Quality of the Relationship between Elderly Spouses: Influence on Spouse Caregivers' Subjective Effectiveness

Abstract

Quality of the Relationship Between Elderly Spouses: Influence on Spouse Caregivers' Subjective Effectiveness* Aloen L. Townsend** and Melissa M. Franks Evidence that caring for older relatives can have negative effects on family caregivers' well-being has been accumulating rapidly (see reviews by Biegel, Sales, & Schulz, 1991, and by Gatz, Bengtson, & Blum, 1990). One of the most frequently studied predictors of caregivers' well-being has been the care recipients' level of impairment. Both greater functional impairment (Gatz et al., 1990, review; Sheehan & Nuttall, 1988) and greater cognitive impairment (see review by Biegel et al., 1991) predict poorer well-being among caregivers. With few exceptions (e.g., Montgomery, Kosloski, & Borgatta, 1990), cognitive impairment has been more consistently linked to caregivers' well-being than functional impairment has. This has been attributed to the unique demands that caring for a cognitively-impaired relative presumably places on caregivers (Boss, 1993; Fiore, Becker, & Coppel, 1983). Of increasing interest are mediating mechanisms that explain why or how impairment exerts its effects on well-being. Recently, Townsend and Franks (1995) found evidence that the quality of relationships between adult-child caregivers and their elderly parents, who were living in separate households, mediated the impact of the parents' impairment on the adult children's well-being. The purpose of the present study was to investigate whether this model of the mediational effects of relationship quality between caregivers and care recipients also applies to elderly spouse caregivers. Given that most impaired older adults are cared for by family (Gatz et al., 1990), the quality of family relationships would seem to be particularly important in later life. Family ties epitomize the interdependence and intimacy that define close personal relationships (Kelley, 1981). At their most positive, such relationships are characterized by love, caring, and affirmation that one is valued and understood (House & Kahn, 1985). Yet, close relationships are also fraught with potential for conflict (Kelley, 1987; Peterson, 1983). Even a well-functioning family can be strained by serious illness in one of its members (Fry, 1986; Kelley, 1981). Caregiving research has, in fact, demonstrated that the greater the elder's functional impairment, the more negative the effects on the relationship between the caregiver and care recipient (Horowitz & Shindelman, 1983; Reece, Walz, & Hageboeck, 1983). A similar association has been found for cognitive impairment (Cohen & Eisdorfer, 1986; Creasey, Myers, Epperson, & Taylor, 1990). Only a few studies (see review by Gatz et al., 1990, and research by Fitting, Rabins, Lucas, & Eastham, 1986, and Richards, Bengtson, & Miller, 1989) have reported positive or null effects of impairment on later-life family relationships. Research has further established a link between the quality of family relationships and caregivers' well-being. Greater affection or intimacy with an impaired relative is related to lower subjective strain or burden among caregivers (Horowitz & Shindelman, 1983; Walker, Martin, & Jones, 1992). Retrospective reports of more positive ties with the care recipient prior to the relative's impairment also predict lower subjective burden (Strawbridge & Wallhagen, 1991; Williamson & Schulz, 1990). In the caregiving literature, as well as the general literature on social support within close relationships (e.g., Kelley, 1987; Rook, 1984), researchers are increasingly aware of the particular significance of interpersonal conflict or social undermining for well-being. Negative social exchanges have been found to be less common than positive ones in caregiving families (Fiore et al., 1983; Stephens, Kinney, Norris, & Ritchie, 1987; Townsend & Franks, 1995). At the same time, negative exchanges have a stronger impact on caregivers' well-being than positive ones have (Creasey et al. …