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[edit] Caring for the Aging Parent

Caring for an aging parent is a topic many adult children may be familiar with. As the public services and long term care facilities are reaching maximum capacity, due to the growing population of older adults, family support and home based care options are becoming more popular. This means that there is an increasing expectation that adult children will take on the responsibilities of caring for their aging parents^[1]. As a result caregivers may experience the burden of caring for their aging parent, along with potential conflicts between family members regarding decision making. Often there are gender differences among those caring for an aging parent due to differences in social roles and demands such as work, and other responsibilities. There are several coping strategies available to help caregivers effectively deal with the stresses of caring for an aging parent. Some of these strategies include community services and counselling. Utilizing these services may help alleviate the stresses associated with caregiver burden and gender differences in order to make caring for an aging parent more manageable.

[edit] Caregiver Burden

[edit] Definition

Becoming a caregiver for an aging parent involves major changes for all people who are involved. There are a range of physical, social, financial and emotional changes. In order to maintain a mutually giving and loving relationship with your parent as you care for them, it is important to learn to cope with these changes in a healthy way. Often times, caring for an aging parent is associated with high levels of stress and caregiver burden. Caregiver burden refers to high levels of stress and fatigue that are experienced by people who are taking care of another person, usually a family member, who is stricken with some kind of illness and can apply to adult children who are taking care of their parents simply because they can no longer care for themselves^[2]. When caring for a person with a chronic illness one may experience loss of intimacy or close friends, financial strain and the pressure of dealing with that person’s symptoms^[2].

[edit] Burden Involved When Caring for Those with Age-Related Complications

[edit] Alzheimer's Disease and Stroke

Research has shown on the issue of caregiving for parents and family members that have been diagnosed with Alzheimer’s disease^[3] or that have experienced a stroke^[4]. The role of a caregiver for a person that is chronically ill can differ dramatically from that of a healthy older individual. It has been confirmed that an illness such as Alzheimer’s disease can place burdens on both the person living with the disease and his or her caregivers as well^[5]. Negative health effects have been confirmed for the caregivers of persons living with Alzheimer’s disease^[5]. The financial, psychological, social and physical pressures dealt with by caregivers negatively affect their quality of life. Black et al.(2010) found that more caregiver burden was experienced by live-in caregivers than by caregivers that did not reside with the person that they were taking care of^[5].

Although little is known about the combined life satisfaction of both the caregiver and the parent being cared for, some researchers find that this is an important area of interest. Bergstrom et al. (2001) found that relationships between stroke victims and their caregivers that expressed discordant life satisfaction placed themselves more at risk for negative caregiver burden^[6]. It appears that the perceived level of positive rehabilitation and the successful completion of everyday tasks played a role in the life satisfaction ratings both the stroke victim and the caregiver^[6]. Information and knowledge pertaining to this issue has clinical benefits which will help to identify caregiver-stroke victim dyads who are more vulnerable to caregiver burden and discordant or disagreeing life satisfaction^[6].

[edit] Depression

National data indicates that older adults who show depressive symptoms receive additional hours of physical assistance from several of their family members^[7]. Research has shown that late-life depression can be treated with antidepressant medications^[7]. There are several benefits to depression treatments which include lowering physical disability, improved mood and better social adjustment^[7]. There is a large impact felt by the caregiver who is dealing with a parent who is stricken with late-life depression. When being treated for depression with antidepressant medications, the caregiver burden is alleviated and both parties begin to feel a sense of relief. In addition to antidepressant medications, caregiver support and education can help to strengthen these positive effects^[7]. The severity of a patient’s depression also plays a role in the level of caregiver burden. With the successful treatment of a parent’s chronic illness,like depression, caregiver burden is alleviated to some degree^[7]. Treatment options can range from therapy groups, family and self, medication, rehabilitation services and social work^[8].

[edit] Ways to Alleviate Caregiver Burden

Caregiver stress relief can be accomplished by implementing direct services to the caregiver, supplying food or meals to the caregiver, providing house cleaning services or making transportation and medical equipment more readily available^[8]. Such services are often available to caregivers, but often times funding is not available to caregivers, and they cannot afford to have such services ^[8]. Management of household chores, finances and medical services are things that caregivers are forced to deal with. Researchers Empen et al. (2010) clearly outline the importance of offering services to caregivers who feel they need help when dealing with their aging parent or family member^[8]. The researchers concluded that offering services such as supplying food or meals to the caregiver, providing house cleaning services or making transportation and medical equipment more readily available, could help to reduce the use of respite services, which provides temporary relief for those who are currently taking care of the aging individual by placing that individual in a facility outside of the home etc., and to reduce caregiver stress. Researchers also outline the importance of asking for help from others in times of need in order to help caregivers cope more effectively with their own issues and stress^[8].

This video helps in training caregivers to properly deal with the duties they are faced with when having to take care of their aging parent whether they are ill or simply not able to take care of themselves. It elaborates on methods of dealing with caregiver burden and explains useful coping strategies.

[edit] Providing Support: 5 Tips for Dealing with Caregiver Burden

• 1. Put your health first: Your continued well-being is an integral part of your loved one's long-term care plan. Remember: the decision to care for yourself isn't just for your own sake -- your loved one needs you to be at your best.^[9]
• 2. Educate Yourself: Try to consider your self-education as a caregiver an ongoing pursuit.Knowing what can -- and can't -- be changed about the situation will help you avoid burnout.^[9]
• 3. Get Help: No matter what you think you can or should do, the truth is you cannot bear the entire responsibility for providing care for a disabled loved one. ^[9]
• 4. Learn Coping Strategies: Make time to connect with a friend, confidante, counselor or spiritual advisor. Sometimes just having someone listen is more important than what's actually being said.^[9]
• 5. Be realistic: Taking care of someone is an especially difficult task. Accepting that you'll have many hard days can make all your days a little more manageable.^[9]

[edit] Gender Differences

Many adults will need help as they grow older and there is an increasing expectation that adult children will take on the responsibilities of caring for their aging parents^[1]. Past research has shown that children of aging parents are the most prominent carers, after spouses, and the amount of children who are taking on care giving responsibilities is growing ^[10] . Furthermore, there are gender differences among spouses and siblings taking care of their aging parents, with research showing that women more often than men tend to be the primary caregivers to their parents ^[10].

[edit] Gender Differences in Caregiving Between Husbands and Wives

An abundance of research has shown that females provide more care for their aging parents than males do ^[11]. Hammer and Neal (2008) looked at the division of labour distributed amongst husbands and wives in caring for an aging parent. They found that wives dedicated considerably more hours per week, on average, to providing care to a parent than their husbands. To explain, on average, women spent approximately 6.8 hours per week, compared to their husbands, who spent approximately 5.1 hours per week ^[12].

[edit] Gender Differences in Caregiving Between Siblings

There has also been a large quantity of research conducted on daughters providing home based care for their aging parents. Previous research has shown that daughters are much more likely than sons to act as primary caregivers for an aging parent ^[10]. Studies indicate that daughters complete more household work as well as personal care for their parents. Some studies propose that as the parent becomes older and more dependent, the son is more likely withdraw from care giving responsibilities, which leaves the daughter with the caregiving duties ^[10]. Romoren (2003) indicated that women were most likely to provide care for againg parents, as 36% of caregivers were daughters, 9% were sisters, 8% were nieces, 7% daughters-in-law, while 9% were spouses and only 19% were sons. More women in this study also reported living with the aging parent. Research has also shown that duration of care is three times higher for daughters than sons^[10]. Women usually take on the primary caregiver role, which includes routine care. Primary caregivers provide regular assistance and include their care giving duties in their daily routines. Men are more commonly back up care providers or absent providers, meaning they only provide occasional, sporadic care, or none at all ^[1].

The above video discusses the important issues concerning siblings caring for an aging parent. Unfortunately inequities regarding the division of care for the aging parent can result in huge conflict among siblings. Home Instead Senior Care, as discussed in the video, has developed the 50/50 Rule to help families plan and effectively care for their aging parents.

[edit] Sharing the Care

The 50/50 Rule was designed to help adult children and their parents deal with the sensitive issues that arise while parents age and their needs begin to change. The program outlines ways siblings can divide the workload and build teamwork among family members to avoid conflict and family tensions^[13]. It is important for adult children to communicate with each other as well as their parents in order to make important decisions regarding care. While sharing may not always be easy for siblings to do, the 50/50 Rule provides tips to help caregivers plan ahead, work together, and share the responsibilities of caring for their aging parent^[13]. Below are tips for siblings on how they can better share the care:

• 1. Talk and Listen: it is important to communicate effectively, preferably before issues of caring for an aging parent occur^[13].
• 2. Research Options: identify services available and discuss these possibilities with siblings. It is important to divide tasks so everyone has the opportunity to share their ideas ^[13].
• 3. Plan Ahead: once needs and resources are identified divide duties among siblings ^[13].
• 4. Be Flexible: the needs of the senior and the caregiver will change. Instead of insisting that all duties be distributed equally, divide labour based on siblings skills and availability ^[13].
• 5. Be Honest: if the duties of being a caregiver get to be too much, tell your siblings anf figure out a way to redistribute responsibilities ^[13].

[edit] Explanations for Gender Differences in Caregiving

Researchers have also investigated the reasons for these differences among men and women when it comes to caring for an aging parent. These differences include employment status, number of hours worked each week, as well as the parent-child relationship ^[1]. Romoren (2003) suggested that differences included a higher proportion of men than women owning their own business. Therefore men had more work responsibilities and less time to help support an aging parent. Additionally, men worked, on average, more hours per week than women, 49.5 hours compared to 38 hours, respectively, therefore women had more time to dedicate to caring for the aging parent ^[12]. Previous studies have also shown that the bulk of the responsibilities are often held by one sibling, and this can create stress and tension among family members ^[1]. Some explanations for one sibling taking on the majority of the resposibilties include relationships between family members, geographical location, other responsibilities, personality, health and socioeconomic status, as well as gender. It has also been suggested that “sibling network composition will affect which children are likely to provide assistance to an aging parent” ^[14]. This idea suggests that daughters take on a more proactive role in care giving because they were socialized that way. Another possible explanation provided for these findings is that culturally, parents have lower expectations when it comes to obtaining care from their sons than from their daughters ^[10].

[edit] Hypotheses of Family Labour

Finley (1989) describes caregiving to aging parents as a form of family labour and discusses four hypothesis of family labour, the first being time-available hypothesis. This theory asserts that the determination of time available for family care is based on our competing time and role demands. According to this model, women have more time available to care for an aging parent. ^[11]. The second theory is called the socialization/ideology hypothesis which states that our attitudes about gender roles are learned during socialization, and this influences the division of care. Traditionally, women have been socialized to take on the feminine role which includes kin keeping and family care responsibilities, which explains why more women than men take on the responsibilities of caring for an againg parent. ^[11]. The external-resources hypothesis assumes that resources gained externally, such as education and income, determines the family dynamics. That being said, those who hold the most power in the family tend to provide the least amount of care. According to this model men usually hold the most power in families and therefore have less time to care for an aging parent. Finally, the specialization of tasks hypothesis states that men and women assume different duties within the family to maximize the wellbeing of the family unit ^[11]. In this model, women assume the role of the caregiver, it is also suggest that men and women help their aging parents in different ways. Males more often provide financial support, whereas women are more likely to provide emotional support, as well as daily living support ^[11].

[edit] Coping Strategies

Coping with caring for an aging parent can be difficult to do, especially if the parent being cared for is ill. It is very important to remember that while taking care of an aging parent, it is vital that caregivers find ways to cope with the stress and frustration that may accompany caring for their parent^[15]. If caregivers neglect themselves, then the care they provide their parent may become compromised. Studies have shown that there are certain coping strategies that are effective in managing the stress of caring for an aging parent. these strategies focus on both mental and emotional changes, as well as using services designed to ease the strain of being a caregiver for the elderly.

[edit] Issues Concerning Caregiver Burden

Caregiver burden is a serious situation in which the person caring for their aging parent feels the stress of the responsibility associated with the care. This often affects a person on more than an emotional level^[15]. It often affects their physical health and well being as well. The caregivers often do not take care of themselves when they are sick or tired,^[15] they are less likely to be physically active,^[16] and many do not engage in the same activities they used too. This leads to them to take more antidepressant and anti-anxiety medications to cope with the ‘burden’ of caring for their aging parent, compared to average people that are not caring for an elderly parent.^[17] For this reason, caregivers should take advantage of the many services offered to assist with caring for their parents.

[edit] Community Services

There are many services that cater to the needs of the elderly, whether or not they are suffering from illness. One of the services that many cities offer is a community care program. These programs offer many services to ease the strain placed on caregivers. Many of them offer home care, geriatric services, mental health services, and respite services, which provides caregiver relief. Home care programs are geared towards people that require help in their day-to-day living, especially with bathing and dressing themselves, along with, for example, getting their breakfast ready. The respite services comprise of day programs. This way the caregiver has time to do things for themselves or their families, such as run errands, and have a break from caring for their aging parent. These programs are a relief to caregivers that have busy lives of their own, especially if they have families and careers to worry about on top of caring for their aging parent.^[18] Another helpful service that the elderly, and therefore their caregivers, benefit from is Meals on Wheels. Meal delivery services are available to deliver a full day's worth of meals to a person, at specific meal times, if the person is unable to cook for him or herself. It is an enormous weight off of a caregiver’s shoulders when they are assured that their parent is eating regular meals.^[19]

[edit] Medical Care

Another service offered to assist in the caring of the elderly is initiated by pharmacies. Often seniors need medication daily, yet they are either unable to pick it up from the pharmacy on their own or cannot remember how many times a day they are supposed to take their medication. Many pharmacies have a home-delivery service available and will also package the medication specific to the number of times per day it must be taken. This is a small task, yet it can be a major inconvenience for a person caring for their aging parent to have to remind their mother or father to take their medication, especially when these medicines must be taken numerous times per day. Help from the pharmacy in this context, similar to the meal delivery program, can leave the caregiver feeling comforted that their parent is staying on top of their health, without them having to remind their parent each day.^[20]

Speaking to a counselor can help alleviate stress

[edit] Counseling

Another way for a person to cope with the stress of taking care of their parent is by attending support groups with other people that are experiencing the same situation. This is a place for the caregiver to share their frustrations, and ask any questions they may have about services or problems they may be having with their parent’s health care.^[21] People can also share resources and information about home health care and anything related to caring for an aging parent. This is an excellent resource for people that are new to caring for their parent, since they probably have many questions and concerns.^[22]

[edit] Self-Help Coping Strategies

A study was done examining coping strategies used by caregivers of aging parents^[23]. There were three main self-help coping strategies identified. The first was referred to as ‘structural role redefinition’. This means working with the people in one’s life to change each person's roles slightly, in order to work around the schedule of taking care of a parent^[23]. The second strategy was ‘personal role redefinition’, which referred to a caregiver’s own values and changing the way they perceive them to fit their roles and lifestyle. The third strategy identified was ‘reactive role behaviour’, which refers to trying hard to meet role expectations. These coping strategies deal with both physical and emotional issues a person might encounter when caring for an aging parent.^[23] Each of these coping methods is beneficial on their own, and are even more effective when combined. Caregivers can use these methods to actively improve their personal well-being in order to cope with the stress and conflicts associated with caring for their aging parent.^[24]

[edit] Conclusion

There are an abundance of services and programs offered for the elderly for caregivers to take advantage of. They range from home care and day programs to providing nutritious meals and medical needs. For the emotional needs of the caregiver there are support groups as well as self-help coping strategies that involve changing the mental framework of the caregiver to a more positive state of mind. All of these coping strategies are very beneficial for the well-being of both the aging parent and the caregiver, and utilizing the strategies will ensure that the process of caring for an aging parent is less of a burden than it may have been once before. These strategies are effective for alleviating the negative effects of caregiver burden and gender differences that arise between siblings and spouses.

[edit] Notes and References

1. ↑ ^{1.0 1.1 1.2 1.3 1.4} Leinonen, A. (2011). Adult children and parental care-giving: Making sense of participation patterns among siblings. Aging and Society, 31, 308-327.
2. ↑ ^{2.0 2.1} Akpicar, B., Kucukguclu, O., Yener, G. (2011). Effects of gender on burden among caregivers of alzheimer’s patients. Journal of Nursing Scholarship,43(3), 248-256
3. ↑ Alzheimer’s disease. In Wikipedia. Retrieved October 25, 2011, from http://en.wikipedia.org/wiki/Alzheimer%27s_disease
4. ↑ Stroke. In Wikipedia. Retrieved October 25, 2011, from http://en.wikipedia.org/wiki/Stroke
5. ↑ ^{5.0 5.1 5.2} Black, S. E., Gauthier, S., Dalziel, W., Keren, R., Correias, J., Huong, H., & Binder, C. (2010). Canadian Alzheimer’s disease caregiver survey: Baby-boomer caregivers and burden of care. International Journal of Geriatric Psychology, 25, 807-813.
6. ↑ ^{6.0 6.1 6.2} Bergstrom, A. L., Eriksson, G., von Koch, L., & Tham, K. (2011). Combined life satisfaction of persons with stroke and their caregivers: Associations with caregiver burden and the impact of stroke. Health and Quality of Life Outcomes, 9, 1-10.
7. ↑ ^{7.0 7.1 7.2 7.3 7.4} Martire, L. M., Schulz, R., Reynolds, C. F., Karp, J., F., Gildengers, A. G., & Whyte, E. M. (2010)Treatment of late-life depression alleviates caregiver burden. The American Geriatrics Society, 58, 23-29.
8. ↑ ^{8.0 8.1 8.2 8.3 8.4} Empen, J., Raming, N. T. J., Irwin, S. A., Nelesen, R. A., & Lloyd, L. S. (2010).The hospice caregiver support project: providing support to reduce caregiver stress. Journal of Palliative Medicine, 14(5), 593-599.
9. ↑ ^{9.0 9.1 9.2 9.3 9.4} Scheve, T. (2009). 5 Tips for dealing with caregiver burden. How Stuff Works. Retrieved from http://health.howstuffworks.com/wellness/aging/elder-care/5-tips-for-dealing-with-caregiver-burden.htm
10. ↑ ^{10.0 10.1 10.2 10.3 10.4 10.5} Romoren, T. (2003). The carer careers of son and daughter primary carers of their very old parents in Norway. Aging and Society, 23, 471-485.
11. ↑ ^{11.0 11.1 11.2 11.3 11.4} Finley, N. (1989). Theories of family labour as applied to gender differences in caregiving for elderly parents. Journal of Family and Marriage, 51(1), 79-86.
12. ↑ ^{12.0 12.1} Hammer, L.,& Neal, M. (2008). Working sandwiched- generation caregivers: Prevalence, characteristics, and outcomes. The Psychologist-Manager Journal, 11, 93-112.
13. ↑ ^{13.0 13.1 13.2 13.3 13.4 13.5 13.6} The 50/50 Rule. Retrieved on November 25, 2011 from http://www.caregiverstress.com/wp-content/uploads/2011/08/The-50-50-Rule-Helping-Siblings-Overcome-Conflict.pdf.
14. ↑ Coward, R.,& Dwyer, J. (1990). The association of gender, sibling network composition, and patterns of parent care by adult children. Research on Aging, 12(2), 158-181. .
15. ↑ ^{15.0 15.1 15.2} Kiecolt-Glaser, J, K; Glaser, R; Gravenstein, S; Malarkey, W, B; Sheridan, J. 1996. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proceedings of the National Academy of Sciences of the United States of America. ,93, no. 7: 3043-7.
16. ↑ Bookwala, J., Fleissner, K., O'Brien, A. T., & Schulz, R. (1995)Psychiatric and physical morbidity effects of dementia caregiving: prevelance, correlates, and causes. Gerontologist, 35(6), 771-791.
17. ↑ Martire, L. M., Keefe, F. J., Schulz, R., et al. (2006). Older spouses' perceptions of partners' chronic arthritis pain: Implications for spousal responses, support provision, and caregiving experiences. Psychology and Aging, 21, 222-230.
18. ↑ Community Care Durham. Retrieved from http://www.communitycaredurham.on.ca/about.html
19. ↑ Meal Call. Retrieved from http://www.mealcall.org/cgi-sys/suspendedpage.cgi
20. ↑ Shops on Avenue. Retrieved from http://www.shopsonavenue.com/soa_1623
21. ↑ Caring.com. (2011). A caregiver's guide to home healthcare after hospital discharge. Retrieved from http://www.caring.com/articles/guide-to-home-healthcare-after-hospital-discharge?utm_medium=email&utm_source=suggests&utm_campaign=eol&utm_content=20111002
22. ↑ Daily Strength. (2011). Caring for aging parents support group. Retrieved from http://www.dailystrength.org/c/Caring-For-Aging-Parents/forum/12966325-caregivers-guide-home
23. ↑ ^{23.0 23.1 23.2} Hall, D. T. (1972). A model of coping with role conflict: The role behavior of college educated women. Administrative Science Quarterly, 17, 471–486.
24. ↑ Riley, L., & Bowen, C. (2005). The sandwich generation: Challenges and coping strategies of multigenerational families. The Family Journal, 13(1), 52-58.