1. Social Support and Caregiving Gero 300 Chapter 12 Nov 2008

2. Social Support Def. All forms of interactions with others. It has affective and emotional aspects-giving and receiving objects, services, affection, is esteemed and valued, belongs and has a sense of mutual obligation. SS is a measure of emotional connectedness with others. Includes concepts of group affiliations, interpersonal interactions, contacts and exchanges, all our social interactions (pos. neg and neutral). Trust and intimacy are part of the definition

3. Social Support Social support refers to the functional content of social relationships such as emotional concern, instrumental assistance and exchange of information. Older Canadians report having companions and confidantes and often it is the same person who plays both roles. Social support networks, an entire web of relationships, for contact and exchange, helps with ADL’s and IADL’s when the elderly require this kind of assistance

4. Definitions Social network-a set of relationships described in terms of structure (density and homogeneity) Social support-the functional content of social relationships such as emotional concern, instrumentality, information. Social integration (or isolation) – the existence or quantity of relationships. Companionship (p 302) individuals with whom you can spend time and activity. Confidantes-sharing personal and emotional feelings

5. Definitions Tangible and Instrumental assistance-activities of daily living-physical and personal care (p303) Instrumental activities of daily living-housework, meals, maintenance, transportation, shopping, banking.

6. Popular Myths Working daughters have no time to care for elderly parents Low fertility rates have produced fewer potential caregivers Mobility has made distance a factor in care- giving Technology has left seniors behind

7. Social Support Caregivers are seen as primary contacts for social support-average network is 30 people (p305) Marital relationships for seniors provide face to face contact, long term commitment, affection, group survival, common life-style, peer ties, social interactions. Married men tend to rely on their wives exclusively for emotional support. As baby boomers age divorce rates will increase as will % of never married. Singles rely on parents, sibs and friends. Life long single-hood may promote self-reliance.

8. Social Support Seniors today (80-85%) have at least one living sib. Past 85 this drops to below 50%. (p306) Sibs tend to stay in contact through the life cycle Over 80% of seniors have weekly contact with their children-visits, shared family times, leisure activities. Concept of intimacy at a distance-do not live with children but sustain close ties. This now includes emails, electronic contacts, cel phones. Women value child relationships more than men. Mother daughter ties are close with similar views.

9. Social Support Read bottom page 306 on senior’s interaction with grandchildren. Also note friendships who are age peers, similar in characteristics and socioeconomics with common experiences and transitions. Friends are age peers, similar in gender and socio- economic status. (p307) Majority of seniors therefore have high social interactions and many social ties. We know little of non-kin interactions and this requires further study. The convoy of social support (p307)

10. Support and Well-Being Well-being is absence of physical or mental illness, happiness or health. Social support and positive well-being are linked and improve QOL Social support mediates stressful events, improves mental health, reduces mortality. Read (page 308-310)-research on social support. Social interaction can be both positive and negative-ineffective help, excessive intrusiveness, unwarranted help, unpleasant help

11. SS Note that the socially competent may have easier access to social support, be more effective in negotiating the health care system and receiving optimal care and treatment. Students please read pages 311-313 on volunteering. Look at definitions of formal volunteer work vs informal. Stats bottom of page 312-313 Benefits page 313

12. Caregiving Def. support to seniors due to health deterioration and lack of function which reduces independence. Informal care is unpaid assistance from informal networks vs formal caregiving. These networks provide 75-85% of total personal care received by seniors-those with long term health problems, temporary difficulties, family tradition. See data on page 314-315 Primary Caregivers are mostly female(p316)

13. Caregiving Roles of sons and daughters are different- females provide hands on and emotional care sons more supervision of fiscal issues and home maintenance. Gender issues predominate in the formal system as well. 8% of seniors provide care to other seniors-spouse or close friend, neighbour. Look at definition of serial care-giving p317 Unmarried seniors most likely to receive no care-giving and assistance and may be in institutions

14. Caregiver Burden Stress effects, care-giving consequences and impact. Burden is a bio-psycho-social-financial issue with objective and subjective components. (p318-320) Stress Process Model-background characteristics, outcomes, intra-psychic, economic. Review data in table 11.2 Fact Book

15. Caregiving In BC 73% female and mean age is 52. 54% are wives and daughters. Often these people are caring for two people and have been doing so for two years or more. There are both primary and secondary care-givers (friends are typically secondary) Profile appears to be female, not in the work force, mid 50’s. Spouses care for partners who are more frail with illness. Read page 321 for BC data on care-giver burden research

16. Respite Pause or cessation of care-giving-in home relief, Adult Day Care, Respite beds. It may be linked to training or other community support. See research data on page 322-323

17. Caregiving Caregivers follow a pattern of traditional gendered division of labor. Caregiver burden-physical, psychological, emotional, social and financial problems experienced by family members caring for impaired older adults. Note objective burden includes changes in routines, health and work demands and subjective burden includes emotional reactions such as morale, anxiety and depression

18. Care-giving The burden of caring for the cognitively impaired includes items such as dealing with agitation, violence and abuse, incontinence, wandering, at risk behavior, hallucinations, embarrassing behaviors, sleep disturbances. Psychological impacts include: guilt, worry, anxiety, loneliness, emotional stress and strain. Impacts on physical health. Adjustment of caregiver to the death of the senior. Read page 320–rewards of care-giving

19. Future Care-giving 2001-2031 steady increase in senior females without surviving children and therefore less informal support Absolute and relative increase in demand for formal support Increased awareness and demand for service by new senior population, might be impacted by compression ratios Complimenting the two systems of care and the ultimate economic costs and policy issues.