Elder Impairment Research Articles

Stress and Service Use Among Minority Caregivers to Elders with Dementia

Research indicates that minority caregivers use fewer outside social and medical services than white, European-American caregivers. Qualitative research has shown non-caregiving stressors stemming from family and community environments as affecting burden and service use among minority caregivers. Yet few studies of caregiver service use include multiple groups of minority caregivers, or quantitatively evaluate the influence of non-caregiving stress. Using Pearlin, Mullan, Semple and Skaff's (1990) model of caregiver stress, we examined the relationship of ethnicity, non-caregiving stressors, and other stress-associated variables to service use by African-American, Chinese, and Latino caregivers. A group of white, European-American caregivers served as a reference group. Results show ethnicity, non-caregiving stress, and the dementia-affected elder's impairment level to predict unmet service need. The results also point to the usefulness of a new measure of non-caregiving stress in evaluating service use among minority caregivers.

The Stress of Caring for a Parent: Effects of the Elder's Impairment on an Employed, Adult Child

MARJORIE E. STARRELS Colorado State University BERIT INGERSOLL-DAYTON University of Michigan* DAVID W. DOWLER University of Michigan** MARGARET B. NEAL Portland State University*** This study examines direct and indirect effects of an elder's impairment on the caregiving stress of employed sons and daughters. Using path analysis and decomposition of variance, it examines data provided by 1,585 employees who care for a parent or parent-in-law aged 60 or older. The direct effect of impairment on stress is stronger for cognitive-behavioral problems than it is for limitations in activities of daily living. Also, there are indirect effects of impairment on caregiver stress via the amount of caregiving. Significant effects also were found for time off from work to help the elder and for the elder's assistance to caregivers. Key Words: caregiver stress, elder care, employed caregivers, elder impairment, parent-child relations, work. Adult children's provision of care to their aging parents is becoming an increasingly important issue as we approach the 21st century. Demographic shifts and cultural norms (e.g., the aging of the population, fewer children per family and childbearing at later ages, greater geographical dispersion of families, and more participation in and commitment to the labor force among middle-aged women) have resulted in compelling dilemmas involving the care of parents. Gorey, Rice, and Brice (1992) reviewed 17 studies that addressed the prevalence of elder-care responsibilities among employees. On average, from one fifth to one quarter of employed family members reported providing care to an older dependent. After implementing statistical controls to adjust for response rates and variability in operational definitions of elder care, Gorey and colleagues estimated that from 7% to 12% of employees have elder-care responsibilities. In addition, Stone, Cafferta, and Sangl (1987) found that, based on data from the Informal Caregivers' Survey, 31% of all caregivers were employed (44% of daughters and 55% of sons). For employed adults, conflicts among jobs, parent care, and other family responsibilities can be stressful. In view of these challenges, it is important to analyze more closely the factors that inhibit or exacerbate the stress often experienced by employed adult children due to their caregiving role. Although there is a sizeable literature addressing the nature and extent of stress outcomes for caregivers of elders (see Walker, Pratt, & Eddy, 1995), there has been limited, albeit growing, attention to the subpopulation of employed family members who provide care to an older person. This group is significant because of its increasing size, as well as the unique role conflicts and constraints that may be experienced by its members. Indeed, employment is generally considered to increase caregivers' vulnerability to caregiver burden, physical fatigue, depression, and other indicators of physical and emotional stress (Brody, 1990; Neal, Chapman, IngersollDayton, & Emlen, 1993; Steuve & O'Donnell, 1989). Building on previous research, this study focuses on the relationship between an elder's impairment and caregiver stress. Previous studies are inconsistent with regard to the effect of the elder's level of impairment on caregiver stress (Dura, Haywood-Niles, & Kiecolt-Glaser, 1990; Miller,1990a, 1990b; Pearson, Verma, & Nellert, 1988). Furthermore, most studies do not consider the indirect effects, as well as direct effects, of the elder's impairment. Therefore, our study contributes to the literature by examining the direct and indirect effects of elder impairment on the stress outcomes of employed daughters and sons who are providing care to their parents and parents-in-law. Previous studies have distinguished between two kinds of impairment: physical impairment and cognitive-behavioral problems. Physical impairment typically involves difficulty in accomplishing activities of daily living or instrumental activities of daily living-difficulties that result from limitations in ambulatory capacity and other basic physical functioning. …

Care-related decision-making satisfaction and caregiver well-being in families caring for older members.

Families provide care and make decisions regarding care within the context of specific structural characteristics and the broader family environment. This research analyzes data from 244 adult child and spouse caregiver interviews. It examines the impact of structural variables (e.g., caregiver type, elder impairment) and family environment (adaptability, conflict, cohesion) on satisfaction with care-related decision making and caregiver well-being. Regression analysis results indicate that aspects of family environment such as adaptability and conflict are the best predictors of decision-making satisfaction are the best predictors of caregiver depression.

Women in the Middle: A Myth in the Making?

In the past decade, a body of literature has evolved around the concept caregiving the (Brody, 1981, 1990). Women midlife who are primary caregivers for older relatives are defined as in the of stressful lifestyles that may include employment, housework, and care of dependent children (Brody, 1981, 1990; Horowitz, 1985; Noelker & Wallace, 1985; Soldo & Myllyluoma, 1983; Stueve & O'Donnell, 1989). Researchers, practitioners, and lay people acknowledge that caregiving is stressful (George, 1990; Zarit, 1989). Further, research continually shows that most primary caregivers to older people are women (e.g., Coward & Dwyer, 1990; Stone, Cafferata, & Sangl, 1987). The degree to which this situation is problematic for caregiving women may not be as grave as some have argued (Spitze & Logan, 1990). There are several reasons--demographic and methodological--for questioning the extent of the problem of women the middle. First, some research has concentrated on whether the situation of women the middle is normative the general population (Spitze & Logan, 1990). These authors argue that the situation defined as women (or men) the middle is not typical of middle-aged persons the United States. That is, the situation of women being the middle is not normative. Similar findings have been reported for middle-aged women Canada (Rosenthal, Matthews, & Marshall, 1989). These authors find, for example, that when women are caring for frail parents, they and their parents tend to be older. Therefore, only a small proportion of women who are providing care to older relatives also have dependent children. Second, several aspects of caregiving women's lifestyles have not been directly examined. For example, there is an assumption that caregiving for dependent parents or children is always stressful, even though comparisons of caregiving and noncaregiving populations are generally not made (George & Gwyther, 1986). Research shows that more caregiving demands (i.e., greater elder impairment, more caregiving tasks performed) are associated with greater caregiver burden or strain (see George, 1990). But how strained is strained? That is, demonstrating a positive, linear relationship between, say, elder impairment and caregiver strain does not indicate the degree to which people are strained, only that as elder impairment increases, caregiver strain also increases. Some researchers suggest that the competing demands of parent care, child care, and employment lead to greater levels of caregiver stress (Older Women's League, 1989; Stone, Cafferata, & Sangl, 1987). The point usually made is that a higher number of demanding situations is more stressful. Because certain proportion of women are caring for older relatives and have dependent children and/or are employed, it is thought that they must be experiencing greater stress because of these multiple or competing demands. The link between these multiple roles and stress is assumed, not demonstrated. Third, some researchers find that care of children exacerbates the stress for women the middle (Rosenthal, Matthews, & Marshall, 1989). Others show that caregivers whose household size is largest describe a pattern of increasing support over time (Clipp & George, 199O, p. S-106). Yet, the relationship between the presence or number of children within a household and caregiver stress or well-being has not been analyzed. The type of living arrangement (shared versus separate), however, has been found to be a important factor affecting caregiver strain (Soldo & Myllyluoma, 1983; Tennstedt & McKinlay, 1989). Adult children caregivers sharing the same residence with care recipients report greater strain or depression than those who live apart from the recipient. Often, the elders' greater impairment prompts the shared living arrangement. In other cases, the increased contact shared living arrangements may lead to increased strain Noelker & Wallace, 1985). …

The Nature of Elder Impairment and its Impact on Family Caregivers' Health and Psychosocial Functioning

This study assessed the nature of elder impairment and its impact on the health and psychosocial functioning of family caregivers. All caregivers were daughters or daughters-in-law living with an elderly parent. Contrary to expectations and previous research, no differences were revealed among caregivers of cognitively impaired, functionally impaired, and nonimpaired elderly relatives in terms of self-reported health or psychosocial functioning. Thus, other aspects of the caregiving context, such as familial generation, gender, and living arrangement, may affect caregiver health and psychosocial functioning more than the nature of the elder's impairment.

The Impact of Elder Health, Caregiver Involvement, and Global Stress on Two Dimensions of Caregiver Burden

This study examined the simultaneous effects of an elder's health, caregiver involvement, and stress on caregiver burden, addressing the questions: (a) What are the direct and indirect effects of level of elder's impairment, caregiver involvement, and stress on personal and interpersonal burden? (b) How do these relationships differ between spouse and adult-child caregivers? Data were from the 1982 National Long Term Care Survey. Results using linear structural relations analysis showed the effect of a frail elder's health and functioning on personal and interpersonal burden is mediated by task involvement and perceived global stress. Contrary to expectation, there were few differences in the direct effect of each dimension of health, functional limitations, cognitive status, and global health rating on each dimension of burden. Although the results suggested mean differences between spouse and adult child caregivers on key variables, there were no differences by family relationship in the system of relationships that comprise the process linking health and burden.