Family Caregiving for Elders

Prevalence

Family caregiving refers to the provision of assistance to a physically and/or cognitively impaired older adult by family members. It includes personal care, help with household tasks, health care assistance, monitoring, coordinating service use, and emotional support (in combination with other assistance). In Western countries, adult children and spouses provide most informal care to older adults. According to the 1997 National Family Caregiver Survey, nearly 1 in 4 U.S. households was involved in caring for an individual 50 years and older at some point during the previous year, and 17.5% were currently involved in caregiving. About 73% of caregivers were women, and 64% were employed. They spent on average 18 hours per week on caregiving and had been providing care for about 4.5 years (National Alliance for Caregiving, 1997). Most informal care is provided by adult children, primarily daughters and daughters-inlaw, and by spouses.

Caregiving Motives and the Process of Becoming a Caregiver

Although it is difficult to predict whether and under which circumstances care needs may occur, attitudes and feelings regarding caregiving often emerge before people decide whether and how to provide support. Blenkner (1965) has presented an idealized image of “filial maturity” as a unique developmental challenge of adult children in which they come to recognize the parent as an individual with personal needs and goals apart from the parenting role, resulting in willingness to assume a caregiving role for the parent. However, many adult children and spouses worry about the extent of future help that might be called for by their aging parents or spouses and whether they would be able to manage this burden. Providing care may be motivated by discretionary reasons, such as affection, closeness, and enjoyment of the relationship, as well as by family or social obligation and perceived lack of alternative sources of care. Although both groups of motives increase the probability of care provision, discretionary motives are associated with lower levels of psychological distress for caregivers, whereas the reverse is true for the obligation motive (Cicirelli, 1993).

The trajectory of becoming a caregiver usually begins with a general awareness of aging of the older adult and progresses to the recognition of concrete health problems and then to actual care provision. The amount of care provision increases with declining health of the care recipient. Caregiving for chronically ill older adults ends with institutional placement or bereavement, although some caregivers continue to provide care while the care receiver is institutionalized, and some provide care for other older adults (caregiver careers).

Effects of Caregiving

Caregiving for older adults has important consequences for the psychological health and the general [Page 449]well-being of caregivers. The overall impact of physical, psychological, social, and financial demands of caregiving has been termed caregiver burden, which can be further differentiated into objective and subjective burden. Objective burden involves primary stressors, including having to manage the caregiver's physical, cognitive, and behavioral changes, and secondary stressors, such as having less time for the family, friends, work, vacations, hobbies, or leisure activities and experiencing financial hardship (National Alliance for Caregiving, 1997). For example, in the National Family Caregiver Survey, 54% of care-givers had to make work-related adjustments, and among those with the highest caregiving demands, 30% gave up working. The demands of caregiving are higher in dementia caregivers than in caregivers for physically frail older adults: Dementia caregivers spend more hours per week providing care and report greater employment problems, reduced time for leisure and other family members, and high levels of distress due to recipients' behavior problems (e.g., aggressiveness, wandering).

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