Informal Caregiving - Who Are The Family Caregivers Of Frail Elders?
Who are the family caregivers of frail elders?
The informal networks of older people are dominated by kin. For impaired elderly people who are married, the spouse is the first line of support. Spouses handle a broader range of tasks, provide more hours of assistance, and are more likely to provide personal care than are other caregivers. Husbands and wives are also more likely than other categories of caregivers to handle caregiving responsibilities on their own, without supplemental help from other informal caregivers or from formal services. The caregiver in an elderly couple is most likely the wife, since women generally live longer than men and are younger than their husbands. Most studies of spousal caregiving report that husbands experience lower levels of burden than wives. Husbands are also more likely than wives to receive supplemental assistance.
When a spouse is not present or when the level of support provided by the spouse is not sufficient, other family members—particularly adult children—step into the caregiving role. Research has demonstrated that children assist over shorter periods of time and provide less intensive assistance than do spouses, with the difference most pronounced among sons. Daughters are more likely than sons to assume the role of primary caregiver, even when the number and gender distribution of all siblings are considered. Daughters provide more hours and a broader range of tasks than do sons, who are less likely to provide daily assistance with routine household tasks or personal care. Daughters are more likely than sons to be monitors of care—assessing need, finding someone to provide the needed assistance, and making sure that tasks are performed correctly. The highest participation of sons in parental caregiving is found in families without daughters.
Elderly people without children living nearby compensate by developing close relationships with other kin and with friends or neighbors. Victor Cicirelli, who has studied sibling relationships in late life, reports that a small percentage of elderly persons rely on siblings for psychological support, for help with business dealings and homemaking, and as companions for social or recreational activities. Deborah Gold argues that elderly siblings serve as ready sources of support in times of crisis or as backups to regular caregivers. Consistent with gender differences in other relationships, sisters both give and receive more help than brothers.
Relationships with extended kin, including aunts, uncles, cousins, nieces, and nephews, vary in both emotional closeness and exchanges of assistance. The amount of assistance provided by extended kin ranges from moderate to low, with the level of help declining with the distance of the kinship relationship. Variation in the level of help also reflects differences in geographic proximity, norms embedded in ethnic culture, and individual family histories. Researchers report that extended kin occupy more pivotal roles in the helping networks of African-American elders than of white elders, a difference that persists when controlling for economic resources.
While older people, especially those without close kin, rely on friends or neighbors, these helpers provide a more limited range of assistance. Friends provide emotional support and, along with neighbors, offer assistance with occasional tasks like running errands or providing transportation. But friends or neighbors are rarely mentioned as a source of help with daily household chores or personal care in long-term illness. Older women are more likely than older men to have developed a network of close friendships that would foster the provision of informal care. The role of friends in providing informal care in late life also varies with ethnicity. For example, research indicates that African-American friendships exhibit greater exchange of both instrumental and emotional support than do white friendships. Friends also play a greater role in linking elders to formal services among ethnic minority elders.
The majority of the literature on caregiving for frail elders is consistent with the concept of a hierarchy of preferred caregivers. The hierarchical compensatory model, developed by Marjorie Cantor, posits that involvement of informal helpers reflects a normatively defined preference hierarchy based on the relationship between the care provider and the older care recipient (Cantor and Little). This notion of "preferred helpers" is used to explain the successive involvement of spouse, adult children, other family members, and friends and neighbors described in the empirical literature. The selection order becomes relevant when a previous category of helper is unavailable (a situation referred to as "substitution") or is unable to provide enough help to satisfy the older person's needs (a situation referred to as "supplementation"). This approach argues that the availability of helpers rather than the types of assistance needed by the older person explains the composition of informal networks (Miller and McFall).
The empirical research on informal caregiving is generally consistent with this preference hierarchy, but the hierarchical compensatory model does not explain which adult children or which other relatives will be recruited into the support networks of frail elders. Researchers studying the selection or recruitment of specific individuals as caregivers have identified characteristics of the elderly person, the potential caregiver, and their relationship as key predictors. Marital status of the care recipient is an importance factor, since spouses are the first-line caregivers. Gender is another factor. Most caregivers are women, but the gender of the elderly care recipient is also important. The predominance of adult daughters over adult sons can in part reflect the fact that most widowed parents are women, and older women may prefer to receive hands-on personal assistance from a daughter than from a son because of taboos involving intimate body contact (Lee). Geographic proximity is a prerequisite for routine, daily assistance, but emotional support and financial assistance can be accomplished over the miles.
Economic resources of both parents and adult children also mediate caregiving strategies. Affluent elderly families sometimes prefer to hire private-sector outside help with instrumental tasks. Hiring people to perform occasional chores allows older people to feel that they are still managing on their own, minimizing demands on their children and other informal helpers, and retaining control of the caregiving situation. Social class also influences the experience of providing family care, since affluent families have resources to hire supplementary assistance or purchase market alternatives for caregiving tasks.
There are also race and ethnic differences in regards to caregiving. For example, African-Americans are more likely to see informal caregiving as their familial responsibility. Cagney and Agree found that African-Americans were more likely to postpone the hiring of formal caregivers or the implementation of institutionalization than were white families.
Researchers have also focused on competing demands on the time and resources of informal caregivers, exploring the hypothesis that other family and employment responsibilities "pull" from caring for elderly relatives. Most of these studies focus on adult children caring for elderly parents. For example, some studies suggest that parental caregiving falls most heavily on unmarried adult children. Other studies explore employment as a constraint on the flexibility of adult children in responding to parental needs, but, with the exception of a slight decrease among adult sons, most studies report that employment has no impact on relationships between adult children and their elderly parents. Logan and Spitze tested the impact of particular configurations of roles on parental caregiving by adult children. They report that combinations of roles have no effect beyond the individual effect of specific roles. They conclude that stresses reported by caregivers who occupy multiple roles come not from the particular configuration of responsibilities but from the stressful responsibility of caring for a frail elderly parent.
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