Aging and the Family

Forces affecting family structure Implications for aging and intergenerational relations

Mortality and life expectancy

Percent of Persons (Various Ages) with 1 or More Living Grandparents: Year010 yrs20 yrs30 yrs40 yrs

Percent of Persons (Various Ages) with One or Both Parents Living: Year40 yrs50 yrs60 yrs70 yrs

Prevalence of multi-generational living arrangements

Generational Composition of the Households of Older Persons Age Living Alone Married Couple 2 Gene- rations 3 or More Generations

Age at Marriage  Increases

Fertility / birth rates

Birth (Fertility) Rates  Declines

U.S. Birth Rates:

Birth (Fertility) Rates  Childlessness

Childlessness Among Ever Married Women 40 to 44 Years Old: 1980 to 1998

Birth (Fertility) Rates  Delayed childbearing

Fertility Rates by Age of Mother, U.S.:

Trends in Family Generational Structure From the “pyramid” To the “beanpole” To the “inverted” pyramid!

Migration  Emptying the nest –cluttering the nest  Amenity migration  Return migration  Intergenerational Contact

How Quickly Can Child(ren) Get to Your Home? 1994, 70 + Time Percentage Less than 1 hour70 1 hour 8 2 hours 6 3+ hours16 Note: Excludes those without children and those living with children.

How Often Do You See Your Child(ren)? 1994, 70+ Frequency Percentage Less than once/ month times/ month15 4 times/ month (weekly) times/month (weekly+) times/month (daily)22 Note: Excludes those without children and those living with children.

How Often Do You Talk on the Phone With Your Child(ren)? 1994, 70+ Frequency Percentage Less than once/ month times/ month 9 4 times/ month (weekly) times/month (weekly+) times/month (daily)39 Note: Excludes those without children and those living with children.

How Often Do You Get Mail from Your Child(ren)? 1994, 70+ FrequencyPercentage Less than once/ month times/ month14 4 times/ month (weekly) 6 Note: Excludes those without children and those living with children.

Divorce

 Consequences – Number of grandparents in blended families – Visitation rights of non-custodial grandparents – Stepchildren and long-term care obligations

Employment of Women

Consequences – Availability – Competing demands – Burden, strain, and stress

Caregiving Measures of impairment Age and impairment Informal vs. formal sources Sources of informal support Multiple roles, women in the middle, and the sandwich generation Caregiver stress and burden Support for family caregivers

Measures of Impairment  Activities of daily living – walking – bathing – transfer from bed or chair – dressing – toileting – feeding

Measures of Impairment  Instrumental activities of daily living – use of phone – handling money – shopping – getting around the community – preparing meals – doing housework

Prevalence of Limitations

Percent of Individuals in Each Age Group Limited in Activities Because of Chronic Conditions

To Whom Do Frail Elders Turn to for Support and Assistance?  Formal sources – e.g., VNA, meals on wheels, paid helpers  Informal sources – e.g., family, friends, neighbors

Distribution of People Age 50+ Receiving Help with 2+ ADLs, by Type of Assistance Received, 1994 Unpaid only Both Paid & Unpaid Paid only

Economic Value of Informal Caregiving (1997) 26 million caregivers Avg. hrs/wk of inf. caregiving: 17.9 Approx. 24 billion hours At $8.15/hour: $196 billion Home care: $32 billion Nursing home care: $83 billion

Who Provides Informal Care?

Distribution of Informal Caregivers Who Help People Age 65+ with ADLs, by Relationship of Caregiver to Recipient, 1994

Preference Patterns Spouse Children – Daughter – Daughter-in-law – Son – Son-in-law Other relatives Friends, neighbors

Preference Patterns If multiple daughters – Proximity – Unmarried – If married, no children at home – Unemployed If daughters and sons (or in-laws) – Gendered division of labor

Caregiving Career Parents then spouse More time spent caring for dependent elders than for dependent children

Multiple Roles Older, frail Working – Continue LFP, possible role overload – go part time – quit and forego income – 30% adjusted schedules to meet caregiving demands

Multiple Roles Children – in home – in college – in nest building stage If married If divorced

Multiple Roles “Women in the middle” “Sandwich generation”

Caregiver Stress and Burden Physical – Higher % reporting fair or poor health – Sleep and eating disorders and fatigue – More MD visits – Impaired immune system functioning – More respiratory tract infections – Higher risk for coronary heart disease – Higher mortality

Caregiver Stress and Burden Psychological – Emotional distress – Anger – Depression – Higher use of psychotropic drugs – Decreased psychological well-being – Persistence after 3 years

Caregiver Stress and Burden Social – Decreased social interaction Economic – Direct, out of pocket costs – Opportunity costs Abuse

Caregiver Stress and Burden Some examples

Concluding Images  Not abandoned  Not dumped  Nursing homes as a last resort  Doing too much  Not letting go

What Would Help?  Employment policies – flex-time – job sharing – EAPs recognizing stress, providing resources and support groups – adult day care on premises (combined with day care for kids)

What Would Help?  Family leave legislation  Respite services – In-home (Vermont HomeShare) – Out of home (VNA) – Temporary in nursing homes or in hospitals

What Would Help?  Government policy that recognizes – contributions of families – that informal, home-based care is a major component of the health care system – that hospital-based, medical model of delivering health care services is inappropriate for LTC

What Would Help?  Government policy that recognizes – that governmental assistance will supplement what the family is doing, not substitute for it

Fertility Rates by Age of Mother, U.S.:

Generational Composition of the Households of Older Persons Age Living Alone Married Couple 2 Gene- rations 3 or More Generations All %44.4%14.9%4.9%