Does type of disease matter? Gender differences among Alzheimer's and Parkinson's disease spouse caregivers

PURPOSE OF STUDY: Mental health outcomes are widely reported among spouse caregivers, with wives generally faring worse than husbands. We hypothesized that gender differences would not be as strong in a cognitively intact group because caring for cognitively intact spouses may involve less severe reciprocity losses. We also examined gender differences in coping strategies within each group. DESIGN AND METHOD: 175 spouse caregivers for patients with Alzheimer's disease (AD; n = 88) and Parkinson's disease (PD; n = 87) were interviewed. Participants completed perceived stress (PSS), depression (CES-D), state anxiety (STAI, Form Y), and coping strategies (WCCL-R) measures. RESULTS: Wives in the AD group reported significantly worse mental health outcomes than husbands, while wives and husbands in the PD group showed no differences. AD caregiving wives were less likely than husbands to use problem-focused coping strategies. There were no significant gender differences in either group for social support or emotion-focused coping. IMPLICATIONS: Loss of reciprocity in marital relationships may affect women more negatively than men. Future studies that address underlying mechanisms of gender differences and focus on similar caregiving situations and contexts deserve attention.     

Men and elder care in Japan: A ripple of change?

An area that has been ignored in the discussions of elder care in Japan is the role of men. This exploratory study is one of the first to examine the role of men in the day-to-day care of an older family member. For this qualitative study, 16 husbands and sons were interviewed to examine the extent of their involvement in caregiving. The research examined five areas: motivation, tasks, impact on work/family lives, community reaction, and meaning. Sons' motivations went beyond filial piety, to one of love and/or an opportunity to pay back a devoted parent; they experienced greater role conflict and used more formal services than husbands. Husbands evolved a spousal obligation to care for their wives, provided more hands-on care, and exhibited greater caregiver stress. Both sons and husbands gained insights from the caregiving role, which was undertaken with little societal recognition or understanding.     

The roles of labor migrants' wives in HIV/AIDS risk and prevention in Tajikistan

This study aimed to build formative knowledge regarding labor migrants' wives' knowledge, attitudes, and behaviors regarding HIV/AIDS risk and protection that would inform developing innovative HIV prevention strategies. This was a collaborative ethnography in Tajikistan that included minimally structured interviews and focused field observations with 30 Tajik wives in Dushanbe married to Tajik male migrant workers currently working in Moscow. The results documented the wives' concerns over their husbands' safety in Moscow and the difficulties of living without husbands. In a male-dominated society, gender norms limit the wives' abilities to protect themselves and their husbands from HIV/AIDS. They have some awareness of HIV/AIDS, but limited abilities to speak about sexual activity, HIV/AIDS, condoms, and HIV testing. Wives do not use condoms with their husbands and depend upon their husband's role as their protector. Wives often turn for support to their "circle of friends" or to a primary care nurse for support, but seldom do these relationships focus on preventing HIV/AIDS. To respond to HIV/AIDS risks amongst the wives of Tajik male migrant workers in Moscow, preventive interventions could build upon migrants' wives' role as the primary family caregiver and their existing sources of social support from women's circles and nurses. The overall intervention strategy could be to expand their role as family caregivers to include HIV/AIDS protection, through enhancing their HIV/AIDS knowledge and prevention skills and negotiation strategies with their husbands.     

Children-in-law in caregiving families

Data were collected from 252 coresident caregiving daughters and daughters-in-law and their husbands. We hypothesized that biological children would give more care than children-in-law and that children-in-law would have very different caregiving experiences and resultant appraisals than biological children. Contrary to our hypotheses, we found that the experiences are very similar for biological children and children-in-law in caregiving families. We suggested that the important factor is not the relationship to the elder that has the impact--it is the quality of the relationship with the elder that is consistently significant.     

Men Providing Care

Abstract

Male caregivers' experiences inpsychoeducational groups remain relatively unexplored. Presented is the experience of recruiting and implementing psychoeducational groups for caregiving men based on a cognitive-behavioral model designed to teach skills for managing distressful emotional reactions resulting from caregiving (e.g., anger, depression). Seven Caucasian men (6 husbands and 1 son) with a mean age of 78 years participated in a psychoeducational group for 6 sessions. Four men, two Caucasians and two Asian-Americans (3 husbands and 1 son), participated in subsequent groups. Feedback regarding the group was gathered in the last group meeting and individual interviews. Men were more likely to contact group leaders at the prompting of a trusted individual, such as another family member or mental health care worker. Participants remained active in roles independent of caregiving requiring that the session duration and number of sessions be truncated. Participants' feedback also included an appreciation of a skills-based approach to managing distress as well as the opportunity to discuss mutual experiences and pass on advice. Despite the difficulty of sharing emotions, participants did so and indicated that this was an important aspect of the group. Asian-American participants suggest that culturally consistent case examples, group leaders, and group members should be incorporated in future groups. Other participants suggest sessions focusing on accessing local community caregiving resources, practical strategies for managing daily care, and extra sessions to practice skills learned. Recommendations for recruitment, scheduling, and implementing future groups as well as directions for research are provided.     

Impact of husbands' involuntary job loss on wives' mental health,among older adults

OBJECTIVES: This study estimates the consequences of older husbands' involuntary job loss for their wives' mental health. METHODS: Using longitudinal data from the 1992, 1994, and 1996 waves of the Health and Retirement Study, multivariate regression models were estimated to measure the impact of older husbands' involuntary job loss on wives' mental health. We created two longitudinal data sets of two waves each to use in our analysis. The first data set, or period, combined Waves 1 and 2 of the Health and Retirement Study and described the 1992-1994 experience of spouse pairs in our sample. It included the wives of 55 husbands who experienced involuntary job loss between these survey dates and a comparison group of wives of 730 continuously employed husbands. The second data set described the 1994-1996 experience of couples. In particular, it included the wives of an additional 38 husbands who were displaced from their jobs between Waves 2 and 3, and a comparison group of wives of 425 husbands who were continuously employed from 1994 to 1996. RESULTS: Husbands' involuntary job loss did not have a statistically significant effect on wives' mental health. We found no evidence that changes in husbands' depressive symptoms modified the effect of his job loss on wives' mental health. In the first period only, the effect of husbands' job loss on wives' mental health was more pronounced for wives who were more financially satisfied at baseline. DISCUSSION: There is limited evidence among this cohort that husbands' job loss increases wives' subsequent depressive symptoms. However, the effect of husbands' job loss on wives' mental health appears to be magnified when wives report being financially satisfied pre-job loss. This suggests that, for subgroups of older couples, mental health services specifically targeted at displaced men should also be made available to wives.     

Multiple role occupancy and social participation among midlife wives and husbands in the United Kingdom

We investigated the relationship between intensive multiple role occupancy and one key dimension of well-being, social participation (i.e., frequency of participation in social and leisure activities and meeting friends or relatives). Moreover, we examined gender differences in the association between individual, spousal and couple intensive multiple role commitments and individual social participation. Our research is based on a sample of mid-life wives (45-59) and their husbands from the 2000 British Household Panel Study (BHPS). Our findings show that, among wives whose husbands were providing care to a dependent for 20 or more hours a week, there was a negative association with social and leisure activity participation, whereas husbands' level of participation in social and leisure activities was higher if their wives were in full-time paid work. We also found lower odds of meeting friends or relatives among wives and husbands in full-time employment, and higher odds of meeting friends and relatives among wives providing care for 20 or more hours a week. Our results will aid policy thinking in addressing how people can be best supported to balance work and family commitments in order to optimize different dimensions of well-being in later life and help alleviate the pressures associated with multiple-role occupancy in mid-life.     

The relationship between care-recipient behaviors and spousal caregiving stress

PURPOSE: This study examines gender differences in spousal caregiver stress associated with care-recipient problem behaviors and helping behaviors. DESIGN AND METHODS: Using data from the National Long-Term Care Survey, we examined bivariate and multivariate relationships between the behaviors of care recipients and the stress experienced by their spouses. RESULTS: Gender differences in caregiver stress emerged with respect to problem behaviors and helping behaviors of the care recipient. Helping behaviors had a moderating effect on the relationship between care-recipient problem behaviors and stress for caregiving husbands, but not for caregiving wives. IMPLICATIONS: As practitioners attempt to reduce spousal caregiving distress, they should assess the extent to which care recipient's problem behaviors and efforts to be helpful contribute to caregiver stress.     

Gender roles, marital intimacy, and nomination of spouse as primary caregiver

Using data from a sample of married men and women undergoing treatment for cancer, we tested two potential hypotheses for the unequal representation of husbands and wives as spousal caregivers, including societal gender role norms and emotional closeness in the marital relationship. Multivariate analyses support both hypotheses; wives are only one third as likely as husbands to select their spouses as caregivers, and spouses who name their mates as confidants are three times more likely than those who do not to also name them as caregivers. We conclude that although gender role norms are key to caregiver selection, the intimacy inherent in the caregiving role renders an emotionally close marriage an important criterion to the selection of spouse as caregiver.     

Differential effects of daughters' marital status on their parent care experiences.

This study compared the parent care experiences of five groups of daughters (N = 492) (married, remarried, separated/divorced, widowed, and never married). Data include demographic characteristics and measures of depression, positive affect, personality strength, health, social support, relationship quality, caregiving burden, caregiving mastery, and caregiving satisfaction. Women with husbands had more socio-emotional and instrumental support, much higher incomes, less financial strain from caregiving, and less depression. They felt their own particular marital status made caregiving easier than did the three groups of not-married women.     

The grief experienced by spousal caregivers of dementia patients: the role of place of care of patient and gender of caregiver.

A comparison of the grief responses of spousal caregivers who cared for their demented partners at home with those who provided ongoing nursing home care, together with an examination of gender differences, is reported here. Four psychological states of grief were examined: anxiety, sadness, anger, and guilt. Sixty spousal caregivers participated in the study: thirty husbands and thirty wives, with equal numbers of home and nursing home caregivers. Content analysis scales were scored to assess the four psychological states. A self-rating, adjective mood scale was also used as a secondary measure of those states. A personal construct model of spousal caregivers' bereavement for their demented partners was developed and provided the two hypotheses about differences in grieving. As predicted, nursing home caregivers expressed significantly higher levels of sadness and guilt than home caregivers. Against prediction, home caregivers expressed significantly more anger than nursing home caregivers. Home caregiving wives were found to be the most angry cohort. Also, as predicted, caregiving wives expressed significantly higher levels of anxiety, sadness, and anger than caregiving husbands. The results of the content analysis scales were confirmed by the secondary measure, but the former measure proved more powerful for detecting statistically significant differences. The inclusion of severity of the patients' dementia, and the spiritually and age of the spousal caregivers as covariates in the statistical analyses showed place of care and gender of caregiver to remain the most powerful predictors of the four psychological states of grief.     

Comparison of informal caregiving by black and white older adults in a community population

OBJECTIVES: To examine the prevalence of informal caregiving and demographic factors associated with caregiving time in older community residents and compare caregiving prevalence and time spent providing care by black and white residents. DESIGN: A cross-sectional, population-based study. SETTING: The study was conducted as part of the Chicago Health and Aging Project (CHAP) in a geographically defined community of black and white residents aged 65 and older. PARTICIPANTS: Participants were 5,924 community residents (61.4% black; 38.6% white) who answered questions about informal caregiving responsibilities during a structured interview about a broad range of health and social factors. METHODS: Data were collected during an in-home interview. Multiple logistic and linear regression models were used to examine the association between caregiving and race, gender, age, marital status, and education. RESULTS: More than 16% of residents had provided care to others during the previous 12 months, and 10.3% were currently providing care. Compared with whites, blacks were 30% more likely to be caregivers, spent almost 13 more hours each week in caregiving activities, and were more likely to assist friends. The probability of caregiving increased significantly with age for married persons, decreased with age for unmarried persons, and was lower for men compared with women. The time spent providing care each week increased significantly with age for married persons and did not differ between men and women. CONCLUSIONS: Although physicians and other healthcare providers typically view older people as the recipients of informal care, individuals older than age 65 provide a substantial amount of care to others with health problems and disability. Most research has focused on the needs of young and middle-aged caregivers, and little is known about the needs of these older caregivers. Future research should use sampling strategies that provide adequate numbers of white and non-white participants for meaningful comparisons. This will permit identification of racial and cultural differences in caregiving so that interventions can be tailored to specific groups.     

Gender differences in caregiver stressors, social resources, and health: an updated meta-analysis

This meta-analysis integrates results from 229 studies on gender differences in caregiver psychological and physical health, caregiving stressors, and social resources. Contrary to common perceptions, gender differences in caregiving variables were small to very small. Women had higher levels of burden and depression, and lower levels of subjective well-being and physical health. They reported that their care recipient had more behavioral problems; they provided more caregiving hours, helped with more caregiving tasks, and assisted with more personal care. Women and men did not differ in the use of informal and formal support. Statistically controlling for gender differences in stressors and resources reduced the size of gender differences in depression and physical health to levels that have been observed in noncaregiving samples. The results support stress-and-coping theories on gender differences in caregiving.     

Well-being in older Mexican American spouses

PURPOSE: There is a strong connection between marriage and well-being, with evidence suggesting that the well-being of one spouse is closely correlated with that of the other. However, among older Mexican Americans, there is little information about this phenomenon. To address this, we explore two research questions: Does one spouse's well-being predict the other spouse's well-being? Are there gender differences in these effects? DESIGN AND METHODS: We assess information from 553 couples who participated in Wave 1 (1993-1994) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Using structural equation models, we examined three aspects of well-being among older Mexican American couples: depressive symptoms, life satisfaction, and self-rated health. RESULTS: The findings revealed evidence of an association between the well-being of one spouse and that of the other. Specifically, the self-rated health of husbands and wives predicts that of their partners. However, there is evidence that husbands' depressive symptoms and life satisfaction influence wives' well-being, but not the reverse. IMPLICATIONS: The findings from this study are important because they add to the literature on the connection of well-being among spouses, point to important gender differences, focus on an understudied minority group with unique cultural characteristics, and have implications for the examination of well-being within a marriage framework.     

Weighing the care: patients' perceptions of physician care as a function of gender and weight

OBJECTIVE: To examine patients' reports of the level of care that they receive from their physicians, and determine the influence of weight and gender in these reports. DESIGN:: In a four-cell design, male and female, overweight and nonoverweight patients reported on the medical care that they received immediately following their appointment. SUBJECTS: A total of 125 patients affiliated to one of four large clinics in the Texas Medical Center of Houston completed this study. MEASUREMENTS: Patients reported the positivity of the care that they received, the time that physicians spent with them, and the extent to which physicians discussed weight-related topics with them. RESULTS: Overweight patients, as a whole, did not report poorer levels of care than did their thinner counterparts. Rather, the weight and gender of the patient significantly interacted across each of the measures to reveal some divergence between male and female patients' weight-based experiences. When significant differences in reported perceptions emerged, overweight men reported deficits in care relative to average weight men (eg, physicians spent less time), whereas overweight women reported enhanced care relative to average weight women (eg, better levels of care, more topics discussed). CONCLUSION: Based on patients' reports, this study reveals that physician care may not be as influenced by patient weight as previously thought. Yet, there is a discernable impact of patients' weight on physician behavior. Overweight men, who may comprise the most at-risk population, indicate that less time is spent with them than that indicated by average weight men. While this may be alarming, overweight women do not report reductions in care. We propose that not only might physicians respond to them differently, but overweight female patients may also be engaging in denial strategies or compensatory behaviors that assure them of quality care.     

“Isn’t he wonderful?” Exploring the contribution and conceptualization of older husbands as carers

This paper explores the relationship between the dimensions of a debate cited at the intersection of ageing, gender, and family care. It draws together evidence from the General Household Survey for Britain 2000 and social research to explore the contribution and conceptualization of caring by older husbands. UK research on caring reveals that among older spouses, equal numbers of husbands and wives provide intensive care. It has been argued that within late-life marriage an over-riding desire to retain independence erodes gender-determined task allocation, suggesting not only similarity but equality between wives and husbands as carers. More recent qualitative research challenges this assumption and suggests two key findings: that older husbands are motivated to care by a combination of marital duty and reciprocal love, and that they manage the tasks of caring within an instrumental framework. Further, it is clear that pre-existing gender relations continue to be powerful determinants of the experience of caring, and that marital power is retained by men in late-life marriage. Overall, the caring contribution of older husbands is imbued with positive meaning, is highly valued, and offers a distinctive role and identity; this contrasts sharply with the caring experiences of older wives. Her key research interests are older people with mental health problems, older carers, preventive services, and social inequalities and later life. Her current research interests are service provision for older people and quality of life, the service user movement in welfare, citizenship rights, and user empowerment. Material from the National Statistics is Crown Copyright; it has been made available by the Office of National Statistics through the Data Archive and has been used with their permission. Neither the ONS nor the Data Archive bears any responsibility for the analysis or interpretation of the data reported in this paper.     

Spousal characteristics as predictors of well-being in older couples.

This study examined the relations between spousal variables and the psychological well-being of husbands and wives in older couples to determine if spousal characteristics were more important determinants of well-being for wives than for husbands. One hundred-twenty older married men and women completed standardized self-report measures and a short interview. The variables investigated included education, verbal intelligence, personality, physical health, marital adjustment, psychological well-being, as well as response bias to marital defensiveness. Spousal variables significantly predicted wives' well-being (R2 = 29%) with the three most influential predictor variables being the husbands' perception of the marriage, positive dimension of well-being and physical health. In contrast, spousal variables did not significantly predict husbands' well-being. The study supported the hypothesis of differential responsiveness of men and women to spousal variables and highlighted the importance of marital adjustment for the psychological well-being of older wives.     

Re-focusing the Gender Lens: Caregiving Women,Family Roles and HIV/AIDS Vulnerability in Lesotho

Gender and HIV risk have been widely examined in southern Africa, generally with a focus on dynamics within sexual relationships. Yet the social construction of women’s lives reflects their broader engagement with a gendered social system, which influences both individual-level risks and social and economic vulnerabilities to HIV/AIDS. Using qualitative data from Lesotho, we examine women’s lived experiences of gender, family and HIV/AIDS through three domains: (1) marriage; (2) kinship and social motherhood, and (3) multigenerational dynamics. These data illustrate how women caregivers negotiate their roles as wives, mothers, and household heads, serving as the linchpins of a gendered family system that both affects, and is affected by, the HIV/AIDS epidemic. HIV/AIDS interventions are unlikely to succeed without attention to the larger context of women’s lives, namely their kinship, caregiving, and family responsibilities, as it is the family and kinship system in which gender, economic vulnerability and HIV risk are embedded.     

Gender differences in cardiovascular response to dementia caregiving

PURPOSE: This study examined gender differences in cardiovascular responses to laboratory-based stress, as well as in ambulatory hemodynamic (i.e., blood pressure and heart rate) functioning among caregivers of persons with dementia. DESIGN & METHODS: Participants were 25 men and 25 women caregivers, matched on age, type of care recipient's dementia, and relationship to the care recipient. After cardiovascular reactivity to a laboratory-based caregiving stressor was assessed, the ambulatory hemodynamic functioning levels of caregivers were measured in caregivers' natural environments. RESULTS: Female caregivers displayed greater systolic and diastolic blood pressure reactivity to a laboratory-based stress task (i.e., discussing caregiving difficulties) compared with male caregivers (p < or =.01). In contrast, no gender differences were found for ambulatory hemodynamic functioning when aggregated overall or when in the presence of the care recipient. IMPLICATIONS: Laboratory-based findings suggest that female caregivers experience greater blood pressure reactivity to caregiving-related stress than do male caregivers. However, these laboratory-based gender differences may not generalize to differences in hemodynamic functioning in caregivers' daily lives.     

Characteristics of strong commitments to intergenerational family care of older adults

OBJECTIVE: The purpose of this research was to describe the characteristics of strong commitment to home-based elder care among intergenerational family caregivers. METHODS: I conducted two qualitative studies using in-depth interviews with primary and secondary intergenerational caregivers. A total of 45 primary caregivers, 10 spouses, and 11 adult grandchildren discussed development of their relative's care, their caregiving experiences, use of paid services, and how caregiving affected their lives. I followed McCracken's five-step method for analysis of long interviews. RESULT: Strongly committed caregivers composed half of the total sample. All primary caregivers with strong commitments were women; some strongly committed secondary caregivers were men. Strong commitments had moral, religious, and affectionate bases. Participants gave compassionate care and reframed adverse situations as manageable challenges. Family members and paid providers assisted primary caregivers. Participants viewed caregiving as rewarding and as an opportunity to teach compassion to children. DISCUSSION: Results suggest that strongly committed intergenerational caregivers need support from both family and formal care services to sustain their commitments to care. Future research can investigate the role of resilience in caregiver commitments and develop caregiver commitment measures for use in elaborating models of informal long-term care.