ERIC Identifier: ED279993
Publication Date: 1986-00-00
Author: Libert, Anne Blanford
Source: ERIC Clearinghouse on Counseling and Personnel Services Ann Arbor MI.
Elderly Parents and Adult Children as Caregivers. Highlights: An ERIC/CAPS Digest.
Children of infirm elderly have always been a source of assistance to their parents, despite personal hardship, and continue to be so today. This digest presents a contemporary description of American elderly and adult children's caregiving to their parents. This description is based on recent gerontological literature available in the ERIC database.
A PROFILE OF AMERICAN ELDERLY
Since 1970 the median age of the United States population has been rising and is expected to continue to rise into the mid-21st century. In this so-called graying of America, a greater proportion of the population will be over 65. In 1900, one American in twenty-five was age 65 or over; in 1984, one in nine. By the middle of the next century, one in five Americans will be elderly. The proportion of oldest-old Americans, those 85 and over, is growing even more rapidly. This part of the population is expected to triple in size between 1980 and 2020. The oldest-old are especially important to caregiving studies, since this group of elderly is most likely to have chronic health problems and children who are elderly themselves.
A recent trend known as "countermigration" supports the importance of family caregivers. Some retirees who moved to the sunbelt in early retirement are moving back later to be near their children.
The elderly as a group have economic status similar to the non-elderly. However, subgroups of the elderly exhibit much lower levels of economic resources. Older women have dramatically lower incomes than older men, largely associated with a pattern of lifelong economic dependency on men, and status changes accompanying old age. Minority elderly have lower incomes than their white counterparts.
On a measure of disability called "activity of daily living limitation," 19 percent of the elderly over 65 have some limitation, while only 3 percent are severely disabled. However, those over 85 are four times as likely to be disabled as those 65 to 75. Today, chronic conditions such as hypertension, arthritis, hearing impairments and heart conditions are the most prevalent health problems of the elderly. Although older people have fewer mental impairments than other age groups, a leading reason for institutionalization for the elderly is cognitive impairment, resulting from Alzheimer's disease or other conditions.
Spouses and other relatives provide important assistance to those elderly with limitations who are not institutionalized. Spouses contibute substantial amounts of care to each other, especially wives to husbands. As spousal support diminishes with increasing age, other relatives become caregivers. Children provide about a quarter of the care to elderly fathers and a third of the care to elderly mothers. Formal community caregivers provide only about a fifth of the care. Although only five percent of the elderly are in nursing homes at any particular time, one in four elderly persons will eventually need long-term care assistance. In summary, while most elderly are not severely disabled, many do require assistance because of their limitations. With increasing numbers of elderly, especially the oldest-old, this need can be expected to rise. (This profile is drawn from AGING AMERICA, 1985-86.)
CAREGIVING BY ADULT CHILDREN
Traditionally, it has been the duty of adult children to care for their elderly parents. For previous generations, children served as old age insurance. Today's elderly may be more financially independent than their predecessors, but family still plays an important role for the elderly (Shanas, 1979).
How do adult children help? As elderly parents become impaired through chronic illness, senility, or disability, these elders may lose their ability to be self-sufficient. Adult children may become caregivers to their parents. For the severely impaired elderly, adult children as caregivers can provide direct assistance with activities of daily living such as eating, bathing and dressing (Clark and Rakowski, 1983). Even those less severely impaired elderly may need assistance with shopping housework, transportation, home maintenance and bill paying.
An extremely valuable caregiving task adult children perform is to coordinate and monitor services. This can include locating a nursing home and monitoring its quality, procuring medical services, arranging public service assistance and handling finances. The quality of these types of caregiver services rests on the interest the caregivers have in their tasks. Family caregivers have an emotional tie and filial duty to procure the best for their parents; a paid coordinator may settle for adequate services, not the best.
IMPACTS ON CAREGIVING
People are living longer and in greater numbers. As the baby boom generation becomes old, the number of elderly will rise dramatically. This has particular impact on the baby boom generation in that they have fewer children who in turn will be able to assist them in their old age. In a mobile society, adult children are less likely to live in the same locality as their parents.
High divorce rates and women's participation in the work force have an impact on caregiving today and will have an even greater impact in the future. Divorced children tend to provide less assistance to their elderly parents than those from intact marriages (Cicirelli, 1983). Traditionally, women as daughters or daughters-in-law have provided the majority of family care (Horowitz, 1985). As these women become more involved in their job responsibilities, they may have less time and energy to devote to their elderly parents.
The tasks of caregiving can result in caregiver strain. Elderly parents may become an emotional burden to their children. In the reversal of roles from parent as caregiver to child as caregiver, misunderstanding and ill-will can develop. Adult children may suffer multiple role strain as parents to their own children, spouses, employees, and caregivers to elderly parents (Cantor, 1983). Caregivers and care receivers may also suffer from a limited future outlook (Rakowski and Clark, 1985), or caregivers may simply tire out from the added duties at a time in their lives when they may have expected to be free from responsibility, perhaps in their own retirement.
How can family caregiving be protected and strain reduced? Semi-independent elderly parents can live in companion or congregate housing. Those with greater impairment can utilize nursing homes. Adult children may find help in support groups, including groups specifically for family members of Alzheimer's disease victims (Schmidt and Keyes, 1985). For those children of parents who remain in the home, outside service provision can be of assistance. Personal care assistance, chore service, respite care, and day care can relieve the burden on adult children. Caregivers may also need to use cognitive therapy to relabel their help as resulting from filial duty, not affection (Jarrett, 1985).
The graying of America forces us to take a look at contemporary family caregiving and to consider the future needs of American elderly. Family caregiving has changed through the generations, but is and promises to continue to be a most valued social resource.
FOR MORE INFORMATION
AGING AMERICANS: TRENDS AND PROJECTIONS (1985-86 ed.). Washington, DC: U.S. Department of Health and Human Services, 1986. ED 275 928.
Cantor, M. Strain Among Caregivers: A Study of Experience in the United States. THE GERONTOLOGIST, 23 (1983): 597-604.
Cicirelli, V.G. A Comparison of Helping Behavior to Elderly Parents of Adult Children with Intact and Disrupted Marriages. THE GERONTOLOGIST, 23 (1983): 619-625.
Clark, N.M., W. Rakowski. Family Caregivers of Older Adults: Improving Helping Skills. THE GERONTOLOGIST, 23 (1983): 637-642.
Horowitz, A. Sons and Daughters As Caregivers to Older Parents: Differences in Role Performance and Consequences. THE GERONTOLOGIST, 25 (1985): 612-617.
Jarrett, W.H. Caregiving Within Kinship Systems: Is Affection Really Necessary? THE GERONTOLOGIST, 25 (1985): 5-10.
Rakowski, W., N.M. Clark. Future Outlook, Caregiving, and Care-receiving in the Family Context. THE GERONTOLOGIST, 25 (1985): 618-623.
Schmidt, G.L., B. Keyes. Group Psychotherapy with Family Caregivers of Demented Patients. THE GERONTOLOGIST, 25 (1985): 347-350.
Shanas, E. The Family As a Social Support System in Old Age. THE
GERONTOLOGIST, 19 (1979): 169-174.
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