Chapter 35 Family Caregiving

Introduction Aging is a family affair Impact of an individual's aging process has a ripple effect on the entire family unit Families are absorbing more complex responsibilities over longer periods of time Nurses need knowledge of family structure, roles, and relationships to be effective

The Older Adult’s Family Almost every individual is part of a family unit Many families today do not reflect the stereotypical nuclear family Diversity of family structures Need to explore the family unit for all “significant others” Persons beyond traditional thinking

Identification of Family Members Look for those individuals who fulfill family functions Modified family functions that address the needs of the older adult Questions that can facilitate the identification of persons who perform family functions Include all persons providing care in the development and evaluation of the care plan

Question Is the following statement true or false? When interviewing older adults, it is important to explore all persons who are “significant others” to an individual and fulfill a family role.

Answer True Rationale: When interviewing older adults, it is important to explore all persons who are “significant others” to an individual and fulfill a family role, regardless of whether they are unrelated or reside in different households.

Family Member Roles Determined as a result of socialization processes, family needs, and expectations Decision-maker Caregiver Deviant Dependent Victim Impact of role

Question Which of the following statements best describes the deviant family member role? One who is granted responsibility even though that person is not geographically close One who provides direct services and manages the home One who is seen as the “scapegoat” and provides a sense of purpose for family members One who depends on other members of the family for economic support

Answer C. One who is seen as the “scapegoat” and provides a sense of purpose for family members Rationale: The deviant, as a family member role, is described as the “problem child” who has strayed from family norms and may be the family scapegoat or may provide a sense of purpose for family members who “rescue” or compensate for this individual.

Family Dynamics and Relationships Can have positive or negative effect Need to explore the following issues: How family members feel about each other The manner of communication Attitudes, values, and beliefs Links with organizations and the community

Family Dynamics and Relationships (cont.) Majority of older adults have regular contact with their children Most older adults want to live in their own residence Grandparenting Sibling relationships Older couples Relationships in old age

Scope of Family Caregiving Most home care is provided by family members Statistics Types of assistance provided to older family members Provision of assistance is usually a subtle and gradual process

Protecting the Health of the Older Adult and Caregiver The family chain is only as strong as its weakest link Health of all family members must be maintained and promoted Maintaining older persons’ independence facilitates normality in family relationships Sound health practices to prevent disease and disability are crucial

Protecting the Health of the Older Adult and Caregiver (cont.) Older adults themselves are often caregivers Physical, emotional, and social health of caregivers must be assessed on a regular basis Caregivers’ TLC: Training, Leaving, Caring Middle-aged daughters as caregivers

Question Is the following statement true or false? Caregivers need to care for themselves through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, stress reduction, and health management.

Answer True Rationale: This is the “C” component of caregivers’ TLC. Caregivers need to care for themselves through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, stress reduction, and health management. The gerontological nurse should review the TLC needs of caregivers during every contact to unsure their continued effectiveness.

Family Dysfunction and Abuse Many factors can threaten the healthy functioning of the family unit Nurses must have the knowledge to identify and intervene when necessary Forms of family dysfunction Characteristics of families experiencing dysfunction

Family Dysfunction and Abuse (cont.) Abuse statistics Profile of the older adult at risk for abuse Abuse occurs in all types of families Types of abuse Older adults may be reluctant to report or admit abuse

Family Dysfunction and Abuse (cont.) Subtle clues of abuse Elder Mistreatment Assessment Instrument Nursing management of abusive situations Assess the degree of immediate danger Support for the abused person Good family history Care of the family

Rewards of Family Caregiving A caring, interested family is one of the most valuable resources an individual can possess in old age Caregiving can add a unique depth and meaning to the family Opportunities for relatives to learn more about each other Gratification in giving back to the aged