Functional Limitations and Physical Health in Community-Dwelling Medicare Advantage Beneficiaries: Variation by Race and Hispanic Subgroup.

Objectives: The objective is to examine racial and ethnic heterogeneity in older adults' functional limitations and physical health. Methods: Data were from 2011 to 2015 Health Outcomes Survey of Medicare Advantage beneficiaries 65 and older (N = 828,946). Outcomes were Physical Component Summary (PCS) scores and need for assistance with activities of daily living (ADLs). Six non-Hispanic racial groups and five Hispanic subgroups were analyzed. Regression models adjusted for sociodemographic and health characteristics. Results: White and Asian respondents had the lowest unadjusted ADL difficulty rates and highest PCS scores. In adjusted analyses, Cuban respondents had the highest PCS scores and lowest rates of any ADL difficulty; White respondents had the lowest rates of specific ADL difficulties. Native Hawaiian or other Pacific Islander and multiple Hispanic respondents had the highest ADL difficulty rates. Discussion: Both the healthiest and highest need subgroups of Medicare Advantage beneficiaries were Hispanic. Understanding racial and ethnic subgroup differences may help target interventions to prevent or aid with functional limitations.

Cardiovascular Disease and Health-Related Quality of Life Among Asian American, Native Hawaiian and Pacific Islander Older Adults.

Objectives: Assess the relationship between cardiovascular disease (CVD) and health-related quality of life (HRQOL) among Asian American, Native Hawaiian, and Pacific Islander (NH/PI) compared to white older adults. Methods: Data were from the 2011-2015 Health Outcomes Survey. HRQOL was assessed using the Veterans RAND 12-Item Survey, composed of physical (PCS) and mental component scores (MCS). Lower scores represent worse health. Multivariate regression was conducted to estimate PCS and MCS mean score differences related to self-reported CVD (coronary artery disease, congestive heart failure, myocardial infarction, other heart conditions, stroke) and race/ethnicity. Results: There were marked differences in PCS and MCS scores by disaggregated Asian American and NH/PI subgroups. After adjustment, Asian American and NH/PI older adults had better PCS but worse MCS than white older adults. Race/ethnicity moderated the relationship between CVD and HRQOL. Discussion: Asian American and NH/PI older adults with CVD had poorer mental health compared to their white counterparts.

Changes in Therapy Utilization at Skilled Nursing Facilities Under Medicare's Patient Driven Payment Model.

OBJECTIVES: The Patient Driven Payment Model (PDPM) was implemented in October 2019 to reimburse skilled nursing facilities (SNFs) based on Medicare patients' clinical and functional characteristics rather than the volume of services provided. This study aimed to examine the changes in therapy utilization and quality of care under PDPM. DESIGN: Quasi-experimental design. SETTING AND PARTICIPANTS: In total, 35,540 short stays by 27,967 unique patients in 121 Oregon SNFs. METHODS: Using Minimum Data Set data from January 2019 to February 2020, we compared therapy utilization and quality of care for Medicare short stays before and after PDPM implementation to non-Medicare short stays. RESULTS: The number of minutes of individual occupational therapy (OT) and physical therapy (PT) per week for Medicare stays decreased by 19.3% (P < .001) and 19.0% (P < .001), respectively, in the first 5 months of PDPM implementation (before the COVID-19 pandemic). The number of group OT and PT minutes increased by 1.67 (P < .001) and 1.77 (P < .001) minutes, respectively. The magnitude of PDPM effects varied widely across stays with different diagnoses. PDPM implementation was not associated with statistically significant changes in length of SNF stay (P = .549), discharge to the community (P = .208), or readmission to the SNF within 30 days (P = .684). CONCLUSIONS AND IMPLICATIONS: SNFs responded to PDPM with a significant reduction in individual OT and PT utilization and a smaller increase in group OT and PT utilization. No changes were observed in length of SNF stay, rates of discharge to the community, or readmission to the SNF in the first 5 months of PDPM implementation. Further research should examine the relative effects of individual and group therapy and their impact on the quality of SNF care.

Trends in Cardiovascular Disease by Asian American, Native Hawaiian, and Pacific Islander Ethnicity, Medicare Health Outcomes Survey 2011-2015.

BACKGROUND: The burden of cardiovascular disease (CVD) is increasing in the aging population. However, little is known about CVD risk factors and outcomes for Asian American, Native Hawaiian, and Other Pacific Islander (NH/PI) older adults by disaggregated subgroups. METHODS: Data were from the Centers for Medicare and Medicaid Services 2011-2015 Health Outcomes Survey, which started collecting expanded racial/ethnic data in 2011. Guided by Andersen and Newman's theoretical framework, multivariable logistic regression analyses were conducted to examine the prevalence and determinants of CVD risk factors (obesity, diabetes, smoking status, hypertension) and CVD conditions (coronary artery disease [CAD], congestive heart failure [CHF], myocardial infarction [MI], other heart conditions, stroke) for 10 Asian American and NH/PI subgroups and White adults. RESULTS: Among the 639 862 respondents, including 26 853 Asian American and 4 926 NH/PI adults, 13% reported CAD, 7% reported CHF, 10% reported MI, 22% reported other heart conditions, and 7% reported stroke. CVD risk factors varied by Asian American and NH/PI subgroup. The prevalence of overweight, obesity, diabetes, and hypertension was higher among most Asian American and NH/PI subgroups than White adults. After adjustment, Native Hawaiians had significantly greater odds of reporting stroke than White adults. CONCLUSIONS: More attention should focus on NH/PIs as a priority population based on the disproportionate burden of CVD risk factors compared with their White and Asian American counterparts. Future research should disaggregate racial/ethnic data to provide accurate depictions of CVD and investigate the development of CVD risk factors in Asian Americans and NH/PIs over the life course.

Differences in Caregiving Intensity Among Distinct Sociodemographic Subgroups of Informal Caregivers: Joint Effects of Race/Ethnicity, Gender, and Employment.

More than 40 million informal caregivers in the United States provide essential care to older adults. Recent research has identified substantial differences in caregiving intensity by gender, race/ethnicity, and employment status. Using intersectionality theory, the current study extends the existing literature by exploring the relationship between caregiving intensity and the unique experiences of individuals with different intersections of gender, ethnicity, and employment. We used generalized linear models to estimate multivariate associations between caregiving intensity assessed by three different measures (hours of caregiving per month and number of activities of daily living and instrumental activities of daily living [IADLs] assisted with) and the three sociodemographic factors of interest (race/ethnicity, gender, and employment status). Unemployed White males provided, on average, 77 fewer hours per month of care (p < 0.001) and assisted with 1.9 fewer IADLs (p = 0.004) than unemployed Black males. Employed White females provided 42.6 fewer hours per month of care (p = 0.002) than employed Black females and 49.2 fewer hours per month (p = 0.036) than employed females of other races. Study findings suggest that examining racial/ethnic or gender differences in isolation does not provide a true picture of differences in caregiving intensity. There is a critical need to understand how the intersections of race/ethnicity, gender, employment, and other sociodemographic factors shape the experiences of caregiver subgroups. [Journal of Gerontological Nursing, 47(7), 23-32.].

Participation of Latinos in the Diabetes Self-Management Program and Programa de Manejo Personal de la Diabetes.

BACKGROUND AND OBJECTIVES: The Diabetes Self-Management Program (DSMP) and Programa de Manejo Personal de la Diabetes (PMPD) have been shown to reduce complications from poorly controlled diabetes. Only a few research studies have examined Latino individuals' participation in them. This study examines workshop completion among DSMP and PMPD participants and the effects of race/ethnicity, workshop language, workshop type, and workshop site on program completion rates by participants. RESEARCH DESIGN AND METHODS: We used data from the National Council on Aging's data repository of individuals who participated in DSMP or PMPD between January 2010 and March 2019. Using a pooled cross-sectional study design, we examined workshop completion among 8,321 Latino and 23,537 non-Latino white (NLW) participants. We utilized linear probability models to estimate the effects of race/ethnicity and workshop language/type among the full sample; a stratified model estimated the separate effects of workshop language, type, and delivery site among Latinos. Participant characteristics included age, sex, education, number of chronic health conditions, living arrangement, health insurance status, and geographic location of workshop. RESULTS: Compared to NLW participants in DSMP English workshops, Latinos enrolled in any workshop had a higher probability of completing at least four workshop sessions, and Latinos enrolled in PMPD Spanish workshops had a higher probability of completing six of six sessions. Among the Latino subsample, participation in PMPD Spanish or English workshops was associated with completing at least four sessions or all six sessions compared with participation in DSMP Spanish or English workshops. Among Latino participants, the effects of workshop site on completion rates were mixed. DISCUSSION AND IMPLICATIONS: Diabetes self-management education programs tailored for Latino participants had higher completion rates. Further research is warranted to better understand the effect of workshop site and participant characteristics on completion of DSMP and PMPD programs.

Mental Health Attribution for Mexican-Origin Latinx and Non-Latinx Older Adults: A Latent Class Analysis.

BACKGROUND AND OBJECTIVES: Providing appropriate and culturally sensitive care to the rapidly growing number of U.S. Latinx older adults with psychiatric conditions presents a major public health challenge. We know little about older Latinx adults' perceived causes of mental health problems, offering clinicians limited insight to guide successful and culturally congruent treatment. Moreover, there is a paucity of mental health research examining heterogeneity in how Latinx individuals may attribute mental health symptoms. The present study sought to identify how Latinx and non-Latinx older adults attributed the sources of their mental health problems and how these types of attributions differ by ethnicity. RESEARCH DESIGN AND METHODS: This study analyzed data collected from a retrospective chart review and survey of 673 adults aged 55-95 years (430 Mexican origin and 244 non-Latinx) from a rural psychiatric outpatient clinic near the California-Mexico border. We conducted stratified latent class analysis (LCA) by race/ethnicity to explore the mental health attribution beliefs of Mexican-origin and non-Latinx clinic patients. RESULTS: Different LCA patterns for Mexican-origin Latinx versus non-Latinx groups were found. For non-Latinx adults, there was a class of individuals who attributed their mental health issues to social and financial problems. For Mexican-origin adults, there was a class of individuals who attributed their mental health issues to spiritual and/or supernatural factors, unaffected by acculturation level, depressive symptom severity, and time spent in the United States, but differing by gender. We found within-group heterogeneity: Not all Mexican-origin or non-Latinx older adults were alike in how they conceptualized their mental health. DISCUSSION AND IMPLICATIONS: Mexican-origin Latinx and non-Latinx older adults attributed their mental health issues to different causes. More Mexican-origin older adults attributed their symptoms to spiritual causes, even after controlling for contextual factors. Further research is needed to determine whether attribution beliefs are affected by specific mental health diagnoses and other cultural factors not measured in this study.

Burden and Bad Days Among Mexican-Origin Women Caregivers.

OBJECTIVES: This article examines the construct of burden and the use of coping strategies among Mexican-origin caregivers of older adults. METHODS: In-depth semistructured interviews were conducted with 44 Mexican-origin women caregivers living in the East Los Angeles area. Audio files were transcribed and analyzed in Atlas.ti V7.1.8. Data were analyzed using a grounded theory approach. RESULTS: Caregivers did not typically talk about caregiving as a burden per se; they used other terms for burden that resonated with their experiences. Caregivers viewed caregiving difficulty in physical and emotional terms as it related to specific caregiving circumstances and situations. Caregivers used a variety of coping strategies to get through bad days, including reframing stressful situations to make sense of their circumstances. DISCUSSION: Findings shed light on the mixed results found in the literature on Latino caregiving burden. Results suggest that Mexican-origin women caregivers have a more nuanced experience of caregiving burden than has been found in prior literature. Results also suggest research using traditional measures of burden may not fully capture situational and cultural distinctions to the extent Mexican-origin caregivers ascribe other language to represent difficult caregiving experiences.

The Juntos Pilot Study: A Diabetes Management Intervention for Latino Caregiving Dyads.

PURPOSE: The purpose of this study was to design a culturally sensitive dyad-level diabetes intervention to improve glycemic control for older Latino adults with type 2 diabetes. METHODS: This study used a pretest-posttest noncontrol group design. The intervention was developed from formative research with Mexican-origin caregiving dyads. The curriculum was adapted from 2 randomized trials of community interventions specifically designed for Latino older adults with type 2 diabetes. The curriculum consisted of communication skill-building exercises and dyad decision making on lifestyle changes to improve the older adult's blood glucose levels. Thirty-two community-dwelling dyads completed a 6-week program of one-on-one sessions with a trained program facilitator. Main outcomes were feasibility and acceptability of the Juntos program. The authors assessed feasibility by examining participant burden and retention and acceptability by participant exit interviews. Although underpowered for outcomes, A1C, health status, and dyadic communication were also assessed to evaluate whether trends suggested the effectiveness of the intervention. RESULTS: Most participants viewed Juntos as an acceptable program and wanted the program expanded in terms of length and scope. All outcomes showed improvement from baseline through 6 months postintervention. CONCLUSIONS: Results show that Juntos is acceptable to Mexican-origin caregiving dyads and is a promising approach for effectively controlling type 2 diabetes among older Latino adults who have a family caregiver.

Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers.

Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7-45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life.

Overcoming a Bad Day: a Qualitative Look into the Dementia Caregiving Experiences of Mexican-Origin Women in East Los Angeles.

The number of Latinos with Alzheimer's disease (AD) is projected to more than double by 2030. Yet, the current literature is lagging on Alzheimer's caregiving among Latinos. This study explores how Mexican origin women experience dementia caregiving, and the coping strategies they use to manage their caregiving situations. Nine women were identified as caregivers of a family member with AD or dementia from a larger study on caregiving. Interviews with them were collected and subsequently analyzed using a modified grounded theory approach to reduce the data to identify thematic content. All but one participant described caregiving as "tiring," "wearing," or "hard." They reported suffering from stress, insomnia, nervousness, migraines, and/or depression because of their caregiving experiences. Participants engaged in various coping strategies to help combat the perceived negative consequences of their caregiving experiences. The most commonly reported strategies were various forms of distraction, and meditation or prayer. The Mexican origin women in this study experience faced two types of interpersonal challenges related to dementia caregiving: changes in the care receiver's personality and behaviors, and physical care needs. They engaged in various coping to strategies to address the difficulties of their situation. This study provides formative research for identifying research questions and topics of examination in the future.

Interdependence in Health and Functioning Among Older Spousal Caregivers and Care Recipients.

Older spousal caregiving relationships involve support that may be affected by the health of either the caregiver or care recipient. We conducted a longitudinal analysis using pooled data from 4,632 community-dwelling spousal care recipients and caregivers aged ⩾50 from the 2002 to 2014 waves of the Health and Retirement Study. We specified logistic and negative binomial regression models using lagged predictor variables to assess the role of partner health status on spousal caregiver and care recipient health care utilization and physical functioning outcomes. Care recipients' odds of hospitalization, odds ratio (OR): 0.83, p<.001, decreased when caregivers had more ADL difficulties. When spouses were in poorer versus better health, care recipients' bed days decreased (4.69 vs. 2.54) while caregivers' bed days increased (0.20 vs. 0.96). Providers should consider the dual needs of caregivers caring for care recipients and their own health care needs, in adopting a family-centered approach to management of older adult long-term care needs.

Depression Among Older Adults in the United States by Disaggregated Race and Ethnicity.

BACKGROUND AND OBJECTIVES: As the population becomes increasingly diverse, it is important to understand the prevalence of depression across a racially and ethnically diverse older population. The purpose of this study was to compare rates of depression by age and disaggregated racial and ethnic groups to inform practitioners and target resource allocation to high risk groups. RESEARCH DESIGN AND METHODS: Data were from the Centers for Medicare and Medicaid Services Health Outcomes Survey, Cohorts 15 and 16, a national and annual survey of a racially diverse group of adults aged 65 and older who participate in Medicare Advantage plans (N = 175,956). Depression was operationalized by the Patient Health Questionnaire-2 (PHQ-2); we estimated a logistic regression model and adjusted standard errors to account for 403 Medicare Advantage Organizations. RESULTS: Overall, 10.2% of the sample (n = 17,957) reported a PHQ-2 score of 3 or higher, indicative of a positive screen for depression. After adjusting for covariates, odds of screening positively for depression were higher among participants self-reporting as Mexican (odds ratio [OR] = 1.19), Puerto Rican (OR = 1.46), Cuban (OR = 1.57), another Hispanic/Latino (OR = 1.29), and multiple Hispanic/Latino (OR = 1.84) ethnicities, compared with non-Hispanic whites. Odds were also higher among participants reporting that their race was black/African American (OR = 1.20), Asian Indian (OR = 1.67), Filipino (OR = 1.30), Native Hawaiian/Pacific Islander (OR = 1.82), or two or more races (OR = 1.50), compared with non-Hispanic whites. DISCUSSION AND IMPLICATIONS: Prevalence varied greatly across segments of the population, suggesting that certain racial/ethnic groups are at higher risk than others. These disparities should inform distribution of health care resources; efforts to educate and ameliorate depression should be culturally targeted.

Racial/Ethnic Variation in the Impact of the Affordable Care Act on Insurance Coverage and Access Among Young Adults.

OBJECTIVES: To examine the impact of the Affordable Care Act's (ACA's) 2010 parental insurance coverage extension to young adults aged 19 to 25 years on health insurance coverage and access to care, including racial/ethnic disparities. METHODS: We pooled data from the Behavioral Risk Factor Surveillance System for the periods 2007 to 2009 and 2011 to 2013 (n = 402 777). We constructed quasiexperimental difference-in-differences models in which adults aged 26 to 35 years served as a control group. Multivariable statistical models controlled for covariates guided by the Andersen model for health care utilization. RESULTS: On average, insurance rates among young adults increased 6.12 percentage points after ACA implementation (P < .001). All racial/ethnic groups experienced increases in coverage. However, the impact varied by race/ethnicity and was largest for Whites. Young adults had a 2.61 percentage point (P < .001) decrease in experiencing barriers to health care because of cost issues after the ACA, with variation by race/ethnicity. CONCLUSIONS: The ACA's expansion had a significant positive effect for young adults acquiring health insurance and reducing cost-related barriers to accessing health care. However, racial/ethnic disparities in coverage and access persist. Public Health Implications. Policies not dependent on parental insurance could further increase access and reduce disparities.

Characterizing Caregiving Intensity Among Mexican-origin Women Caregivers.

Purpose of the Study: Objective (physical) caregiving burden has not often been associated with subjective (emotional) burden among Mexican-origin women caregivers. Yet, many studies show that Latina caregivers suffer from negative psychological outcomes related to caregiving at a higher rate than non-Latino Whites. This study considered whether self-rated intensity of ADL/IADL support explained the relationship between number of care recipient illnesses and caregiver emotional drain among Mexican American women caregivers. Design and Methods: Participants included Mexican-origin women caregivers (n = 132) in East Los Angeles, CA who completed a survey that asked culturally appropriate questions about their experiences caring for elderly relatives. Results: Logistic regression models indicated that ADL/IADL supports ranked as difficult were also chosen as causing emotional drain. Mediation models revealed a significant indirect effect of number of care recipient illnesses on caregiver emotional drain for English-speaking caregivers but not for Spanish-speaking caregivers. These results indicate that Mexican-origin women caregivers do experience subjective burden associated with specific objective ADL/IADL supports and suggest that culturally relevant survey design can assist in better understanding the emotional drain among this population. Implications: Cultural values should be considered when discussing aspects of care provision with Mexican-origin women caregivers in order to elicit an accurate description of their informal caregiving experiences that may contribute to caregiver burden.

Perceptions of Survivorship Care among Latina Women with Breast Cancer in Los Angeles County.

OBJECTIVES: Cancer "survivorship" is a distinct and important aspect of the cancer experience. More research is needed about survivorship care in underserved populations such as Latinas. This study examined issues of breast cancer survivorship care among Latinas to understand their experiences and needs, to inform the design of future programs. DESIGN AND SAMPLE: Six English- and six Spanish-language focus groups were conducted, with a nonprobability sample. About 74 Latinas who varied in terms of characteristics including stage, time since diagnosis, and English proficiency were recruited through support groups, health fairs, and promotoras. MEASURES: A semi-structured question guide was used to examine experiences with follow-up care, barriers, and meaning associated with breast cancer survivorship. RESULTS: Results indicate numerous gaps and unmet needs in Latinas' survivorship care experiences, including problems with finances, continuity of care, unmet needs for information, and symptom management. Participants identified sources of support including patient navigators, and assigned both positive and negative meanings to survivorship. CONCLUSIONS: This research lays a foundation for future work to develop interventions addressing Latina breast cancer survivors' unmet needs. Recommendations include enhancing peer and professional support services for patients, family, and caregivers. Further work is also needed to promote the implementation of survivorship care plans.

Internet-Based Resources for Disease Self-Care Among Middle-Aged and Older Women with Chronic Conditions.

OBJECTIVE: This two-part study analyzed data collected from middle-aged (age 44-64) and older women (age 65+) with one or more chronic conditions who completed the National Council on Aging Chronic Care Survey. MATERIALS AND METHODS: Part One analyzed data from 418 women to describe sociodemographics, disease types, and healthcare utilization associated with Internet use among middle-aged and older women with 1 or more chronic diseases. Part Two analyzed data from the 251 Internet-using women to identify the online self-care resources they are using (format, host organization) and for what purposes. RESULTS: Approximately 31% of participants were age 65 years or older, 30% reported having three or more chronic condition types, and 65% reported using the Internet. A significantly larger proportion of older women reported multiple chronic conditions, and a significantly fewer number of older women reported using the Internet. A significantly smaller proportion of Internet users were non-Hispanic white, more educated, and employed. A significantly larger proportion of non-Internet users reported needing help learning what to do to manage their health conditions and needing help learning how to care for their health conditions. Among only Internet-using women, 18.7% participated in online discussions/chatrooms/listserv and 45.2% read about the experiences of others with chronic diseases. Interest in websites and online courses varied. CONCLUSION: Understanding Internet use among women with chronic conditions can inform targeted efforts to increase Internet availability, educate potential users about the benefits of online resources, and effectively tailor Internet-based materials to self-care needs.

Beliefs and expectations of family and nursing home care among Mexican-origin caregivers.

This study examined perceptions of family care, nursing homes, and expectations of future care among 85 Mexican-origin women caregivers, some who lived in Mexico City and some who lived in East Los Angeles, California (East LA). Attitudes of Mexican-born women-living in Mexico City and in East LA-were more similar to each other than those of U.S.-born women. Most caregivers reported a preference for family care and had negative views of institutional care. In addition, despite the negative views about nursing homes, some caregivers expressed a willingness to seek nursing-home care for themselves so as to avoid burdening their children in the future. Findings lend support to the persistence of Mexican cultural values in this sample of Mexican-origin caregiving women, regardless of where they were born.

The Perceived Role of Family in Heroin Use Behaviors of Mexican-American Men.

The influence of the family is not well understood as it relates to drug use behaviors of Hispanic male adults. We examined the family's influence on drug use behavior, as perceived by Hispanic men who use heroin. One-time qualitative interviews were conducted with 21 current and former heroin users who participated in a larger study on long-term heroin use in Mexican-American men. Data were analyzed using a thematic analysis approach. Three main themes emerged: family as a supportive environment for heroin use; heroin as a family legacy; and, the family's strategies for helping to stop using heroin. A sub-theme emerged on the paradox of family involvement, which spanned the three main themes. This research lays a foundation for future work to disentangle the risks and benefits of family involvement to inform culturally-centered therapies and cultural adaptations to traditional therapeutic approaches with Mexican-American men who abuse drugs.

The Concept of Familism in the Lived Experiences of Mexican-Origin Caregivers.

This study qualitatively examined the experiences of Mexican-origin women caring for elderly family members in order to identify aspects of familism in their caregiving situations. Data were collected from onetime interviews with 44 caregivers living in the greater East Los Angeles area. Kinscripts guided the framing of familism in this study. Data were analyzed using a grounded theory approach. Caregivers' descriptions of the Mexican family reflected an idealized view of familism. Caregivers reported a lack of support from others and relying for support on fewer family members than were potentially available to them. Findings suggest that the construct of familism has evolved from its long-standing portrayals in the literature. More research is needed to reexamine familism as a theoretical perspective to explain how Mexican-origin families negotiate and construct elder care over the family life course.