This FIRST Award research project will (1) compare the processes of symptom of recognition, evaluation, and management by family caregivers of frail elders to findings in the self-care literature and (2) identify predictors of family caregivers' responses to symptoms of their frail relatives under varying conditions. Family caregivers' responses, i.e., their strategies and criteria for identifying and assessing symptoms and the factors influencing their decisions to self-treat, seek medical care, seek alternate forms of care, or take no action will be examined and compared to the findings reported in the self-care literature. The impact of socio-cultural factors will be examined by comparing African American and White caregivers in terms of available resources (social supports, economic status, education and access to medical care), information sources (including shared norms, values and beliefs concerning health and illness, availability of peer and professional consultants, and prior experiences with the illness and with the use of health services) and attitude sets (self-reliance, health locus of control, coping styles, attitudes toward medical professionals) and how these factors influence caregivers' reactions to their relatives' symptoms. The effect of type of illness underlying the care-receiver's symptoms, the subsequent character of those symptoms (e.g., whether symptoms are physical or psychological) and accompanying risk factors and past use of health services will be examined by comparing family caregivers' reactions to symptoms of dementia and cardiovascular disease. The sample will consist of 420 family caregivers (20 respondents for the pilot, 400 for the study) who are women caring for frail, older, community-dwelling spouses. The sample will be equally divided between dementia and cardiac caregivers and African American and White caregivers. Data collection and analysis will include both quantitative and qualitative approaches. Data collection will consist of in-depth interviews and three weeks of daily health diaries completed by each respondent. Insight into the factors influencing caregivers' responses to symptoms of their impaired relatives may facilitate a more collaborative relation between caregivers and health professionals.
