1. Multiple Caregiving Roles on Occupational Balance experienced by the Sandwich Generation Facilitated by: Study Group 3 (Saira, Mary, Sarah, Susie, Juana, Louis, Vanessa)

2. Research Topic What is the impact of multiple caregiving roles on occupational balance as experienced by the sandwich generation? Hypothesis: Multiple caregiving roles negatively impact the occupational balance of the sandwich generation

3. Outline of Seminar Definitions Original Model Process for Finding Research Papers Critical Appraisal of Research Identification of Areas for Future Research Modified Model Suggestions of Constructive Research Approaches Discussion

4. Sandwich Generation - “people aged 35 to 64 who have at least one child at home & at least one parent aged 65 or older” (Smith & Dumas, 1994, p.115) Multiple Caregiver - person within sandwich generation who cares for at least one parent and at least one child simultaneously; definition of what constitutes ‘care’ varies among literature (i.e., hours, tasks) Formal Support - “professional caregivers such as doctors, nurses, and social workers” (Novak & Campbell, 2001) Informal Support - “unpaid help given by friends, neighbours, & family” (Novak & Campbell, 2001) Clarification of Definitions

5. Occupational Balance – “balance of engagement in occupations leads to well-being” “Balance may be achieved – among physical, mental, & social occupations – between strenuous & restful occupations – between doing & being occupations – between obligatory & chosen occupations” (Wilcock, 1998)

6. Caregiving Parent & Child All Other Occupations Multiple Caregiver Original Model

7. Process for Finding Research Newspapers - National Post (Sept. 29), Globe & Mail, Toronto Star University of Toronto Libraries - On-line Disciplines - Psychology, Sociology, Education, Occupational Therapy Search Interfaces - Ovid, CSA, PsychNet, Pubmed Databases - AgeLine, Cinahl, Communications, Education, Eric, Medline, Psychology, PsycInfo, PsycARTICLES, Social Services, Sociological, Sociology Keywords or Title - Multiple Caregiving, Multiple Roles, Caregiver, Parent Caregiver, Occupational Balance, Balance, Occupation Journals - Psychology & Aging, Research on Aging, Women & Health, Dissertation Abstracts International, Medical Care Criteria - Study multiple caregivers, discussion of an aspect of well-being Shortfall in Process - Work-life balance research

8. Purpose: Examine how the caregiver role affects distress levels of middle-aged women Examine the relationship between multiple roles of caregivers & levels of distress & role strain Hypothesis: Stress levels increase when the role-set is expanded with the caregiver role Distress of caregivers would decrease when women have few other social roles and increase when women have multiple roles Dautzenberg, M., Diederiks, J., Philipsen, H., & Tan, F. (1999). Multigenerational caregiving and well-being: distress of middle-aged daughters providing assistance to elderly parents. Women & Health, 29(4), 57-74.

9. Dautzenberg et al. (1999). Methods: 786 middle-aged women (40-56 yrs, mean=45.6 yrs) in The Netherlands Longitudinal telephone survey (parent care, mother, spouse, employment) Caregiver role commitment, caregiver role strain, distress (Likert type scales) Statistical analyses performed on data Findings: Caregiver role not associated with increased levels of distress None of the 3 major additional roles of caregivers appeared to affect their levels of distress

10. Critical Analysis of Study: Positivistic paradigm, quantitative data analysis, sociological background Level of Question = 3 (test knowledge) (DePoy & Gitlin, 1998) Level of Evidence = IV (well-designed non-experimental study) (Holm, 2000) Criteria of a caregiver (multiple roles) Quantitative? - how does this test meaning of caregiving Telephone survey? - large sample size, examined numerous variables, able to generalize data Scales? - validity Level of knowledge generated? - not all caregivers experience distress, need to examine why this is the case Dautzenberg et al. (1999).

11. Critical Analysis in Relation to Our Hypothesis: Authors conclude that multiple caregiving roles do not increase caregiver’s levels of distress Identifies trends towards our hypothesis Occupational balance = balance of engagement in occupations Balance among physical, mental, & social occupations Dautzenberg et al. (1999).

12. Martire, L., Townsend, A., Stephens, P. (2000). Centrality of Women’s Multiple Roles: Beneficial and Detrimental Consequences for Psychological Well-Being. Psychology and Aging, 15(1), 148-156. Definitions to Consider… Role centrality: degree to which social role serves as an identity anchor or means of defining oneself Primary Caregiver: family member who spends the most time caring for the parent Social Roles: parent care, mother, wife, employee Purpose: Examine main & exacerbating effects of centrality for women who simultaneously occupied roles of parent care provider, mother, wife & employee Hypotheses: Greater centrality of a social role is associated with better psychological well-being Centrality of a role exacerbates negative effects of stress.

13. Martire et al. (2000). Method: 296 women simultaneously occupied 4 roles (25-60 yrs, mean=43.9 yrs) in Northern Ohio & 2 counties in Pennsylvania Structured, in person interviews conducted in respondent’s home or other place of their choosing from July 1994 - December 1995 Participants asked to rate how stressful certain experiences in each role had been during past 2 months, using scale from 1 (not at all) to 4 (very much) Findings: Greater centrality of parent care, mother, wife & employee roles associated with better psychological well-being Centrality of all 4 roles related to greater life satisfaction & employee centrality related to fewer depressive symptoms Wife centrality exacerbated the effects of wife stress on life satisfaction & employee centrality exacerbated effects of employee stress on depressive symptoms Centrality of mother role buffered women from negative effects of mother stress on depressive symptoms

14. Martire et al. (2000). Critical Analysis of Study: Positivistic paradigm, quantitative data and analysis, psychological approach Level of Question = 3 (test knowledge) (DePoy & Gitlin, 1998) Level of Evidence = IV (well-designed non-experimental study) (Holm, 2000) Examined multiple caregiving roles (parent, mother, wife, employee), as well as other important variables (roles, stress, depressive symptoms, life satisfaction, centrality Sample Size and Type: 25-60 yrs, recruited from Northeastern Ohio, Caucasian and African American, socio-economic status (compared to median family income with both partners in labour force) Did not look at health status of parent and child Generalizing the findings to women caregivers? Level of knowledge generated: greater centrality of a role will lead to higher life satisfaction and less depressive symptoms

15. Martire et al. (2000). Critical Analysis in Relation to Our Hypothesis: Researchers studied the effects of centrality on psychological well-being for women occupying 4 social roles Findings: Greater centrality of the parent care, mother, wife and employee roles was associated with better psychological well-being Greater centrality (personal meaning) of a social role well-being Occupational Balance well-being Assume centrality of social role = chosen occupation Occupational Balance = chosen occupation + other obligatory occupations of everyday life No direct link to occupational balance in research study

16. Purpose: To investigate: (1) the independent additive effects &, (2) the interactive effects of being an informal caregiver of an elderly parent & 3 role commitments (being married, having a child or grandchild co-reside, & being employed) on depressive symptomology Methods: Gather sample (n=259) from HRS (n=12,564), a US survey of adults 51-61 yrs. Depressive symptoms measured using a14-item scale derived from CES-D Parent care = personal care, at least 100 hours in last year Findings: Caregiver for father = increased depressive symptoms Caregiver for mother = no effect on depressive symptoms Married / employed = decreased depressive symptoms Interaction effects either decrease depressive symptoms or had no consequences Chumbler, N.R., Pienta, A.M. & Dwyer, J.W. (2004). Depressive Symptomology of parent care among the near elderly: The influence of multiple role commitments. Research on Aging, 26(3), 330-351.

17. Chumbler et al. (2004). Critical Analysis of Study: Strengths & Limitations Nationally representative sample Included respondents who have a living mother & a living father Adjusted for particular types of health status characteristics of the caregiver HRS data = personal care, not instrumental care No information regarding: quality of caregiving experience, specifics of caregiving activities, quality of relationship, coping mechanisms, amount parents help caregivers Cross-sectional design = no way to control for pre-existing mental health conditions or reasons why people had assumed multiple roles

18. Chumbler et al. (2004). Critical Analysis of Study: Content of Study Quantitative, sociological paradigm Research questions, previous research & theories composing the framework clearly presented & identified Methods & findings more difficult to understand due to complexity of statistical analysis methods Level of Questions = 2 (relationships between variables) (DePoy & Gitlin, 1998)

19. Chumbler et al. (2004). Critical Analysis in Relation to Our Hypothesis: Caring for father = increased depressive symptoms – Researchers projected this could be a result of fathers requiring more assistance due to poorer health – This would negatively impact occupational balance due to increase in strenuous and doing occupations Engaging in other occupations = decreased depressive symptoms – Assume this is due to increased balance, as a result of increased diversity of roles

20. Summary of Additional Research Themes that emerged: Physical & Psychological Health Gender Culture (ethnicity, cultural environment, sociodemographics) Resources (social support, sibling, & spouse/partner assistance) Employment Other Roles (spouse, mother, daughter) Rewards Stress Level of Dependence vs. Independence of Care Recipient Meaning of Multiple Caregiving Role

21. Areas for Future Research Gender Differences Cultural Influences Influences of Socio-economic Status Longitudinal Studies Multiple caregiving across the lifespan Impact of Assistance and Resources Quality of Caregiving Relationship Continuum of Dependency

22. Modified Model Occupational Balance Multiple Caregiver Multiple Caregiving (Occupation) Phys HealthPsych Health Individual Differences Cultural Environment Socio- Demographics Gender Resources Rewards Employment All Other Occupations Meaning Stress Degree of Dependency (Person)

23. Constructive Research Approaches Findings: Quantitative, Deductive – Focused on testing hypotheses, predictions and relationships – Both quantitative and qualitative data collected – Surveys, quantified interviews, scales – Level 2 (relationships between variables) & Level 3 (test hypothesis) (DePoy & Gitlin, 1998) – Level IV (well-designed, non-experimental study) (Holm, 2000)

24. Future Approaches: Qualitative, Inductive & Abductive – Focus on understanding and interpreting human experience – Discover meaning behind multiple caregiving & occupational balance – Observation in context, qualitative interviews & questionnaires – Analyze what themes emerge from data Continue Quantitative, Deductive Research Focus on question & allows its nature to direct research approach Constructive Research Approaches

25. Discussion How does culture influence multiple caregiving and occupational balance? – Personal experiences – Thoughts, ideas – Knowledge from research How would you study this research question? – Quantitative, Qualitative – Methods for data collection – Specifics to ensure a good study