.-born counterparts.
Hispanic health paradox; smoking; functional limitations; chronic morbidity; nativity
Adults of Japanese descent (Nikkei) in the United States have higher risk for colorectal cancer (CRC) than their white counterparts. Family norms toward CRC screening may influence screening behaviors of Nikkei adults. This community-based participatory research study explores if mailing educational pamphlets to Nikkei families can influence CRC knowledge, attitudes, and screening adherence; and trigger intergenerational communication about CRC. Among 56 parent-offspring dyads contacted, 24 were eligible (e.g., no prior CRC screening/diagnosis) and were randomized into 3 cohorts defined by the “target recipient(s)” of study pamphlets about CRC screening: parent only, offspring only, and both parent and offspring. Among the 19 completed dyads (79.2%=19/24), results showed that CRC knowledge of most pamphlet recipients increased in all cohorts; however, some misinformation and attitudinal barriers persisted. Although some parent-offspring communication about CRC increased after mailing pamphlets to offspring, only spousal communication occurred after mailing pamphlets to parents. Additional benefits were not observed in increasing parental screening intent/behavior after mailing pamphlets to both parent and offspring. At the end, among the 10 parents who reported developing CRC screening intent or having scheduled a CRC screening, 8 attributed to study pamphlets and 2 to communication with their offspring. Self-reported barriers preventing screening and parent-offspring communication about CRC were identified. This exploratory study describes preliminary findings that will inform future research aimed to promote CRC screening and reduce racial/ethnic disparities at the community level by enhancing intergenerational communication among Nikkei families.
colorectal cancer screening; preventive care; Japanese Americans; older adults
This paper examines the prevalence and correlates of depressive symptoms among older persons of Punjab, the largest Province of Pakistan. Data were gathered from 4191 older persons aged 60+ using Probability Proportional to Size (PPS) of population. A version of the CES-D Scale adapted for low-literate populations was used to measure self reported depressive symptoms. Various independent factors, including socioeconomic factors, self-reported health conditions, and functional impairments were examined to see their net effect on depressive symptoms among older persons. Results of logistic regression analysis showed that region, area, living index, independent source of income, self-reported health conditions, and functional impairment were significant factors affecting self-reported depressive symptoms among older persons in Punjab. An important cross-cultural difference was a lower risk of depressive symptoms among older women, which may reflect the buffering effects of family co-residence and the position of seniors in extended families.
Functional impairment; Health conditions; Independent source of income; Living index; Self-reported depressive symptoms
Caregivers in Miami, Florida (185 Cubans, 108 other Hispanics, 229 non-Hispanic Whites, and 73 Caribbean Blacks) were described and compared along demographic and health variables, cultural attitudes, and caregiving behaviors. Participants were recruited at random through Home Health Services (61 %) and convenience sampling in the community (39 %), and interviewed at their home. Standardized instruments and measures constructed for this study were pretested. Multivariate analyses showed that the ethnic groups differed in age, education, income, and number of persons giving care, while caregiver health and patient functioning were similar. Controlling for demographics, differences in cultural variables were small. The sense of obligation, emotional attachment, openness about who should give care, spirituality, use of family help or community services were comparable in all groups. Commitment to caregiving was high, driven mainly by patient needs. Cubans had the greatest family stability, and worked the hardest, with the lowest sense of burden. Caribbean Black caregivers lived in bigger families, were youngest, and their patients had the lowest cognitive status. Burden was felt most by White caregivers who were older than the others. Professionals need to understand complex belief systems and behavior patterns to assist caregivers in mobilizing appropriate resources.
Family caregiving; Ethnic differences; Culture; Family stability; Family growth; Cuban; Hispanic; Caribbean Black
This research focuses on patterns of English proficiency and use-of-English among older immigrants living in linguistically concentrated, ethnic neighborhoods. A sample (n=60) of older Puerto Ricans, who moved from the island to the mainland in their twenties, were divided into English proficiency groups (fluent, high intermediate, low intermediate) via the Adult Language Assessment Scales. Participants then provided self-ratings of their English proficiency (understanding, speaking, reading, and writing), their use of English in social domains (language spoken with own-family, in-laws, spouse, children, neighbors, and workmates), and their use of English in private psychological domains (language of talking to oneself, counting, writing notes to oneself, thinking, dreaming, praying, and expressing feelings). Finally, all participants completed the Puerto Rican Bicultural Scale. Results show a cohort of immigrant elders whose first language is protected by their ethnic neighborhoods but whose domestic and private lives are increasingly permeated by English. In particular, children emerge as powerful forces of language socialization in English for their parents. Further, there are important individual differences by level of proficiency, with a lowest proficiency group that is less acculturated, lower in socioeconomic status, and even more linguistically isolated than groups with higher proficiency. In essence, level of second language proficiency is a potent source of intracultural variation. Methodologically, the paper makes the important point that self-rated patterns of language use are consistent with scores on formal measures of proficiency. The paper also provides empirical verification of the logic of dividing language use into external, social speech and internal, psychological speech.
English proficiency; intracultural variation; older immigrants; Puerto Ricans
Family networks are widely assumed to be a key source of support for older people in Indonesia and Southeast Asia more generally, although empirical study of their composition and functioning is in its infancy. This paper draws on ethnographic and survey data collected in longitudinal research of ageing in three rural Indonesian communities, in order to identify demographic and social factors limiting the size of elders’ networks. Gaps in networks commonly emerge as a result of childlessness, migration and alienation, but their implications for older people’s vulnerability are shaped by socio-economic status, reputation and cultural norms.
Adoption; Childlessness; Elderly; Migration; Networks; Socio-economic stratification; Vulnerability
This article describes the development of SHARE-Israel, the survey of persons aged 50 and older in Israel, and preliminary results from an early data release. The introduction of an HRS-inspired computer-based survey into a Middle East country required linguistic and cultural adaptations of the survey mechanisms that had not been previously experienced in other countries. Preliminary findings showed that the majority group of veteran Jewish-Israelis aged 50 and over is in a favorable position in terms of health, employment status and household income compared to Arab-Israelis and to new immigrants to Israel from the Former Soviet Union. Arab-Israelis aged 50 and over are at greater risk due to greater disability and lower incomes. Recent immigrants from the former Soviet Union are at greatest risk. They report having the highest degree of depression, long term problems and activity limitation, the fewest children, low rates of home ownership and low incomes. Comparing the older Israeli population with their European counterparts revealed that Israelis are more depressed; more Israeli women are employed, and fewer Israeli men are retired; and household income in Israel is lower, but rises relatively when correcting for purchasing power parity. These trends point to several areas that will require attention in the formulation of public policy on behalf of the aging population in Israel.
SHARE; HRS; Israel; 50 and older; Survey
Researchers at the South African Medical Research Council/University of the Witwatersrand Rural Public Health and Health Transitions Research Unit (Agincourt) fieldsite in rural South Africa consider Mozambican residents more vulnerable than others in the local population. These self-settled refugees, many of whom are still not South African citizens, primarily came to South Africa in the 1980s during the Mozambican Civil War. This perceived economic vulnerability is rooted in their difficulties in accessing social grants, until recently legally available only to those with South African citizenship documentation. This paper focuses on semi-structured interviews with 30 ‘older’ women of Mozambican-descent living in the Agincourt area. These interviews highlight three important aspects of vulnerability; the respondents: (1) perceive a risk of deportation despite their having lived in the country for 20 years, (2) are unable to easily access social grants, namely the state-funded old-age pension, and (3) struggle to make ends meet when faced with daily needs and crisis situations. All three of these vulnerabilities were mediated to some extent by these women’s resourcefulness. They generated ties to South Africa through obtaining identification-documents, used these documents to access pensions, and used the pensions to help them sustain their multigenerational households.
Aging; Refugees; Social grants; South Africa; Vulnerability
Forty people over 60 years of age took part in longitudinal research over the course of a year on the impact of the HIV epidemic in southern Uganda. In this paper we focus mainly on the data from 26 of the 40 who were HIV-positive. While we observed that feelings of depression were frequently experienced by many of the people in our study, the state of ‘being depressed’ was not constant. Participants regularly expressed economic frustration (because of a lack of money to buy food and other commodities including sugar and soap); medical problems (including those related to HIV) as well as old age, the burden of dependents (including concerns about school fees for grandchildren), feelings of sadness and isolation, and a lack of support from others, as well as stigma, whether real or perceived. However, while worries, sorrow and despondent thoughts were reported in many of the interviews across the study, moods fluctuated moving from happiness and hope, to sadness and despair, from month to month. Concerns regarding the psychological wellbeing amongst older people, including those living with HIV and older carers in Uganda deserve greater attention.
Despondence; Depression; HIV and AIDS; Hope; Social isolation; Uganda
In Canada’s multicultural society, ethnic identity is important to the elderly and can influence areas such as access to services, health promotion and care. Often, the complex nature of ethnic identity is underestimated when looking at cultural groups. This study aims to: (a) validate the factor structure of a Chinese ethnic identity measure for older Chinese in Canada, (b) examine the level of ethnic identity of the participants, and (c) examine the correlates of ethnic identity in these older individuals. Using data from a large, national research project on the elderly Chinese in Canada, this study analyzed the results gathered from a total of 2,272 participants. Principal component analysis, maximum-likelihood confirmatory factor analysis, and multiple regression analysis were performed. The results indicated that ethnic identity of the older Chinese is a multi-dimensional construct made up of three factors: (a) culture related activities, (b) community ties, (c) linkage with country of origin, and (d) cultural identification. The findings have provided a better understanding of how ethnic identity can be measured among the aging Chinese population in Canada.
Chinese elderly; Immigrants; Ethnic identity
Abstract In recent years, a vast literature has accumulated on the negative effects on family caregivers of providing care to elders, while relatively little research has explored caregiving as a positive experience. Only a handful of studies have examined any aspect of informal caregiving among American Indians. This mixed methods study explores the negative and positive aspects of providing elder care among 19 northern plains American Indian family members. These caregivers described low levels of burden and high levels of reward, attributable to cultural attitudes toward elders and caregiving, collective care provision, strong reciprocal relationships with elders, enjoyment of elders, and relatively low levels of care provision. Caregiving manifested as part of a complex exchange of assistance rather than a unidirectional provision of assistance from the family member to the elder. That caregiving emerged as such an overwhelmingly positive experience in a community faced with poverty, alcohol disorders, trauma, and cultural traumatization is testimony to the important roles that elders often continue to play in these communities.
American Indian; Caregiving; Elders; Family; Positive valuation of elders; Caregiving reward