Informal Caregiving and Network Turnover Among Older Adults

Informal Caregiver Social Network Types and Mental Health: The Mediating Role of Psychological Resilience

Little is known about whether and why social networks protect mental health among informal caregivers. This study examined the association between informal caregiver social network types and depressive symptoms and the mediatory mechanism of psychological resilience. Latent class analysis, applied to cross-sectional data on 278 Singaporean caregivers, identified four social network types: restricted (42%), friend (16%), family (21%), and diverse (21%). Path analysis showed that the diverse social network type, compared to the restricted social network type, was associated with a lower level of depressive symptoms, and psychological resilience fully mediated this association. Interventions should help caregivers to maintain social networks with their family and friends.

"Systems seem to get in the way": a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease

BACKGROUND

The well-being of informal caregivers of people living with chronic kidney disease is influenced by their experiences with support, however, few studies have focused on exploring these experiences. This study aimed to explore informal caregivers' experiences accessing and receiving support while caring for someone living with chronic kidney disease.

METHODS

Informal caregivers of people living with chronic kidney disease (n = 13) in the United Kingdom were primarily recruited via community organisations and social media adverts to participate in semi-structured interviews. Interviews explored support needs, experiences of receiving support from different groups (e.g. healthcare professionals, family/friends), and barriers and facilitators to accessing support. Support was understood as including emotional, practical, and informational support. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated: (1) "Systems seem to get in the way" - challenges within support systems, illustrating the challenges informal caregivers encountered when navigating complex support systems; (2) Relying on yourself, describing how informal caregivers leveraged their existing skills and networks to access support independently, while recognising the limitations of having to rely on yourself to find support; and (3) Support systems can "take the pressure off", showing how support systems were able to help informal caregivers cope with the challenges they experienced if certain conditions were met.

CONCLUSIONS

In response to the challenges informal caregivers experienced when seeking support, improvements are needed to better consider informal caregiver needs within healthcare systems, and to develop interventions tailored to informal caregiver needs and context. Within the healthcare system, informal caregivers may benefit from system navigation support and better integration within healthcare teams to ensure their informational support needs are met. New interventions developed to support informal caregivers should fit within their existing support systems and incorporate the qualities of support, such as empathy, that were valued. Additionally, use of an equity framework and user-centered design approaches during intervention development could help ensure interventions are accessible and acceptable.

Changes in Network Size, Quality, and Composition among Informal Caregivers in Different Welfare Clusters: Longitudinal Analyses Based on a Pan-European Survey (SHARE)

INTRODUCTION

This study analyzed the association between transitions into informal caregiving, inside and outside their own household, and changes in network size, quality, and composition among older adults (≥50 years) in four different welfare systems in Europe.

METHODS

Data from waves 4, 6, and 8 of the Survey of Health, Ageing and Retirement in Europe was used and included up to 110,823 participants (aged ≥50 years) from 12 countries. Participants were asked about informal caregiving inside and outside the household and their network size, quality (emotional closeness, contact frequency), and composition (family, friends, men, women). Adjusted linear and Poisson fixed effects regression analyses were conducted.

RESULTS

Participants transitioning into any caregiving (inside or outside the household) had a larger network. More women and family members were found among all those transitioning into caregiving, but only outside caregiving was associated with more men and friends in the network. Transitioning into caregiving outside was associated with reduced network closeness and contact. Changes among caregivers outside were similar in all welfare states but were more pronounced among caregivers inside the household of Eastern Europe.

CONCLUSION

Different patterns of changes in network size, quality, and composition were found among adults transitioning into caregiving inside and outside the household. All parameters changed among caregivers outside the household. However, the welfare system played a key role in the network changes among inside household caregivers. Thus, the micro as well as the macro context of caregiving is important for the support network of informal caregivers.

Social disadvantage, context and network dynamics in later life

How do personal networks evolve as individuals age? To what degree do social disadvantage and contextual factors matter for network dynamics in later life? This paper answers these two questions based on egocentric network data of older adults over a ten-year period. Specifically, I use longitudinal and nationally representative data on 1,168 older adults from the National Social Life, Health, and Aging Project. I use between-within models to separate the within- and between-individual effects of sociodemographic characteristics and contextual factors on three aspects of social connectedness in later life: network size, frequency of contact, and proportion of kin. Patterns of network change vary among people of different races and ethnicities as well as educational levels. Black and Hispanic respondents have a significantly smaller network size and a higher average frequency of contact with confidants. Moreover, Hispanic respondents have a higher proportion of kin in the network, compared to White respondents. Similarly, older adults with less education have a smaller network size, higher frequency of contact and higher proportion of kin in their confidant networks compared to those who attended college. Older adults who have better mental health are more likely to have a higher frequency of contact and higher proportion of kin. When an older adult starts to work for pay, their frequency of contact with confidants tends to increase. Older adults living in neighborhoods with stronger social ties are more likely to have a larger network size, higher frequency of contact, and lower proportion of kin in their confidant network. The above results show that disadvantaged backgrounds and contextual factors are associated with certain less favorable network characteristics, which helps to explain the concentration of social disadvantage on certain populations.

Elder Mistreatment Experienced by Older Caregiving Adults: Results from a National Community-Based Sample

BACKGROUND

With an aging population, older adults are increasingly serving as caregivers to others, which may increase their risk of adverse interpersonal experiences.

OBJECTIVE

To investigate the prevalence and types of elder mistreatment experienced by older caregiving adults.

DESIGN

Cross-sectional analysis PARTICIPANTS: National sample of community-dwelling US adults over age 60 in 2015-2016.

MAIN MEASURES

Caregiving (assisting another adult with day-to-day activities) was assessed by interviewer-administered questionnaires. Experience of elder mistreatment was assessed by participant-reported questionnaire in three domains: emotional, physical, and financial. Multivariable logistic regression models examined associations between caregiving status and each domain of elder mistreatment, adjusting for age, race, ethnicity, gender, education, marital status, concomitant care-receiving status, overall physical and mental health, and cognitive function. Additional logistic regression models examined associations between being the primary caregiver (rather than a secondary caregiver) and each domain of mistreatment among older caregivers.

KEY RESULTS

Of the 1898 participants over age 60 (including 1062 women and 836 men, 83% non-Hispanic white, and 64% married or partnered), 14% reported serving as caregivers for other adults, including 8% who considered themselves to be the primary caregiver. Among these older caregivers, 38% reported experiencing emotional, 32% financial, and 6% physical mistreatment after age 60. In multivariable models, caregiving was associated with experiencing both emotional mistreatment (AOR 1.61, 95% CI 1.15-2.25) and financial mistreatment (AOR 1.72, 95% CI 1.18-2.50). In analyses confined to caregiving older adults, those who served as primary rather than secondary caregivers for other adults had an over two-fold increased odds of emotional mistreatment (AOR 2.17, 95% CI 1.07, 4.41).

CONCLUSION

In this national cohort of older community-dwelling adults, caregiving was independently associated with experiencing emotional and financial mistreatment after age 60. Findings suggest that efforts to prevent or mitigate elder mistreatment should put more emphasis on vulnerable older caregivers.

Understanding the effects of informal caregiving on health and well-being: Heterogeneity and mechanisms

This study examines the heterogenous effects of informal caregiving on caregivers' health and well-being and the mechanisms of the effects, which remain largely undiscussed in previous literature. We used a combined estimation of fixed effects and the instrumental variables to address unobserved time-invariant individual characteristics and the endogeneity problem between caregivers' health and caregiving status. Using data from the four waves of the Japanese Study of Aging and Retirement collected in 2007, 2009, 2011, and 2013, and covering individuals aged 50 to 75 at the baselines, we found robust evidence of the negative effects of informal caregiving on caregivers' mental health and life satisfaction, but not on their physical health. Regarding heterogenous effects, we found that informal caregiving adversely affected female but not male caregivers' mental health and life satisfaction. Our results also showed that informal caregiving had greater effects on individuals providing care for their mothers-in-law, with a higher socioeconomic status, living with their in-laws, and belonging to younger groups. Our results indicated that the loss of social networks and leisure and social activities were channels through which informal caregiving might negatively affect caregivers' health and well-being. This study provides suggestions that policy makers may use to mitigate the negative effects of caregiving with targeted interventions, while formulating policies to support informal caregivers.

Profiles of social, cultural, and economic capital as longitudinal predictors of stress, positive experiences of caring, and depression among spousal carers of people with dementia

OBJECTIVE

We explored (1) social, cultural, and economic capital in spousal carers of people with dementia; (2) profiles of carers with different levels of capital; (3) whether the identified profiles differ in levels of stress and positive experiences of caring, and likelihood of depression over time.

METHODS

Baseline (2014-2016), 12-month, and 24-month follow-up data were analyzed for 984 coresident spousal carers of people with dementia. We assessed social, cultural, and economic capital, stress, positive experiences of caring, depression.

RESULTS

On average, carers reported infrequent social and cultural participation. Most carers were not socially isolated, trusted their neighbours, had education at least to age 16, and had an income aligned with the 2014 UK average. We identified four groups of carers with different levels of capital. Although on average stress was low, depression was infrequent, and positive experiences of caring were moderately frequent, the group of carers with lowest capital was the least stressed and reported the most positive experiences of caring over time. Compared to the two groups with better capital, those with poorer capital were more likely to be depressed over time.

CONCLUSION

Social, cultural, and economic resources may decrease likelihood of depression, but not stress, in carers of people with dementia.

Tracking Egocentric Social Network Change Across Three Rounds of National Survey Data

BACKGROUND

The National Social Life, Health, and Aging Project (NSHAP) has collected 3 rounds of data on older adults' egocentric social networks. We describe the structure of network data collection for different components of the sample and the data that are available for those groups. We also describe survey techniques that were used to track specific personnel changes that occurred within respondents' networks during the 10-year study period.

METHOD

Descriptive statistics are presented for measures of network size, composition, and internal structure at all 3 rounds, respondent-level summary measures of change in these characteristics between and across rounds, and measures of change associated with the loss and addition of network members across Rounds 1, 2, and 3. Procedures that were used to clean the network change data are also explained.

RESULTS

The NSHAP network change module provides reliable information about specific changes that occurred within respondents' confidant networks. For returning baseline respondents, there is considerable overlap with respect to which confidants are named in successive rosters, but the norm is for Round 3 networks to be composed primarily of new confidants.

DISCUSSION

These data provide new insights into the dynamic nature of networks in later life. Data limitations, and directions for future research, are discussed.

Typologies of Dementia Caregiver Support Networks: A Pilot Study

BACKGROUND AND OBJECTIVES

There are nearly 18 million family caregivers in the United States assisting an older adult in need of help. Identifying the caregivers in greatest need of support requires an understanding of the current social support networks available to family caregivers and whether specific groups of caregivers are at risk of having an insufficient support network.

RESEARCH DESIGN AND METHODS

We collected personal network data from a nationally representative sample of 66 family caregivers to persons with dementia (PWDs) in the United States aged 18 and older, including information on network members' support to the caregiver and help to the care recipient.

RESULTS

We found four common caregiving network types: large networks with many helpers; large networks primarily supporting caregivers; small, dense networks supporting both caregivers and care recipient; and small networks providing little help to either caregiver or care recipient. Gender, income, and geographic proximity of caregiver to the care recipient were significantly associated with caregiver network type.

DISCUSSION AND IMPLICATIONS

This study suggests that there are different types of care and support networks available to caregivers to PWDs, and that the size and structure of networks vary considerably among demographic groups. As the population ages, a better understanding of the supports available to caregivers will be crucial for ensuring that caregivers are adequately supported, and caregiving needs of families are met.

Changes in Caregiver Personal Support Networks: Gender Differences and Effects on Health (CUIDAR-SE Study)

Technological changes have led to important advances in medical diagnoses and treatments that prolong the informal care process. Support from the personal network of informal caregivers is an undervalued resource and the changes that have occurred over time are unknown. The aim of this study was to analyze the changes in personal network support among informal caregivers and to examine the effect of these changes on self-perceived caregiver health, with a focus on differences between men and women and caregivers with high and low levels of burden We also investigated caregiver perceptions and explanations of changes to their support network (losses and additions and no change). Using a mixed-methods approach, data were obtained from 32 caregivers that were intentionally selected in Spain, who were interviewed twice with a one-year interval. In the quantitative phase, personal networks analysis was performed with Egonet software, which obtained data on the composition and functional content in social support from 1600 personal relationships (25 alters for each ego in the two waves). In the qualitative phase, semi-structured interviews were conducted in the two waves with a guide in order to explore the changes in informal support resources over time. The selected men with high levels of burden pointed out a loss of network support with more discouraging reports compared with the low-burden male caregivers. Furthermore, the selected women with low burden levels mentioned losses too; however, their reports were more positive. Women reported improved health, especially those with low burden scores in the first wave and those who did not lose support. Caregivers with a high initial burden and who lost support reported worse health, particularly men and women with a strong sense of duty toward care. Social support from personal networks is important for caregiver health and its effects are influenced by gender roles. Our findings could help by improving the relational and social capital of informal caregivers and adapting them to the new needs of formal home care systems.

Patterns of stress and support in social support networks of in-home hospice cancer family caregivers

Family caregivers of home hospice cancer patients often experience burden and distress, which can be mitigated by perceived social support. However, less attention has been paid to the non-family sources of support within social networks, or to how sources of support may also be sources of stress. We describe support and stress in social networks of hospice family caregivers and identify caregiving characteristics associated with classes identified in our data. We collected demographic and psychosocial self-report data from family caregivers providing in-home hospice care for advanced cancer patients (N = 90). Caregivers also reported perceived support and stress from specific family and non-family relationships. We identified three classes with unique patterns of stress and support within caregivers' support networks using a latent class analysis. Classes include: 1) high support, low stress across family and non-family network members ("supportive"; 53% of caregivers); 2) high support, high stress across family and non-family network ("ambivalent maximizers"; 26%); and 3) high support, high stress across family network only ("family-focused ambivalent"; 21%). Caregivers in the ambivalent maximizer class reported more burden than caregivers in the supportive class (p = .024). This is one of the first studies to systematically explore the role of non-family support, as well as how stress and support co-occur within relationships and across networks. As informal support networks of hospice family caregivers are complex and multifaceted, understanding the patterns of support and stress across various network members is essential to offer services to more effectively manage caregiver burden.

Homeostasis Revisited: Patterns of Stability and Rebalancing in Older Adults' Social Lives

OBJECTIVES

To examine patterns of change in later-life social connectedness: (a) the extent and direction of changes in different aspects of social connectedness, including size, density, and composition of social networks, network turnover, and three types of community involvement and (b) the sequential nature of these changes over time.

METHOD

We use three waves of nationally representative data from the National Social Life, Health, and Aging Project, collected from 2005/2006 to 2015/2016. Respondents were between the ages of 67 and 95 at follow-up. Types of changes in their social connectedness between the two successive 5-year periods are compared to discern over-time change patterns.

RESULTS

Analyses reveal stability or growth in the sizes of most older adults' social networks, their access to non-kin ties, network expansiveness, as well as several forms of community involvement. Most older adults experienced turnover within their networks, but losses and additions usually offset each other, resulting in generally stable network size and structural features. Moreover, when older adults reported decreases (increases) in a given form of social connectedness during the first half of the study period, these changes were typically followed by countervailing increases (decreases) over the subsequent 5-year period. This general pattern holds for both network and community connectedness.

DISCUSSION

There is an overwhelming tendency toward either maintaining or rebalancing previous structures and levels of both personal network connectedness and community involvement. This results in overall homeostasis. We close by discussing the need for a unifying theoretical framework that can explain these patterns.

Interpersonal Correlates of Dementia Caregivers' Emotional Support Networks: Considering Family History

Caregiving networks of individuals with Alzheimer's disease and related dementias (ADRD) are comprised of family and friends directly involved in caregiving activities and those supporting these activities. The purpose of this study was to investigate whether caregiving-related behaviors and interactions (i.e., uplift, malfeasance, and nonfeasance), kinship tie (i.e., friend, family), and family history of ADRD were associated with caregivers' emotional support networks. Seventy-one caregivers across 30 families provided information about 776 network members. Perceived emotional support and interactions representing uplift, malfeasance, and nonfeasance were assessed. Results indicated that uplift and friendship were associated with increased, whereas nonfeasance was associated with decreased, likelihood of perceived emotional support. Caregivers with a family history of ADRD were particularly more likely to report emotional support from friends and uplifting network members. Findings suggest the need for differential strategies based on families' prior caregiving experience to facilitate positive and minimize negative interactions within caregiving networks.

Geographic distance and social isolation among family care-givers providing care to older adults in Canada

Family care-giving is associated with social isolation, which can lead to adverse health and wellbeing outcomes among family care-givers. The role of geographic distance in care-giver social isolation (CSI) is unclear and has received mixed research findings. Framed by the Ecological Model of Caregiver Isolation, this study examined the relationship between geographic distance and CSI, including the interaction between geographic distance and care-giving intensity for CSI. Linear regression and analysis of covariance were used to test these hypotheses using a sub-set of family care-givers from the 2012 Canadian General Social Survey (N = 2,881). Care-givers living a short distance from receivers reported lower levels of social isolation than co-resident, moderate-distance and long-distance care-givers. Being involved in higher-intensity care-giving as the primary care-giver, undertaking more care-giving tasks and providing care more frequently resulted in higher CSI scores. Long- and moderate-distance care-givers reported greater CSI than co-resident and short-distance care-givers only when providing higher-intensity care-giving. Employing a granulated measure of geographic distance positioned within an ecological framework facilitates an understanding of the nuanced association between geographic proximity and CSI. Furthermore, the identified interaction effects between geographic distance and care-giving intensity on CSI further explicate the complexity of care-giving experiences. The findings are relevant for programmes supporting care-givers in different contexts, especially distance care-givers.

Within-couple dissimilarities in functional impairment as determinants of spousal care arrangement among older married couples

Existing research on spousal care focuses on one spouse receiving care from the other, which fails to address the complexity that is created when both spouses experience some impairments. Our study included situations in which one or both spouses have functional impairments when examining the extent to which spouses from the same couple hold a (dis)similar level of functional impairment and whether such within-couple (dis)similarity has an impact on the spousal care arrangement. A subsample of 1170 older married couples was selected from the 2014 Health and Retirement Study. Descriptive statistics were used for describing the level of each spouse's functional impairment regarding the number of limitations in activities (activities of daily living [ADL]) or instrumental ADL (IADL). Logistic regressions were used to examine whether spousal dissimilarity in functional impairment (dissimilar, similarly low, similarly high) was associated with spousal care arrangement. Within couples with one functionally impaired spouse, the impaired spouse was more likely to receive spousal care when reporting a higher level of ADL/IADL impairment. Within couples with two functionally impaired spouses, the more impaired person was more likely to receive spousal care (without giving back) when spouses reported dissimilar level of IADL impairment; spouses were more likely to report mutual care when they had similarly high levels of IADL impairment. By documenting the role of spousal dissimilarities in functioning for determining spousal care arrangement, our study can inform couple-based interventions that capitalize on each spouse's capabilities and resources.

Online health communities, contributions to caregivers and resilience of older adults

The aim of this paper is twofold. Firstly, to investigate the potential benefits of online health communities (OHCs) for informal caregivers by conducting a systematic literature review. Secondly, to identify the relationship between the potential benefits of OHCs and resilience factors of older adults. Performing a thematic analysis, we identified the potential benefits of OHCs for informal caregivers of older adults, including two salient themes: (a) caregivers sharing and receiving social support and (b) self and moral empowerment of caregivers. Then, we uncovered how these potential benefits can support resilience of older adults. Our findings show that sharing and receiving of social support by informal caregivers, and self and moral empowerment of informal caregivers in OHCs, can support four resilience factors among older adults, including self-care, independence, altruism and external connections. This review enables a better understanding of OHCs and Gerontology, and our outcomes also challenge the way healthcare and aged-care service providers view caregivers and older adults. Furthermore, the identified gap and opportunities would provide avenues for further research in OHCs.

Social networks and health in later life: a state of the literature

Late life is a period frequently marked by decline in personal health and heightened need for social support. Consequently, the social networks in which individuals are embedded assume an increasingly central role in the health and wellbeing of older adults. In the present article, I review the state of the literature on social networks and health in later life. By drawing on insights from the sociology of ageing and the life course, I address new developments and current challenges within the field. Chief among these developments and challenges is the recognition that the ageing process does not occur in a vacuum. Rather, individuals are consistently exposed to numerous changes to their social lives which have strong implications for current and future health outcomes. Upon highlighting the latest innovations within the field of networks and health, I conclude with useful directions for future research.