Family support in late life: A review of the literature on aging,disability, and family caregiving

ABSTRACT

For older adults and people with disabilities in the United States, family caregiving is an important part of remaining at home and in the community. As care recipients and caregivers age, family dynamics change, and the health, social, and financial impacts of this (largely unremunerated) work have implications for individuals, families, and social policy. In this review, the authors map the literature across multiple fields related to disability and aging to understand caregiving in late life, what it means to be an older caregiver and/or to care for older people. The authors summarize the findings of 97 articles to address the care, services, and supports family caregivers provide for older adults; negative and positive impacts for caregivers serving in this role; supports that family members use or need; and societal impact of family caregiving. Much of the literature describes the work family caregivers provide and negative impacts of caregiving. Less attention is devoted to caregiving benefits, supports used by family caregivers, and societal impacts. The authors conclude with an agenda for future research that attends to the need for research that includes: more diverse samples, new types of caregivers, longitudinal data, qualitative data and analysis, and comparative research.     

Coping strategies used by LGB older adults in facing and anticipating health challenges: A narrative analysis

ABSTRACT

Given that lesbian, gay, and bisexual (LGB) older adults face notable health disparities compared to their heterosexual counterparts, there is a need for understanding how LGB adults cope with health challenges in late life. The current study analyzes narratives from nine LGB adults age 65 and older living in an urban area in the Southeast United States. Participants spoke of coping strategies related to health promotion behaviors, shifting perspectives of health and body, trusting in spirituality for comfort, and accepting the end of life. We discuss implications for social services professionals who work with older LGB adults and for future research.     

Sense of Need for Financial Support and Respite Services among Informal Caregivers of Older Americans

ABSTRACT

Financial support and respite services are two of the most frequently reported types of help that caregivers of older adults need. Using an expanded health behavioral model, this study examined the effects of predisposing, enabling, and needs factors on caregivers' sense of need for these two types help. Data were drawn from the 1999 National Long-Term Care Survey and included 1,058 caregiving dyads in the community. The results indicated that caregiver-related factors more than care recipient–related factors affected caregivers' sense of need to seek both types of help. The findings direct to two important implications for long-term care policy for and practice with older adults: improvement of service for caregivers and service delivery systems.     

Transitions to Caregiving,Gender, and Psychological Well‐Being: A Prospective U.S. National Study

Guided by a life course perspective, this study examined the effects of transitioning into caregiving activity for a child, spouse, parent, other relative, or nonkin associate on nine dimensions of psychological well‐being. Data came from adults ages 19–95, who were noncaregiver primary respondents in the National Survey of Families and Households in 1987–88 and who were followed up longitudinally in 1992–93 (N= 8,286). Results from multivariate regression models confirmed that the transition to caregiving for primary kin (i.e., a child, spouse, or biological parent) was associated with an increase in depressive symptoms. However in selected instances, caregiving was associated with beneficial effects (e.g., women who began to provide nonresidential care to a biological parent reported more purpose in life than noncaregiving women). Evidence regarding gender differences was inconsistent, varying across caregiving role relationship types.     

Families,Work, and an Aging Population

Abstract

This article examines the intersection of family caregiving, work, and long-term care. Supporting families who provide care in order to minimize negative work effects while enhancing the acceptability of care options is of common concern to employers, state and federal policymakers, and the homecare professionals in the community-based care system. The contribution of families to the long-term care system, how employer policies have developed, how the public policy agenda has addressed family caregiving, and the importance of a more effective partnership on the state level are discussed.     

Social Work Practice with Older Soviet Immigrants

ABSTRACT

With the recent sociopolitical changes in the Former Soviet Union, significant numbers of older Soviets have arrived in the U.S. with their families. Soviet immigrants who enter the U.S. are no longer automatically considered political refugees, which has limited their entitlement to services. Recent changes in public welfare and immigration policy place the responsibility for care of elderly members solely on the family. While caring for older adults is stressful for any family, new immigrants may be especially burdened since they have limited knowledge of services, few coping resources to provide adequate care, and little experience resolving cultural conflicts with their older parent. By using a practice model designed to evaluate late-life caregiving situations, two case scenarios are presented to examine practice and service delivery issues of older Soviet immigrants and their families.     

Geographic distance and intergenerational relationships in Chinese migrant families

ABSTRACT

This study examines the effect of adult Chinese migrants’ geographic distance from home on their intergenerational relationships with parents who remain behind. We compared monetary and family care support as well as emotional relationships among four parent-child groups: older adults and international migrant children, older adults and internal migrant children (who migrated to other cities in China), older adults and coresiding children, and older adults and local children (living in the same city as their parents). Data were derived from 332 older adults in Beijing, China, with at least one child who migrated to another country or city. Results from chi-square tests, anaylsis of variance (ANOVA) tests, and regression analyses indicate that international and internal migrant children maintain similar intergenerational relationships with their parents, and that both of those groups are less likely than coresiding and local children to have family care exchanges and emotionally close relationships with their parents. The results may help professionals develop supportive services and policies for older adults in migrant families.     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

The Vulnerability for Elder Abuse Among a Sample of Custodial Grandfathers: An Exploratory Study

ABSTRACT

Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Preventing Economic Hardship Among Chinese Elderly in Hong Kong

Abstract

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

Chapter 6. Issues in Caregiving

SUMMARY

Some 10 to 29% of persons over 65 in the United States are sufficently physically, cognitively, or emotionally impaired to need some level of caregiving from their informal and formal support systems. Unfortunately, there are still some older persons who need care, but care is either not provided, inadequate, or involves some form of mistreatment. This chapter discusses the difficulties of maltreatment and substance abuse.     

Young adult carers: a literature review informing the re-conceptualisation of young adult caregiving in Australia

The experiences of young adult carers (YACs) have been vastly under-researched, particularly within Australian caregiving literature. This article explores the existence, extent and nature of informal young adult caregiving in Australia, defining YACs as individuals aged between 18 and 25 years who provide unpaid care or support to family members living with chronic illness or disability. The aim of this article is to provide a foundation for the re-conceptualisation of YACs as a distinct carer cohort who, without suitable recognition and specifically targeted support, may experience significantly reduced future life opportunities. The traditional, narrative-based review will first redefine YACs in accordance with overseas literary definitions and will then explore the complex nature and extent of young adult caregiving in Australia. Explanations as to why young adults are increasingly undertaking these informal caregiving roles and how YACs differentiate from their non-carer peers will then follow. Finally, three prominent paradigms, namely the clinical, social capital and carers' rights' perspectives, will be presented to establish a greater understanding of the implications, contextual experiences and unmet civil rights of YACs in Australia.     

The effects of adoption openness and type on the mental health,delinquency, and family relationships of adopted youth

ABSTRACT

Analyzing the 2007 National Survey of Adoptive Parents, this study examines the impact of open adoption, demographics, and other factors on adopted children’s mental health, delinquent behavior, and family relationships. Specifically, we compare findings for youth in private and public (i.e., foster care) adoptions and identify key similarities and differences between predictors of children’s well-being across these two types of adoption. We find that youth in open foster care adoptions are more likely to receive an attachment disorder diagnosis than those in closed foster care adoptions but are also more likely to have family relationships characterized by trust and adoptive parents’ willingness to recommend adoption to others. Further, we find children in both public and private adoptions who are older at placement are more likely to have posttraumatic stress disorder diagnoses. For children in private adoptions, no statistically significant predictors affected youths’ delinquency outcomes or family relationships, with the exception of parents of private adoptees in households characterized by lower levels of poverty indicating they would be more likely to recommend adoption to others. The implications of the key findings are discussed with regard to service provision for multiple types of adoptive families.     

Exploring the relationships among practitioners’ consultation skills,competence to counsel lesbian,gay, and bisexual clients,and attitudes toward transgender people

Abstract

Consultation is an intervention that can diffuse expertise in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) issues throughout systems of care. Practitioners (N?=?145) were surveyed on their lesbian, gay, and bisexual (LGB) counseling competence, attitudes toward transgender people, and consultation skills. Hierarchical multiple regression analysis identified that consultation competence significantly influenced (p?≤?.01) LGB counseling skills over and above LGB knowledge and awareness, attitudes toward transgender people, and participant demographic characteristics. The domains of LGB competence and attitudes toward transgender people were also significantly correlated within the participant sample. Implications for practice, training, and future research are discussed.     

Adult Day Centers and Mental Health Care

ABSTRACT

This research focused on the mental health issues at adult day centers and used a cluster analysis to profile older persons who received these services. The sample included 280 participants who attended adult day care. The data were collected from intake files using a biopsychosocial framework to guide the selection of variables from January 1, 1999 to December 31, 2000. A cluster analysis revealed two distinct profiles of participants. The first profile was characterized by women, who were single, African-American, had low incomes, relied more on public funding, and had no psychiatric diagnoses. The second profile was differentiated with more men, who were married, relied more on private funding, and had higher incomes and psychiatric diagnoses. Participants clustered in the second profile, including those diagnosed with psychiatric disorders, disenrolled at a faster rate than those in the first profile, including older adults without psychiatric disorders. Both profiles were similar in age, education, caregiving, religious affiliation, household size, and service intensity. They also resembled each other with respect to functional limitations, nutrition risk, and prior nursing home placement. Slight differences were found in frequency of previous hospitalizations and years of education. Recommendations for strengthening the mental health training of social workers employed at adult day centers were made.     

Attitudes Toward Lesbian,Gay, and Bisexual College Students: The Contribution of Pluralistic Ignorance,Dynamic Social Impact,and Contact Theories

Abstract

Social psychology theories may be useful in developing new interventions to reduce prejudice against lesbian, gay, and bisexual (LGB) college students. For this preliminary study, the authors surveyed 109 college dormitory residents to determine their personal comfort with LGB students and their perceptions of other students' comfort with these individuals. They found widespread evidence of pluralistic ignorance—the students rated themselves as significantly less anti-gay than either their friends or the typical student. Students' attitudes showed geographic clustering, with the building of residence a significant predictor of students' attitudes. Finally, consistent with the contact hypothesis, the perception that 1 or 2 LGB students lived on the same floor or in the same building was associated with more positive attitudes.     

Transactions between older people and the hospital environment: A social ecological analysis

PurposeTo illuminate how problems arise between older adults and the hospital environment through examination of the transactions between the two rather than a focus on one or the other.Design and methodsA critical ethnographic study that used constant comparative analysis applied to three data sets: hospital observations, interviews with older adults, and hospital employees.FindingsTwo groups of older people are distinguished: those identified as appropriate older patients and those found to be different or less appropriate. Incongruent relationships emerge only when older people who are inappropriate for the hospital's cultural space confront four areas of poor fit: architectural features, bureaucratic conditions, chaotic atmosphere and hospital employee attitude. These environmental features act in independent and interactive ways to produce a disempowering synergy that erodes independence and confidence; produces stress, worry and anxiety; and enhances disabilities when functional impairments exist. Being different is key to a lack of fit in the hospital environment and the construction of problems. Problem construction with older people is less about age and more about the efficiency of a one-size fits all approach to acute care. Ageism emerges as a bi-product of the pressure on hospital employees to keep the system moving.     

Lavender Faith

Abstract

Lavender Islands is the first strengths-based study of lesbian, gay and bisexual (LGB) persons in New Zealand. In total, 2,269 LGB participants responded questions in many domains, including spirituality and religion. This study found that women are more likely to believe in a spiritual force than men, and respondents 40 years of age and older are more likely than younger to believe in a spiritual force. Respondents did not believe that partners needed to share beliefs. Christians reported that their religious tradition was more a difficulty than a support than those with no religion. LGBs appear to be disaffiliating with Christianity at 2.37 times the rate of the general New Zealand population since 1966. LGBs reporting no religion experienced more support from their families for themselves and their partners than those who were raised Christian. Religious traditions had no effect on the ages that respondents first felt different from their childhood peers, or when they actually came out. Respondents reporting no religion were significantly happier with their sexual identity than Christian respondents. Social workers should be aware of and address these conflicts and challenges with LGBs they encounter in their practice settings. doi:10.1300/J377v26n03_04     

Conducting Research Among Older Lesbian,Gay, and Bisexual Adults

Gerontologists and developmental researchers have neglected the study of sexual orientation among older adults. The apparent assumptions are either that it does not exist or that it is not necessary to know; consequently, older lesbian, gay, and bisexual (LGB) adults remain invisible groups with the exception of a relatively small number of studies using convenience samples. This article examines some conceptual, practical and ethical challenges involved in designing and conducting research among older LGB adults. The limitations and emphases of extant research and the challenges in conducting such research are examined. The design of two studies that focused on mental and physical health and on care-giving among older LGB adults are discussed to suggest ways of meeting the challenges.