Asian Americans (AA) are the fastest-growing racial/ethnic group in the United States (U.S.) comprising about 7.2% of the U.S. population (Jones et al., 2021). The proportions of AA foreign-born immigrants are higher than other racial/ethnic groups (Budiman & Ruiz, 2021), with approximately 57% of AAs being foreign-born immigrants—this varies by Asian ethnicity from 27% of Japanese to 85% of Bhutanese Americans. The AA population has grown 88% between 2000 and 2019 (from 11.9 million to 22.4 million) (Budiman & Ruiz, 2021). Despite these rapidly rising numbers of middle-aged and older AAs, their health and healthcare needs remain understudied (AARP, 2014).

AAs are a highly diverse and heterogeneous group of people from over 50 countries and speak 100 different languages (Johns Hopkins Medicine, 2020). At the same time, many AAs share common cultural backgrounds and practices such as collectivistic values, religious beliefs, and family and intergenerational practices, that emphasize respect for older adults (Kramer et al., 2002). Caring for aging family members is embedded into many Asian cultures by children observing or assisting their parents caring for their grandparents or grandparents-in-law while growing up (AARP, 2014). Multigeneration households are common in Asian countries which facilitates and promotes elder caregiving, and this pattern also is similar in AA communities in the U.S. (AARP, 2014; Miyawaki, 2015). Thus, AAs tend to provide intergenerational elder caregiving—caring for at least one generation older family member (Lien & Huang, 2017) due to the Asian cultural concept of filial piety, feeling of obligation, as well as societal expectations (Do et al., 2015). The consequences of these traditional practices have caused mixed results in terms of caregiver burden and caregiver’s mental health (Pinquart & Sorensen, 2005). Therefore, it is unknown if they can continue elder caregiving the way they used to do in their home countries. Thus, it is important to explore the caregiving situation in AA communities in the U.S. so that we can better provide appropriate assistance and support to family caregivers, as well as their older care recipients. We examined the prevalence and characteristics of elder caregiving in community-dwelling AA adults (≥25 years) of different ethnic origins and compared them to other racial/ethnic groups of caregivers. Caregiving can create various stressors and bolster relationships, which may impact the caregiver’s physical and mental health (Schulz & Sherwood, 2008). Therefore, we also examined the health of AA caregivers compared to AA non-caregivers.

Of the 4440 AA respondents aged ≥25 who completed the Caregiver Module, 9.5% (weighted) were caregivers, lower than the 20.7% (p < 0.001) of respondents from all other racial/ethnic groups who were caregivers. However, among caregivers, the prevalence of providing care for an older adult was similar by race/ethnicity: 43.8% of AA and 42.9% of non-AA caregivers (p = 0.88).

Table 1 presents the demographic and health characteristics of AA caregivers (n = 315) and non-caregivers (n = 3822). Most caregivers were female (59.3%) and aged ≥45 (82.1%). Most were married (71.1%) and did not have children in the household (81.8%). Educational attainment was high, with 86.2% attending at least some college. Caregivers were most commonly retired (44.9%), though more than one-third were employed (38.9%); most (55.5%) reported an annual income of ≥$50,000. About three-quarters (76.0%) reported their general health to be excellent/very good/good but 65.9% had at least one chronic condition, and 19.3% were classified as having frequent mental distress. Compared to AA non-caregivers, caregivers were more often older, with no children in the household, retired, in fair/poor health, experienced frequent mental distress, and had at least one chronic condition. Caregivers were less likely to be employed than non-caregivers.

AA caregivers most frequently assisted a parent/parent-in-law (39.3%) or a spouse/partner (27.5%; Table 2). About half (48.7%) provided care for ≥2 years and 33.4% provided care for, on average, ≥20 hours/week. Most assisted with personal care (63.0%) and household tasks (78.9%). The prevalence of caregiving for an older adult was higher among other racial/ethnic groups than among AAs (4.3%) (range: 6.6% of Hispanic adults to 12.8% of AIAN adults, p = 0.04 to p < 0.001). Nonetheless, the characteristics of the caregiving experiences were generally similar across all racial/ethnic groups. Most cared for <20 hours/week and provided help with both household and personal care tasks. There were some differences in the relationship between caregiver and care recipient: AA caregivers were less frequently caring for a parent/parent-in-law than Hispanic or non-Hispanic White caregivers and were more commonly caring for a spouse/partner than Black or Hispanic caregivers. Otherwise, there were no statistically significant differences in caregiving patterns or caregiver characteristics between AA caregivers for older adults and caregivers in other racial/ethnic groups. Among non-caregivers, 12.8% of AAs expected to begin providing care in the next 2 years, which was lower than the proportion of AIAN non-caregivers (17.2%, p = 0.03) but similar to non-caregivers in other racial/ethnic groups (i.e., 15.0% of Black, p = 0.11; 14.7% of Hispanic, p = 0.17; and 14.5% of White, p = 0.17 non-caregivers).

We found that the characteristics of AA caregivers and non-caregivers were fairly similar. However, AA caregivers were older and had a higher prevalence of chronic health conditions than non-caregivers, which suggests that they may need additional support to maintain their own health and continue in the caregiving role. This was not unique to AA caregivers as the high prevalence of experiencing chronic health and mental health conditions among informal caregivers across racial/ethnic groups has been well documented including caregivers of foreign-born, immigrant care recipients (Geng et al., 2018; Moon et al., 2020; Rote et al., 2019; Wang et al., 2014). All caregivers may have chronic conditions that they need to manage in addition to providing care for an older family member with a health condition or disability.

AA adults served as caregivers less frequently than adults in other racial/ethnic groups. Because of the AA cultural background—elder caregiving as 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 AA cultures and therefore, AAs may not identify themselves as caregivers (Miyawaki, 2017; 2020), and thus, caregiving by AAs might be under-reported. The BRFSS caregiver module is structured so that the respondent is asked about activities that are performed, and no respondent is directly asked to explicitly identify themself as a caregiver: “During the past 30 days, did you provide regular care or assistance to a friend or family member who has a health problem or disability?” Because caring for their loved ones is a given, some AAs may not think that they are assisting some relatives.

As we noted earlier, 57% of AAs are foreign-born and first-generation immigrants who may bring with them their original home culture and expectations and carry out their traditional cultural activities in the host country (AARP, 2014). However, such cultural practices often change with time in the host country and acculturation, especially among the younger generations (Miyawaki, 2015; 2020). Although AA families may try to maintain the traditional living arrangement of multigeneration households in the U.S., due to different lifestyles and living arrangements in the U.S., adult children may not be able to provide hands-on care as often as they wish despite their cultural background and good intentions (Liu et al., 2018). Those caregivers of immigrant care recipients may feel more stressed and burdened because they may have to spend more time with their loved one’s daily activities and medical care due to different healthcare systems and cultural and linguistic barriers (Moon et al., 2020; Rote et al., 2019).

We need to acknowledge some limitations of this study. Although our sample of caregivers is representative of each state, the final AA sample size was small and we were unable to analyze disaggregated data by state or, due to data access, ethnic subgroup. Like other national surveys (Nugraheni & Hastings, 2021), the BRFSS was conducted only in English and Spanish, so those with a different primary language may not have been able to complete the survey. More than half of the AA population is foreign-born (Budiman & Ruiz, 2021) and only 50% of immigrants from East and Southeast Asia are proficient English speakers (Radford, 2019). Foreign-born AAs more often expect to become caregivers for older relatives than their American-born counterparts (74% vs. 65%) (AARP, 2014). If those who do not speak the survey languages (most likely foreign-born AAs) are not included in the count, this may not fully reflect the picture of AA caregivers.

AA caregivers for older adults generally are older and in poorer health than their non-caregiver counterparts. This study was unique because the prevalence and characteristics of AA caregivers were compared to other racial/ethnic groups of caregivers across the nation. In general, the caregiving experience was similar across racial/ethnic groups, though AA caregivers differed from some other groups in the relationship to the person they cared for. Efforts to support and assist caregivers should be attentive to cultural practices and the demographic and health characteristics of those caregivers. Ethnic-specific adult day centers that provide ethnic-specific meal and activity programs may alleviate AA caregivers who try to adjust to new lifestyles in the host country but try to maintain their traditional elder caregiving culture while they work outside the home (Lendon et al., 2021; Moon et al., 2020; Rote et al., 2019). Some geographic areas where many different ethnic groups of immigrants reside (i.e., California, New York, 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 will continue to increase, the importance of these ethnically and linguistically responsive programs is paramount. Policymakers should consider measures that provide increased availability of and access to these culturally responsive programs to accommodate the increasing needs of not only AA but also other racial/ethnic groups of caregivers so that they can continue providing adequate care for their loved ones.