Caregiver In Canada

In Canada, there are approximately 120,000 people that have been diagnosed with dementia or a related condition. Dementia is a condition that is a progressive mental disorder and is characterized as deterioration of intelligence and personality (Myers, 2009). By 2031 this number will drastically increase to 750,000 due to the baby boomers aging (Statistics Canada, 2013; Black, et al., 2010). A caregiver is a person who contributes to another person's social, medical, environmental and economic resources (Myers, 2009). Family members taking on the role of the caregiver can experience a sense of gratification, great meaning and benefit in providing care (Kramer, 2000). This will lead to a major impact on the labor force, health insurance,

pension plans and will increase demand on health care services. These people will require assistance with activities of daily living (ADL) which are performed by caregivers that are usually family members (Black, et al., 2010). Family members caring for a person in their family with dementia take on the burden of psychological, emotional, financial and physical which can lead to depression. Depression is a state of abnormal mood disturbances characterized by feelings of despair, sadness and worthlessness (Myers, 2009). Caregivers that are responsible for people diagnosed with dementia are believed to have an 83% chance of being diagnosed depression (Sun, Ong, & Burnette, 2012). According to O'Rourke, Cappeliez, & Neufeld, (2007) caregivers working with this population have the largest increase in becoming clinically depressed and having concurrent physical health issues.
Different cultures and ethnicities have different values and beliefs surrounding how to care for family members. Chinese culture have a word "xiao" that is translated into responsibility and affection which Chinese culture see as a type of obligation towards family and caring relationships (Chan, 2014; Lai, 2010). Traditional Chinese families from strong family commitments and ties to each member which can be important if a family member requires a caregiver however it can become a barrier because families might get discouraged by receiving external support especially if they are new immigrants or unfamiliar with the environmental surroundings (Chan, 2014).
Literature Review
There are many articles regarding caregiver depression, stress and burnout.

According to Black et al. (2010), the surveys performed is their study provide information that show caregivers of people with dementia have increased reports of fatigue, helplessness, stress and onset of depression symptoms. This study continues to state that the caregivers are usually family member and that they take on the financial burden and they can spend as much as one thousand dollars a month for prescriptions and other medical care (Black, et al., 2010). O'Rourke, Cappeliez, and Neufeld (2007) performed a study on caregivers responsible for people with dementia and the relation to recurrent depression. This strengthens Black et al. (2010) article by showing that caregivers are significantly compromised and during the 10 year study these caregivers have reports symptomatic depression and furthermore leading to decrease in their physical health. Another study by Mitchell et al. (2015) states that there is a strong correlation between increased amount of time spent caring for the dementia person and increased distress of the

caregiver.
Most studying has shown that there is increased chance for caregivers to become distressed, depressed and eventually burnout. However, Lilly, Robinson, Holtzman and Bottorff (2012) states caregiver's burdens are a societal problem as well. The primary goal of the health care system is to avert institutionalization rather than providing funds to caregivers to afford respite costs. Furthermore, caregivers can only utilize resources only when they are at imminent risk of decreasing health status.
There is only one study found that relates to culture and beliefs in Chinese decent. Chan (2014) states that there is limited data and understanding in the different Asian communities. Understanding different caring practices is important for two reasons. First, people of different ethnic backgrounds practice different caring methods within their environment. Second, in Vancouver, British Columbia, the diversity of ethnicities has drastically increased (Chan, 2014). Understanding all these different caring practices is important for caregivers to perform medical practices especially if the person has dementia. For example, in Chinese culture, caregivers believe that dementia is a result of normal aging, biomedical disease or superstitions (Hinton, Franz, Yeo, & Levkoff, 2005; Mahoney, Cloutterbuck, Neary, & Lin, 2005). Understanding the different caring practices will promote stronger caring policies, strategies and better outcomes for the patient (Chan, 2014).
Purpose
The purpose of this study is to explore how cultural beliefs and values can affect the level of distress in caregivers of dementia patients in Chinese families living in Canada.
Objective
The main objectives are (a) to achieve an understanding of Chinese cultural beliefs and values on caregiver’s role (b) to acquire an idea of Chinese cultural beliefs and values on dementia as well as (c) to raise the awareness of policymakers, clinicians, and other health care providers on the importance of culturally sensitive health care.
Study Rationale
The importance of this study lies in a number of areas.

Firstly, findings from this study can fill the gap and limitation that exist in current literature on caregivers of dementia patients. Chan & O’Connor (2014) pointed out that “there is an overall agreement and concern in the general and dementia care literature that ethnic minorities are an understudied group” (p. 191). Owing to the fact that the Chinese community represents the largest and also the fastest growing group of minorities in British Columbia (Statistics Canada, 2006a), more effort and attention on research for this population is justifiable. In fact, according to Statistics Canada (2006b), 1 in every 5 people in Vancouver is Chinese and they were mostly born outside Canada. Therefore, lack of research information about this ethnic group can result in many negative health outcomes in caregivers of dementia patients due to insufficient resources and support offered to this population in the health care system. Secondly, this study can raise the awareness of policymakers and stakeholders around the significance of culturally congruent and competent care which is necessary in a multicultural society like Canada. This idea is supported by the nursing theorists on transcultural nursing, Madeleine Leininger, who emphasizes that “cultures have their own unique cultural concerns that influence their health, well-being, or death that they want health care providers to address” (Leininger, 2002). Increase in

awareness of the influence of culture in health can inspire future studies to investigate other cultural minorities in Canada. Thirdly, a recent report from the Office of Seniors Advocate British Columbia (2015) highlighted that 29% of caregivers are in distress, one of the highest reported rates in Canada. This figure is a wake-up call to policymakers and health care providers. Since the Chinese community represents the largest group of ethnic minority in this province; if caregivers of dementia patients in Chinese families can receive culturally-appropriate health care services, their level of distress which often leads to other physical as well as mental health issues can be reduced. This can ultimately lowers the physical, emotional, and financial costs to families and, to a greater extent, the society (Chan & O’Connor, 2014).
Research Question and Hypothesis
The population for this study is a group of caregivers of dementia patients in Chinese families in Canada. These caregivers have cultural values and beliefs around caregiver’s role as well as dementia that are different from those of the mainstream culture in Canada. For instance, Chinese families have strong cultural-based sentiments about obligations to care that can be a barrier for caregivers to seek outside help and support (Sun, Ong & Burnette, 2012). These differences in values and beliefs can affect the level of distress experienced by these caregivers.
P: Caregivers of dementia patients in Chinese families in Canada
I: Chinese Cultural beliefs and values
C: Absence of Chinese cultural beliefs and values
O: Feeling of distress
The research question that this study aims to answer is: Are cultural values and beliefs affecting the level of distress in caregivers of dementia patients in Chinese families in Canada? The study will be conducted to test the following hypothesis: Cultural values and beliefs contribute to an increase in the level of distress in caregivers of dementia patients in Chinese families in Canada.