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From Aging Wiki 09

Caring for the Aging Parent

Contents 1 Caregiver Burden 1.1 Definition 1.2 Gender Differences 1.3 Alzheimer's Disease and Stroke 1.4 Treatment 1.5 Providing Support 1.6 5 Tips for Dealing with Caregiver Burden 2 Gender Differences 2.1 Gender Differences Between Husbands and Wives 2.2 Gender Differences Between Siblings 2.3 Why These Differences Exist 2.4 Hypotheses of Family Labour 3 Notes and References

Caregiver Burden

Definition

Caregiver burden refers to a high level of stress and fatigue that is usually experienced by people who are taking care of another person, usually a family member, who is stricken with some kind of illness^[1]. When caring for a person with a chronic illness you may experience loss of intimacy or close friends, financial strain and the pressure of dealing with that person’s symptoms^[1].

Gender Differences

It appears that there is a gender difference apparent when dealing with caregiver burden. A study Effects of Gender on Burden Among Caregivers of Alzheimer’s Patients^[1] explains that women caregivers are subjected to a higher degree of caregiver burden than male caregivers. Some factors that affected the burden of both men and women caregivers were: mean duration of daily caregiving, total duration of caregiving, education, employment status, income and the age of the parents being cared^[1]. The areas in which women experienced more burden were those of developmental, physical, social burden and also time dependence. It appears that both men and women experience the same level of emotional burden when taking care of a family member that is ill^[1].

Alzheimer's Disease and Stroke

Various research has been prepared on the issue of caregiving for parents and family members that have been diagnosed with Alzheimer’s disease^[2] or that have experienced a stroke^[3]. 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 proven that an illness such as Alzheimer’s disease can place burdens on both the person living with the disease and their caregivers as well^[4]. Negative health effects have been confirmed for the caregivers of persons living with Alzheimer’s disease^[4]. The financial, psychological, social and physical pressures dealt with by caregivers negatively affect their quality of life. A study Canadian Alzheimer’s disease caregiver survey:baby-boomer caregivers and burden of care, found that more caregiver burden was experienced by live-in caregivers, those where the person being cared for lives with the caregiver, than by caregivers that do not reside with the person that they are taking care of^[4].

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. A research piece investigating Combined life satisfaction of persons with stroke and their caregivers: associations with caregiver burden and the impact of stroke, found that relationships between stroke victims and their caregivers that expressed discordant life satisfaction placed themselves more at risk for negative caregiver burden^[5]. 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^[5]. Both the Stroke Impact Scale^[6] and the Caregiver Burden Scale^[7] were used to assess life satisfaction among the dyad. 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 life satisfaction^[5].

Treatment

National data indicates that older adults who show depressive symptoms receive additional hours of physical assistance from several of their family members^[8]. There are several benefits to treatments which include: lowering physical disability, improved mood and better social adjustment^[8]. 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^[8]. 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, caregiver burden is alleviated to some degree^[8]. Treatment options can range from therapy groups: family and self, medication, rehabilitation services and social work^[9].

Caregiver stress relief can be accomplished by measures such as implementing direct services to the caregiver, supplying food or meals to the caregiver, providing house cleaning services or making transportation and medical equipment available^[9]. Such services are often available to caregivers although often times funding is not available to caregivers and they cannot afford to have such services offered^[9]. Management of household chores, finances and medical services are things that caregivers are forced to deal with. A project labeled A Hospice Caregiver Support Project: Providing Support to Reduce Caregiver Stress, clearly outlines the importance of offering services to caregivers who feel they need help when dealing with their aging parent or family member^[9]. The study concluded that offering such services could help to reduce the use of respite services and to reduce caregiver stress. Researchers also outline the importance of asking for help from others in time of need in order to help caregivers find the time to cope with their own issues and stress^[9].

Providing Support

5 Tips for Dealing with Caregiver Burden

• 5. Put your health first^[10]
• 4. Educate Yourself^[10]
• 3. Get Help^[10]
• 2. Learn Coping Strategies^[10]
• 1. Be realistic^[10]

--Ao08tp 18:06, 31 October 2011 (EDT)Audrey Ouimet

Gender Differences

Many of us will need help as we grow older. As our public services and long term care facilities are reaching maximum capacity, 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 ^[11]Support from the family is becoming crucial as our municipal services for the elderly are unable to support the growing population of older adults ^[12]. 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 ^[13] .

Gender Differences Between Husbands and Wives

There has been an abundance of research reporting that females provide more care for their aging parents than males do ^[14]. Hammer and Neal (2008) looked at the division of labour distributed amongst husbands and wives in caring for an aging parent. Researchers found that wives dedicated considerably more hours per week, on average, to providing care to a parent than their husbands, as women spent 6.8 hours per week, compared to their husbands 5.1 hours per week ^[15]. Suggestions for these differences include a higher proportion of men than women owning their own business, therefore men have more work responsibilities and less time to help support an aging parent. Another suggestion is that husbands work, on average, more hours per week than their wives, 49.5 hours compared to 38 hours, respectively ^[15]. Moreover, significantly more husbands in this study held full time jobs, than their wives, which would give wives more time to provide care to an aging parent. Additionally, women claimed to have more flexibility in their jobs than men, which can contribute to one’s availability and provide care. Researchers also found that as a result of women providing more care to an aging parent than their husbands, women also experienced high depression and absenteeism at work ^[15].

Gender Differences 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 to act as primary caregivers for an aging parent than sons ^[13]. 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 to become more withdrawn from care giving responsibilities, which leaves the daughter with the care giving duties ^[13]. Romoren’s 2003 study indicated that women had the highest prevalence for care, as 36% of caregivers were daughters, 9% were sisters, 8% were nieces, 7% daughters-in-law, while 9% of were spouses and only 19% were sons. More women in this study also reported living with the aging parent, and almost all sons reported working full time, whereas less than half of the daughters had full time work schedules ^[13]. Research has also shown that duration of care is three times higher for daughters than sons; one possible explanation provided for these findings is that culturally, parents have lower expectations when it comes to care giving for their sons than they do their daughters ^[13].

Why These Differences Exist

Researchers have also investigated the reasons why there are differences among siblings 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 ^[12]. Research has shown that in terms of caring for an aging parent, good parent-child relationships are a much better motivator than feelings of obligation. 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. The sibling who provides the majority of the care may feel angry or resentful towards their less active siblings. On the other hand, the sibling that provides minimal care may experience feelings of guilt ^[12]. These stresses can be lowered by making actual or psychological equities. To explain, making an actual equity means trying to change the siblings behaviour by asking them to provide more help. Further, creating a psychological equity is coming up with excuses or explanations for the sibling who does not actively participate in caring for the aging parent, as well as providing rationales for the sibling who provides the most care ^[12]. Some explanations include relationships between family members, geographical location, other responsibilities, personality, health and socioeconomic status, as well as gender. Women usually take on the primary caregiver role, which includes routine care. Primary care gives 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 ^[12]. It has also been suggested that “sibling network composition will affect which children are likely to provide assistance to an aging parent” ^[16]. This idea suggests that daughters take on a more proactive role in care giving because they were socialized that way. Gender role attitudes are learned early in life and influence who will take on the responsibility of caring for an aging parent; this could explain why two thirds of care givers are women ^[16].

Hypotheses of Family Labour

Finley (1989) describes care giving 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. Results showed that job responsibilities reduced time available for care giving duties for men, but not for women ^[14]. Based on this model researchers also found that women that did not have jobs provided more care than women that had full time jobs, and that single people were more likely to provide more care than married people. 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 ^[14]. 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, however women who are employed, still tend to provide the most care. 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 ^[14]. In this model, women assume the role of the care giver, but the results 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 ^[14].

--Jv08ti 22:32, 31 October 2011 (EDT)

Notes and References

1. ↑ ^{1.0 1.1 1.2 1.3 1.4} Akpicar, B., Kucukguclu, O., Yener, G. (2011). Effects of gender on burden among caregivers of alzheimer’s patients. Journal of Nursing Scholarship, Vol. 43(3), 248-256
2. ↑ Alzheimer’s disease. In Wikipedia. Retrieved October 25, 2011, from http://en.wikipedia.org/wiki/Alzheimer%27s_disease
3. ↑ Stroke. In Wikipedia. Retrieved October 25, 2011, from http://en.wikipedia.org/wiki/Stroke
4. ↑ ^{4.0 4.1 4.2} 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.
5. ↑ ^{5.0 5.1 5.2} 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.
6. ↑ Ali, D. (2010). Stroke measures: the stroke impact scale. Rehabilitation Measures Database. Retrieved from http://www.rehabmeasures.org/Lists/RehabMeasures/DispForm.aspx?ID=934
7. ↑ Moses, S. (2011). Caregiver burden scale. Family Practice Notebook. Retrieved from http://www.fpnotebook.com/Geri/Exam/CrgvrBrdnScl.htm
8. ↑ ^{8.0 8.1 8.2 8.3} Martire, L. M., Schulz, R., Reynolds, C. F., Karp, J., F., Gildengers, A. G. & Whyte, E. M. (2010). A journal, Treatment of Late-Life Depression Alleviates Caregiver Burden has proven that late-life depression can be treated with antidepressant medications<ref>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. </li> <li id="_note-empen">↑ ^{[[#_ref-empen_0|9.0]]} ^{[[#_ref-empen_1|9.1]]} ^{[[#_ref-empen_2|9.2]]} ^{[[#_ref-empen_3|9.3]]} ^{[[#_ref-empen_4|9.4]]} 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. </li> <li id="_note-scheve">↑ ^{[[#_ref-scheve_0|10.0]]} ^{[[#_ref-scheve_1|10.1]]} ^{[[#_ref-scheve_2|10.2]]} ^{[[#_ref-scheve_3|10.3]]} ^{[[#_ref-scheve_4|10.4]]} 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</li> <li id="_note-4">[[#_ref-4|↑]] Leinonen, A. (2011). Adult children and parental care-giving: making sense of participation patterns among siblings. Aging and Society, 31, 308-327. </li> <li id="_note-Leinonen">[[#_ref-Leinonen_4|↑]] <strong class="error">Cite error 8; No text given.</strong></li> <li id="_note-Romoren">↑ ^{[[#_ref-Romoren_0|13.0]]} ^{[[#_ref-Romoren_1|13.1]]} ^{[[#_ref-Romoren_2|13.2]]} ^{[[#_ref-Romoren_3|13.3]]} ^{[[#_ref-Romoren_4|13.4]]} 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.</li> <li id="_note-Finley">↑ ^{[[#_ref-Finley_0|14.0]]} ^{[[#_ref-Finley_1|14.1]]} ^{[[#_ref-Finley_2|14.2]]} ^{[[#_ref-Finley_3|14.3]]} ^{[[#_ref-Finley_4|14.4]]} 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.</li> <li id="_note-Hammer">↑ ^{[[#_ref-Hammer_0|15.0]]} ^{[[#_ref-Hammer_1|15.1]]} ^{[[#_ref-Hammer_2|15.2]]} Hammer, L., Neal, M. (2008). Working sandwiched- generation caregivers: prevalence, characteristics, and outcomes. The Psychologist-Manager Journal, 11, 93-112.</li> <li id="_note-Coward">↑ ^{[[#_ref-Coward_0|16.0]]} ^{[[#_ref-Coward_1|16.1]]} 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.</li></ol></ref>
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