A life course perspective on parent care is foundational to understanding . in their relationships as a result of assuming a caregiver role (Ziemba, ). . In J. I. Kosberg (Ed.), Family care of the elderly: social and cultural changes (pp. Relationships within Russian families are being transformed. closer to France, where a more liberal understanding of family support is common. Should parents and older relatives help their grown-up children? are receding into the past, new views on how the roles are distributed between family and. The relationship that grandparents have with their grandchildren can also to adjust to their new roles as parents, to a changed relationship with each other, As children get older formal child care services are used more often. . family may not help them out because they do not understand the situation;.
In order to effectively help caregivers of the elderly adjust over the long haul it is important to distinguish clinical depression from shock, loss, and grief.
It is important to keep in mind that the parents may be depressed or traumatized by the changes in health and independence, and such moods will affect those who care for them. Grief and loss are dominant themes in narratives about caregiving and are to be expected Hausman, ; McCarty, ; Shaw, ; Ziemba, Adult children are likely to report guilt, anger, depression, and role reversal Bowers, ; Fischer, In one study, daughters used the term "role reversal" to define the experience of losing the prior support of the parent, in combination with the new demand to provide the safety net for the parents Ziemba, While empirical investigation is lacking, it is likely that others close to the caregiver could be affected by the caregiver's depressive symptoms, depression, and grief.
Other family members might be a source of support and mitigate the negative impact on the primary caregiver, but could also be another source of conflict or a stressor for the primary caregiver due to their own distressed or negative reactions to the situation. Parent care can revive sibling rivalries and other long-standing family issues. Often it is assumed that people from different ethnic or minority backgrounds enjoy the added assistance that comes from large, extended families, and values of family collectivism.
However, such assumptions may lead to false security among health care professionals that the needs of family caregivers are being met. For example, the majority of studies reviewed by Dilworth-Anderson and colleagues that examined social support and culture indicated that non-Hispanic whites have a less diverse set of extended helpers than do minority caregivers.
However, the studies did not support the common assumption that minority caregivers receive more informal social support. For example, when other factors were controlled, it was more likely that African Americans were sole providers of care and in greater need of formal support services. Thus, family and extended family could be actual or potential resources to the primary caregiver, but could also represent additional sources of strain.
Caregiving itself could lead to decreased socialization and isolation for the caregiver. The typical caregiver of elderly parents is female, married, and employed full-time. Adult children may fill many other social roles, such as raising their own children, and pursuing a career. Another strategy to address the care needs of the aging parent is for the parent or child to move in with the other Tennstedt, ; Ziemba, This has implications for other people in the household and typically requires adjustment to the new living arrangements.
Thus, multiple roles—including work roles or childcare—may provide respite, distraction, or resources that offset the demands of caregiving. However, the constellation of benefits and conflicting demands of multiple roles will depend on the situation, and caregivers and their families may face difficult choices or periods of adjustment. Physical Health In contrast to the large volume of studies on the psychosocial effects of caregiving, there is less certainty as to the risks for physical health Reese et al.
Health problems could result from the deleterious effects of stress on the immune system, resulting in less resistance to acute or chronic disease. The family could be at risk for "double trouble" if the caregiver's health is affected by caregiving demands. Other Risks Over the Lifespan In addition to health risks, caregiving can threaten financial well-being. In the short run, there may be additional costs of hired help, which can be very expensive Grunfeld et al. Tennstedt reported analyses by Harrow et al.
Caregivers face other expenses when replacement costs of providing direct care services are considered. In the long run, many caregivers reduce work hours to provide care, take early retirement, or pass up promotions or career changes Guberman et al.
For women pursuing careers, the disruption caused by family caregiving could decrease total earning power, and divert energy and funds from the development of the caregivers' own retirement prospects Grunfeld et al.
The Beneficial Effects of Caregiving Most of the research to date has emphasized harmful consequences on caregivers of the elderly. Belief in the benefits of family caregiving helps to build a strong platform of support for caregivers as a result of a more positive outlook, and thus promotes family health Louderback, Many caregivers do not report role strain or other negative consequences Tennstedt, In life-span developmental approaches, care of elderly parents is often viewed as a developmental task of middle- to late-life through which the adult child gains maturity and wisdom for their own later years e.
While caregiving has potential risks, real costs, and serious implications, it is simply unavoidable for many families when the call comes. As part of the human experience integral to family relationships, family caregiving is often not an option, but a certainty. Adult children feel their duty, and parent care is often assumed out of obligation.
Other common themes were fulfilling family obligations, and repaying parents. Such rewards and benefits of caregiving accrue not only during the time spent caregiving, but increase in value long after the parent's death. A life course or developmental model suggests latent benefits for caregivers since they avoid guilt and find comfort in rewarding memories. A good resolution of the "filial crisis" means that adult children attain greater maturity and are better prepared for their own aging Blenkner, Greater emphasis on the ultimate or "spiritual" meaning of being a caregiver may be a more fruitful approach than focusing on costs.
McLeod asserts that accepting the difficult aspects of caregiving is a realistic approach, and that for caregivers to grow from the event they must internalize the experience in terms of life goals and the importance of human, caring relationships. Improved Family Relationships The most salient and persistent influence on all aspects of caregiver burden is the quality of the relationship between caregiver and care recipient Tennstedt, Caregiving can stress relationships, but it can also improve them.
About a third of caregivers in one study reported an improvement in their relationships as a result of assuming a caregiver role Ziemba, Action Plan for Health Professionals The role of the health care professional is aimed primarily at helping the caregiver cope with the increased demands, and to help caregivers balance responsibilities to the care recipient, to themselves, and to other family members.
Health professionals may find it helpful to choose from the many lifespan developmental and family systems frameworks to guide therapeutic interactions with adults involved in parent care e.
While general stress models highlight the hazards of caregiving, developmental and family systems theories are useful in that parent care is acknowledged as an important and temporary challenge to the family, and thus redirect emphasis to long-term benefits of caregiving as well as draw attention to the roles and needs of other family members.
It is helpful to distinguish between stress and a state of crisis. Caregiving can be viewed as normal family stress but with the potential to cause deleterious health effects on the caregiver and other family members if a state of crisis persists.
The need for care can arise suddenly and dramatically, or can build gradually over many years. Or, sudden death of the parent may preclude the need for caregiving, but not for griefwork. Health professionals with middle-aged clients or family practices need to be alert to the likelihood of caregiving of elderly parents as an emergent or future stressor on the adult child, with potential effects on the caregiver's health especially at midlife and beyond.
Health care professionals also need to recognize that adult children may be responsible for the care of both parents, either at once, or sequentially. As a result, some adult children face cumulative loss and strain Ziemba, Adopt "Family-Friendly" Policies Concerned health care professionals should invite family participation and assess family concerns. Respect for cultural diversity and family preferences mandates assessment of patient preferences for the presence and involvement of family members, especially concerning the procedures and roles of family members in major decisions.
Policies supportive of cultural diversity also include awareness of gender roles and patterns of interaction with authority figures such as with parents, or with health care professionals.
Assessment of the family structure can potentially strengthen resources for the primary caregiver as well as open avenues to understanding the effects of the elder's illness on others in the family.
Strategies can be implemented to help patients and their families discuss caregiving concerns and to make health-related decisions. Health professionals can start by encouraging either the care recipient or the caregiver to formulate anticipatory strategies, such as Living Wills. Adult children may be overprotective or conversely, might need to take charge in the presence of unsafe situations. Parents may even hide their infirmities from their children Ziemba, Adult children may have negative memories of their own upbringing, and parent and child may not necessarily get along.
Despite interpersonal conflict, adult children are often compelled by obligation to persist as caregivers. Therefore, health care professionals need to be sensitive to the perceptions and needs of care recipients and caregivers, in order to help both parties negotiate new roles and behaviors, and attain healthier outcomes for all involved. Caregivers may be so concerned about their parents that they might be overlooking signs of trouble for other important family members.
Health care professionals can inquire about the potential effects on others in the family, such as children who might be feeling ignored or left out. Recognize and respect the significance of the caregivers' loss and emotions, including grief. Caregiving represents painful realities experienced amid a host of heavy emotions such as guilt, anxiety, worry, and frustration.
These are normal reactions and it will take time to resolve them. Learning needs may be simple or complex. Acquiring a sense of mastery can ease caregiving Tennstedt, Caregivers may need help to access information and services.
The health care system itself is often a source of frustration and stress for caregivers, due to gaps in the continuum of care and barriers to information.
Family Health & Caring for Elderly Parents
This problem could be especially intimidating to families with language barriers or cultural values prohibiting the questioning of authority figures.
Caregivers need to be persistent in tracking down information and services that work for them. Good places for caregivers to start their search are the local Area Agency on Aging; social work departments in health care agencies; the Visiting Nurses Association or other home care provider; and libraries and bookstores. Ethnic, religious, and alternative communities often provide services and direction to their members.
There are numerous websites as well. Or, simply typing in "caregiving" in any on-line search engine will yield thousands of web links.
Traditions of Helping inside Families are Changing in Russia
Surfing through the first few should be enough to connect caregivers to on-line support e. Help caregivers to evaluate options, set limits to their involvement, and dash the cherished myth of being all things to all people.
Assist caregivers to recognize the importance of maintaining their own health and peace of mind to the greatest extent possible. Encourage opportunities for caregivers to reflect on the deeper meaning of caregiving and to maintain their spiritual health McLeod, Some of the adult "children" of the elderly are themselves elderly and at risk for health problems. Encourage caregivers to maintain check-ups and screening such as mammograms, etc.
Explore and encourage the recruitment of other family members, friends and services to provide respite so that caregivers can renew their energies and outlook. Be aware of the major transitions that caregivers may face, from combining households with the parent, to changing work status. Caregivers may avoid seeking additional help because of beliefs that the problem will be quickly resolved, from unrealistic expectations of themselves, or from a simple lack of awareness of available services.Role Reversal of Children and Their Aging Parents
There are many resources on caregiving, including support groups at local agencies, a wide range of self-help books in bookstores, and numerous virtual communities e. Encourage Quality Family Time Encourage opportunities for "quality family time," that is, recreational time with the care recipient, and don't leave out the grandchildren.
Despite caregiving's bad reputation in the literature, this time can also be one of great meaning and enjoyment. Interventions aimed at family enrichment e. Advocate for family-friendly policies and procedures such as family conferences, flexible scheduling for office visits, house calls for frail elderly, workplace support for caregivers, and reduction of barriers to information and services.
In addition, meeting the needs of caregivers requires improvement in the continuum of respite services and long-term care options available in the community. Conclusion In summary, taking care of elderly parents is an important event to adult children and their families.
Role Reversal with an Aging Parent
Health care professionals can enable adult children as caregivers through supportive and family-focused strategies. While health risks and benefits to other family members are not as well delineated as those for the primary caregiver, cautious inquiry is advisable in order to prevent secondary harm to the family unit.
Involvement and recognition of the potential contributions of other family members may help to reduce the deleterious effects on the primary caregiver as well as to promote growth of other individuals in the family. Such concern and intervention can help families through a difficult time, strengthen family bonds, and promote comforting memories of their time together as a family.
Old age in the United States: Stress, role captivity, and the cessation of caregiving. Journal of Health and Social Behavior, 34, Mutuality and preparedness as predictors of caregiver role strain. Research in Nursing and Health, 13, The PREP system of nursing interventions: A pilot test with families caring for older members. Research in Nursing and Health, 18, A Critique of the caregiving literature.
The Gerontologist, 30 1 A comparison of employed and not employed daughters. Social Work, 40 3 The life course perspective applied to families over time. A contextual approach pp. Social work and family relationships in later life with some thoughts on filial maturity.
Advances in Nursing Science, 9 2 Hastings Center Report, 24 5 Parent care as a normative family stress. The Gerontologist, 25 1 Caregiving daughters and their local siblings: Perceptions, strains, and interactions. The Gerontologist, 29 4 Family care of the elderly in the United States: An issue of gender differences?
Symbolic interaction and the family. Sibling relationships in cross-cultural perspective. Journal of Marriage and Family, 56, The ethics of home care: Issues of race, ethnicity, and culture in caregiving research: A year review The Gerontologist, 42 2 Elderly parents and the caregiving role: Aging and independence pp. Social support in the context of caregiving: Husbands' provision of support to wives involved in parent care. On the other hand, the system of state care for old people in France is organized in such a way that young people consider it possible to focus on their career and let social services care for the elderly.
The elderly care for their grandchildren In terms of support that could be given by the senior members of a family to the junior, Russians and French also have similar views. Should parents and older relatives help their grown-up children?
Respondents from both countries agree on the importance of mutual support in families. Should grown-up children help their elderly parents? Social expectations among the less protected demographics in Russia have grown. The stability in the French opinion can be largely explained by the stable work of social services.
This leads to a growing number of statements about mutual responsibility of state and family for the weaker members of society. This change can be explained by changes in opinions of those respondents who previously strongly voted for only family responsibility, the authors explain. At the same time the share of respondents who believe that society is the only responsible party has fallen.
Children and parents are less ready to help each other A growing orientation towards sharing the care of weaker members of the society with the state correlates with growing doubts about the necessity of help within families in Russia fig.
The share of those questioning this grew by 8. The share of respondents who believe that the older generation should help the younger has also decreased.