Late-life Families Research Articles

PROJECT, PERSUADE, AND PROTECT: ADULT CHILDREN’S PREDICTION OF PARENTS’ HEALTH STATE VALUATIONS

Abstract Serious illness decision making for older adults frequently involves their adult children. Thus, it is important that adult children are familiar with parents’ illness preferences. In this mixed methods analysis (total N = 114), we examined concordance between older adults’ valuations of illness states, their children’s predictions of their valuations, reasoning behind children’s predictions, and children’s reactions to discordance between their predictions and parents’ valuations. Thirty-eight older parents (M age= 75.8) provided valuations for five different illness states. Two adult children (M age= 46.0) independently predicted their parent’s answers. Family triads participated in a semi-structured conversation about their responses. One-way random effects, absolute agreement, average measures intraclass correlation coefficients (ICCs) showed that average concordance within families was poor for incontinence (ICC = .172, 95% CI [-.497, .572]), dialysis (ICC = .300, 95% CI [-.264, .639]), tube feeding (ICC = .320, 95% CI [-.228, .649]), and chronic pain (ICC = .438, 95% CI [-.015, .710]), and moderate for Alzheimer disease (ICC = .556, 95% CI [.198,.771]). Results from qualitative thematic analysis indicated that children often projected their own values when attempting to predict parents’ valuations. When faced with discordance, many children attempted to persuade parents to change their valuations, while also making assertions to protect the parent’s autonomy. In summary, adult children navigating surrogate or shared decision making may face challenges inferring parent values versus their own and balancing their input with parent autonomy. Future research and interventions in late-life families could target these challenges.

WITHIN-PERSON ASSOCIATIONS BETWEEN MARITAL DISSOLUTION AND SUBSEQUENT COGNITIVE FUNCTION IN MIDDLE AND LATER LIFE

Abstract In light of the growing burden associated with cognitive impairment and dementias on families and society accompanied by the dramatic shifts in late-life family demography, there is growing literature focusing on the relationship between marital biography and cognitive outcomes in middle and late adulthood. This study aimed to contribute to the literature by examining within-person linkages between cognitive outcomes associated with two forms of marital dissolutions experienced in later life—divorce and widowhood. Framed around the key concepts of the life course perspective, we examined within-person changes in cognitive function associated with divorce and widowhood transitions in middle and late adulthood. Drawing from 11 waves of longitudinal data from the Health and Retirement Study (1998-2018), we followed over twenty-three thousand married individuals 50 and older over the study period that spanned nearly two decades (person-wave observations N=128,033). Cognitive function at each wave was evaluated using a modified version of the Telephone Interview for Cognitive Status (m-TICS). Research aims were addressed using within-between random effects models that yielded within-person estimates unconfounded by person-level characteristics. Approximately 4.4% and 17.7% of the study sample experienced divorce and widowhood transitions during the observation period. The model results indicated that divorce transitions were unrelated to changes in cognitive function. Cognitive outcomes associated with widowhood transitions were heterogeneous for women and men, where women who transitioned to widowhood experienced increases in cognitive function, whereas men experienced reductions in cognitive function. These findings are discussed in the context of implications for practice and policy.

Rewriting the Story of Mid- and Late-Life Family Caregiving: Applying a Narrative Identity Framework.

Family caregivers of older people with health needs often provide long-term, intensive support. Caregivers are, in turn, shaped by these caregiving experiences. According to the narrative identity framework, self-narratives from lived experiences influence self-beliefs and behaviors. We assert that family caregiving experiences, filtered through individuals' memory systems as self-narratives, provide substantial scaffolding for navigating novel challenges in late life. Self-narratives from caregiving can guide positive self-beliefs and behaviors, leading to constructive health-focused outcomes, but they also have the potential to guide negative self-beliefs or behaviors, causing adverse consequences for navigating late-life health. We advocate for incorporating the narrative identity framework into existing caregiving stress models and for new programs of research that examine central mechanisms by which caregiving self-narratives guide self-beliefs and behavioral outcomes. To provide a foundation for this research, we outline 3 domains in which caregiving self-narratives may substantially influence health-related outcomes. This article concludes with recommendations for supporting family caregivers moving forward, highlighting narrative therapy interventions as innovative options for reducing the negative consequences of maladaptive caregiving self-narratives.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population.

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

INTERGENERATIONAL PERCEPTIONS OF FAMILY DYNAMICS AMONG OLDER PARENTS AND ADULT CHILDREN ON THE FACES IV AND SFI II

Abstract Standardized measures of family dynamics are rarely used with late-life families in either research or clinical contexts. The purpose of this study was to examine perceptions of family dynamics from the perspective of older parents and their adult children on two widely used family assessment measures. To our knowledge, no previous studies have reported data on these measures with late-life families. Within a larger project examining decision-making in late life, 34 older parents and two of their adult children (total N= 102) completed the Family Adaptability and Cohesion Evaluation Scale (FACES) IV and the Self-Report Family Inventory (SFI) II. Parents were mostly mothers (94.1%; M age= 75), but adult children included both daughters (67.6%; M age= 46) and sons (32.4%; M age= 46). For comparison with published norms, we report subscale scores on both family measures for parents and adult children. The mean intrafamily ICC (two-way, mixed effects, single rater, absolute agreement) for individual items for the FACES IV was .561 (SD= .164, Min= .128, Max= .827), and the mean intrafamily ICC on the SFI II was .422 (SD= .178, Min= .014, Max= .750). Overall, family consistency was in the poor to moderate range, but with a high degree of variability across families. Moreover, within families, parents and children had highly variable inconsistency in their perception of family dynamics. Findings from this study provide insight as to how established measures function in late-life families, and they highlight the importance of assessing multiple family members in order to understand family dynamics.

Families in Later Life: A Decade in Review.

Later-life families encompass the legal, biological, romantic, and kin-like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an acceptable standard of living. Shifting patterns of family formation over the past half-century have created a context in which contemporary older adults' family lives differ markedly from earlier generations. Decreasing numbers of adults are growing old with their first and only spouse, with rising numbers divorcing, remarrying, forming non-marital romantic partnerships, or living single by choice. Remarriage and the formation of stepfamilies pose challenges and opportunities as older adults negotiate complex decisions such as inheritance and caregiving. Family relationships are consequential for older adults' well-being, operating through both biological and psychosocial mechanisms. We synthesize research from the past decade, revealing how innovations in data and methods have refined our understanding of late-life families against a backdrop of demographic change. We show how contemporary research refines classic theoretical frameworks and tests emerging conceptual models. We organize the article around two main types of family relationships: (1) marriage and romantic partnerships and (2) intergenerational relationships. We discuss how family caregiving occurs within these relationships, and offer three promising avenues for future research: ethnic minority and immigrant families; older adults without close kin ("elder orphans"); and the potentials of rapidly evolving technologies for intergenerational relationships and caregiving.

Living Arrangements and Socio-Economic Conditions among Egyptian Elderly. The Determinants of Late-Life Family Structures

Egypt is facing the dual challenges of being both young and rapidly transitioning. Population structure is changing, with main effects on several dimensions of individual and social life, which include family structures and relations. We aim to analyze the conditions of the elderly and to evaluate whether or not household structures, as well as the living arrangements of the elderly, have changed in recent years. Moreover, we aim to individuate the determinants of late-life living arrangements: independent living or co-residence. Trends in late-life living arrangements and intergenerational ties derive fromthree rounds of the Egyptian Labor Market Panel Survey (ELMPS) carried out in 1998, 2006 and 2012. To assess which respondents’ characteristics are related to the individual living arrangement a multinomial regression model, where the dependent variables are represented by the household types, has been implemented in 2012 data. Men and women live the latter part of their life in different living arrangements and relationships. Moreover, findings underlined situations of poor material conditions and poor health. Data confirma need for policy interventions to meet long-term needs of the elderly, taking into account the raising trend toward living alone or in households with only elderly members. In particular, it is essential to discover the channels of intervention in the rural areas of the country to protect the elderly from poverty, as many researchers have already pointed out.

Family Caregivers of Older Adults, 1999-2015: Trends in Characteristics, Circumstances, and Role-Related Appraisal.

To assess trends in family caregiving between 1999 and 2015. We construct nationally representative profiles of community-dwelling older adults receiving help with self-care or indoor mobility and their "primary" family or unpaid caregiver using the 1999 and 2004 National Long Term Care Survey, 2011 and 2015 National Health and Aging Trends Study, and linked caregiver surveys. Trends are examined. Older adults receiving help were incrementally younger, more racially diverse, and better educated in 2015. Primary caregivers overwhelmingly continued to be spouses and adult children. Arrangements were increasingly 4 years or longer in duration (shifting from 44.8% in 1999 to 60.5% by 2015). On average, primary caregivers provided about or in excess of 30 hr per week at all four time points. Spouses provided fewer hours of care, were twice as likely to work, and half as likely to report substantial emotional, physical, and financial difficulty due to caregiving in 2015 than 1999. Adult children provided comparable hours of care to a more impaired population; a similar proportion reported substantial caregiving-related difficulty at each time. Use of respite care nearly doubled from 8.5% in 1999 to 15.7% in 2015. Dementia caregivers were less likely to report substantial physical and financial difficulty and more likely to use respite care in 2015 than 1999. Family caregivers' circumstances generally improved during the 16-year period. Results diverge from prevailing concerns regarding the state of family caregiving and demonstrate the importance of longitudinally monitoring trends in late-life family caregiving.

Praca socjalna w starzejącym się społeczeństwie

The unprecedented demographic shift to an increasingly older society will have a dramatic impact on individual choices over the life course, the structure of the family, and multiple social institutions. Social work can make unique professional contributions to older persons and the late-life family. The author document the challenges to social work and recommend addressing these challenges through innovations.

Handbook of families and aging

This comprehensive, state-of-the-art textbook and reference volume in family gerontology reviews and critiques the recent theoretical, empirical, and methodological literature; identifies future research directions; and makes recommendations for gerontology professionals. This book is both an updated version of and a complement to the original Handbook of Families and Aging. The many additions include the most recent demographic changes on aging families, new theoretical formulations, innovative research methods, recent legal issues, and death and bereavement, as well as new material on the relationships themselves-sibling, partnered, and intergenerational relationships, for example. Among the brand-new topics in this edition are step-family relationships, aging families and immigration, aging families and 21st-century technology, and peripheral family ties. Unlike the more cursory summaries found in textbooks, the essays within Handbook of Families and Aging, Second Edition provide thoughtful, in-depth coverage of each topic. No other book provides such a comprehensive and timely overview of theory and research on family relationships, the contexts of family life, and major turning points in late-life families. Nevertheless, the contents are written to be engaging and accessible to a broad audience, including advanced undergraduate students, graduate students, researchers, and gerontology practitioners. Serious lay readers will also find this book highly informative about contemporary family issues. Comprises 23 chapters of all-original work covering background information, relationships, contexts of family life, and turning points such as retirement and divorce Contributions from 46 distinguished scholars recognized as leading experts in their fields Citations for cutting-edge research on each topic, plus foundational references in new areas A detailed topic index

Relationships between parents and their adult children: a West European typology of late-life families

ABSTRACTFollowing Reher's (1998) seminal paper on family ties in western Europe, the perspective that family solidarity patterns are divided between an individualistic north and a famialistic south has dominated the literature. We challenge this view and address the variability in intergenerational family solidarity within and across countries. Using multiple dimensions of intergenerational solidarity drawn from the Survey of Health, Ageing and Retirement in Europe, we develop a typology of late-life families which is robust across northern, central and southern regions. The four types are: (a) descending familialism: living nearby, frequent contact, endorsement of family obligation norms, and primarily help in kind from parents to children, (b) ascending familialism: living nearby, frequent contact, endorsement of family obligation norms, and primarily help in kind from children to parents, (c) supportive-at-distance: not living nearby, frequent contact, refutation of family obligation norms, and primarily financial transfers from parents to adult children, (d) autonomous: not living nearby, little contact, refutation of family obligation norms, and few support exchanges. The four types are common in each European country, though the distributions differ. The findings suggest that scholars should abandon the idea that a particular country can be characterised by a single dominant type of late-life family. Socio-demographic differentials in family type follow predictable patterns, underscoring the validity of the developed typology.

Family, Know Thyself: A Workbook-Based Intergenerational Intervention to Improve Parent Care Coordination

This pilot study tested the feasibility, acceptability, and impact of a workbook-based intervention to enhance intergenerational collaboration in elder parent care coordination. Older parents and their adult children completed a written assessment of parent care needs and wishes, along with perceptions of family functioning, communication, and decision-making skills. Responses were assembled into a workbook. A facilitator led the family through a 1-hour education session, teaching skills and highlighting areas of agreement and disagreement. Post-intervention ratings suggested that families found the intervention to be informative and useful. Family members commented that the intervention prompted them to consider new issues in parent care and to discover gaps in their knowledge about parents. This type of intervention may help late-life families have important preparatory conversations about care needs and coordination.

The Influence of Osteoporosis on the Marital Relationship of Older Couples

Thirty-four older wives and their husbands participated in interviews about adaptation to the wives’osteoporosis and its influence on their relationship. For most couples, the wives’osteopo-rosis resulted in changes in the structure of their marital relationship but not the overall quality of the marriage. Discrepancies in pain perceptions were associated with lower marital adjustment for wives but not for husbands. The findings suggest the need to focus on the dynamics of the marital relationship to understand chronic illness in late-life families.

Educating Social Workers for an Aging Society

Longevity is one of the great achievements of the 20th century and its implications for the new century will be profound. The unprecedented demographic shift to an increasingly older society will have a dramatic impact on individual choices over the life course, the structure of the family, and multiple social institutions. Social work can make unique professional contributions to older persons and the late-life family. This article asserts, however, that social work is not adequately prepared to practice in the aging society. The authors document the challenges to social work and recommend addressing these challenges through educational innovations.

Reframing Dependence in Old Age: A Positive Transition for Families

This article re-evaluates the role of dependence in late-life development using concepts drawn from psychology, sociology, social work, gerontology, and scholarship on women's development. A perspective of old age as a time of continued, positive growth and change is proposed. Dependence is not a marker of decline and deterioration, but a necessary development for mutual growth and enhancement of late-life family reciprocity. Accepting dependence helps an older person maintain his or her competence, autonomy, and self-esteem. The process of dependence as growth promoting is discussed and illustrated with case examples.

Decision-Making Influence Strategies of Caregiving Daughters and Their Elderly Mothers

Elderly people receive significant amounts of advice from their adult children (Keith, 1983), and families are actively and centrally involved in decision making about elders' care and lives (High, 1988; Hooyman & Lustbader, 1986; Lynne, 1988; Moody, 1985; Pratt, Jones, Shin, & Walker, 1989; Pratt, Schmall, & Wright, 1987). Many professionals, including counselors and health and social service providers, often work with aging families at decision points. Problem solving and decision making are frequently the focal issues in family counseling and consultation with aging families. In addition, improved family problem solving and decision making are important goals in many aging family caregiver education programs (Hooyman & Lustbader, 1986). This work can benefit from these professionals' understanding the nature of decision-making interactions in late life families.

Trends in Family Gerontology Research

This paper reviews and critiques recent research on family relationships of the elderly. It summarizes findings about the interactions of older adults with their spouses, children, siblings, and grandchildren, and the connection between families and community services for the elderly. Finally, it presents implications for practitioners and researchers who focus their work on late life family issues.

Delayed Career Entry, Industrial Pension Structure, and Early Retirement in a Cohort of Unmarried Women

The effects of early family and work patterns and industrial pension structures on the timing of retirement among unmarried women are examined within a life course perspective. The retirement process is viewed in a longitudinal framework with similar combinations of factors influencing successive stages of final withdrawal from work. Logistic regression techniques are applied to data from a panel of unmarried women workers of retirement age to predict early versus late retirement over a five-year period. Having children and delayed career entry along with late life family, pension, and health status affect retirement schedules.