Grandmothers raising grandchildren: results of an intervention to improve health outcomes

A typology of caregiver burden for custodial Black grandmothers

Previous studies of custodial grandparenting tend to aggregate population data or not distinguish custodial grandparenting experiences by race, even though research demonstrates that custodial grandparenting for Black grandmothers is compounded by intersectional disadvantages. Our aim is to contribute to the gerontologic health literature with a nuanced understanding of caregiver burden that captures the strains and joys of custodial grandparenting, more accurately representing the heterogeneous experiences of Black caregiving. Data for this analysis is derived from a mixed methods descriptive concurrent parallel design with 20 custodial Black grandmothers. Quantitative analysis included bivariate associations. Qualitative thematic analysis was used. Quantitative and qualitative data were collected in parallel manner, analyzed independently, then aligned. We identified three distinct groups: High, Moderate, and Low Burden. Two-fifths of custodial Black grandmothers experienced low caregiving burden and one-quarter reported high burden which contrasts with research emphasizing the strains of caregiving for this population. Findings reveal diversity and significant variation in the caregiving experiences of Black grandmothers influencing, and influenced by, psychological and physical well-being. These findings also demonstrate meaningful sociodemographic differences across the three groups, supporting the typology of caregiver burden. The caregiver burden typology can be utilized to inform policy and support services, and as a starting point for future research to assess heterogeneity in custodial Black grandmother's experiences.

Dominant personal values and stress-coping strategies in relation to health and social conditions of kinship foster carers aged 60+ providing care for their biological grandchildren

BACKGROUND

The subject of personal values prompts deep reflection in the context of foster care provided by kinship carers, in particular grandparents, towards their biological grandchildren. Taking over the care of their own grandchildren may play a confrontational role in the context of grandparents' personal values, causing a sense of failure in their parenting skills in relation to their biological children, which has various effects on the creation of attachment relationships and the methods of raising grandchildren, who are often already affected by traumatic experiences. Grandparents also have to face public deliberation whether they are in a position to provide proper care for their grandchild or grandchildren when they most probably made various mistakes while raising and caring for their own children.

AIM

Identification of dominant personal values and stress-coping strategies in relation to the health and social resources of people aged 60 + providing kinship foster care for their grandchildren.

METHODS

This is a continuation of research conducted in 2018-2019 in north-western Poland. The target population comprised 189 families with kinship carers aged 60 + . Consent to participate was obtained from 78 carers, i.e. 41.27% of those eligible for the study. The study was conducted using the diagnostic survey method. The study used the following standardized scales and questionnaires: PVL, Mini-COPE and NEO-FFI, as well as nursing care sheets and an original survey to determine the profile of a kinship foster carer.

RESULTS

Over 75% of the respondents identified "good health, physical and mental fitness" as the dominant personal value. For 50% of the respondents "successful family life" was a symbol of happiness and for 45.16% of them it was "good health". As for the stress-coping strategies, the highest average rank of 4.84 was assigned to the "active coping" strategy, followed by a value of 4.56 for the "planning" strategy, and then "acceptance" and "positive reframing". The strategy which had the lowest rank of 0.08 was "using psychoactive substances", which did not receive a rank value higher than 2 and was assigned a value of 0 by 95.16% of the respondents. The dominant personality traits among kinship foster carers were: conscientiousness (mean ± SD = 3.34 ± 0.41), followed by agreeableness and extroversion. Neurotic personality traits were reported by the smallest number of respondents (mean ± SD = 1.12 ± 0.63).

CONCLUSIONS

Studies have shown that grandparents taking on the responsible role of kinship foster carers for their grandchildren are guided by love. They point to their health as an important resource. They perform their duties conscientiously and are open to new knowledge. They are capable of dealing with stress constructively. Their resourcefulness and a sense of purpose could increase with improved housing and financial conditions.

Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review

This systematic review critically evaluates 21 grandparent-focused prevention programs designed to benefit grandparent caregivers or target grandparent caregivers as agents of change for grandchild development. These grandparent programs were published in 35 peer-reviewed articles in the last 31 years. For each program, we described the phase of development of program (i.e., feasibility, pilot, and efficacy), delivery characteristics, and adaptations of existing evidence-based programs to meet the needs of grandparent caregivers in diverse sociocultural backgrounds. For programs tested under a controlled trial design, we evaluated core components and preliminary effects on targeted outcomes. Most studies targeted grandparents who served as primary or custodial caregivers in the USA, while limited studies targeted supplementary grandparent caregivers. Thirteen programs which were evaluated using pretest-posttest designs demonstrated feasibility and acceptability of the grandparent programs. Moreover, eight programs which were evaluated using randomized-controlled trials (RCTs; 5 pilot and 3 full-scale efficacy trials) demonstrated promising outcomes. Additionally, we identified six core components and 17 specific elements in eight programs evaluated using RCT designs. Overall, we provide a comprehensive critique of this body of literature as well as directions for future studies, including the need to develop programing tailored to grandparent caregivers with unique needs.

Formative Development of a Technology-Based Physical Activity Intervention for Grandparents and Grandchildren

Physical inactivity is a major public health issue among older adults and children. This study presents preliminary results that will inform the development of a technology-based physical activity intervention for grandparents and grandchildren (ages 6-12 years old). The authors used an iterative user-centered design framework to gather quantitative data from grandparents (n = 35) and subsequently invited a subset of 12 of them to engage in qualitative interviews. Participants were 63.1 ± 9.8 years old, 80% female, 64% U.S.-born, 43% Hispanic, 66% single, and 40% <$15K income. The majority of grandparents reported mobile device proficiency, very close relationships with their grandchildren, and interest in participating in an intergenerational intervention. Four key themes related to family closeness, dynamics, routines, and technology informed intervention development. Next steps involved a pilot trial using Fitbits and a fully functioning technology-based prototype. Grandparents are uniquely positioned within their families to serve as agents of change in health-promoting interventions.

Downward transfer of support and care: understanding the cultural lag in rural China

The Chinese culture of filial piety has historically emphasised children's responsibility for their ageing parents. Little is understood regarding the inverse: parents’ responsibility and care for their adult children. This paper uses interviews with 50 families living in rural China's Anhui Province to understand intergenerational support in rural China. Findings indicate that parents in rural China take on large financial burdens in order to sustain patrilineal traditions by providing housing and child care for their adult sons. These expectations lead some rural elders to become migrant workers in order to support their adult sons while others provide live-in grandchild-care, moving into their children's urban homes or bringing grandchildren into their own homes. As the oldest rural generations begin to require ageing care of their own, migrant children are unable to provide the sustained care and support expected within the cultural tradition of xiao. This paper adds to the small body of literature that examines the downward transfer of support from parents to their adult children in rural China. The authors argue that there is an emerging cultural rupture in the practice of filial piety – while the older generation is fulfilling their obligations of upbringing and paying for adult children's housing and child care; these adult children are not necessarily available or committed to the return of care for their ageing parents. The authors reveal cultural and structural lags that leave millions of rural ageing adults vulnerable in the process of urbanisation in rural China.

Perceived Caregiver Stress, Coping, and Quality of Life of Older Ugandan Grandparent-Caregivers

With the continued loss of lives due to HIV/AIDS in sub-Saharan Africa, grandparents bear the stress of caring for children affected by the epidemic, often with very limited resources. Yet, despite the acknowledgement that these older adults serve as the backbone and safety net of the African family in this HIV/AIDS era, very limited research has focused on investigating the specific health outcomes of caregivers in this region and how these changes in health status impact the overall quality of life of caregivers. This study highlights the stress perceived by Ugandan grandparent-caregivers, its impact on their overall quality of life, and the coping strategies they use to manage their stress. Thirty-two grandparent-caregivers (age 50 years and older) were recruited from urban and rural areas in Uganda and individually interviewed in 2016. Using constructivist grounded theory as the qualitative methodology, the narratives generated from the semi-structured, one-on-one interviews were audio-recorded, transcribed, and analyzed using both open and axial coding as well as reflexive and analytic memoing. Descriptions of caregiver stress (physical, emotional, financial, and social) were reported. Additionally, study findings uniquely explore the impact of the perceived stress on the grandparents' overall quality of life. Study findings provide a foundation upon which clinicians, researchers, and policy-makers can design and implement effective interventions to improve the health and quality of life of grandparent-caregivers in sub-Saharan Africa.

Parenting intervention outcomes for kinship caregivers and child: A systematic review

BACKGROUND

Kinship foster caregivers often face serious challenges but lack adequate parenting capacities and resources. The importance of parenting interventions for kinship foster caregivers has been recognized, and researchers have assessed the effect of various parenting interventions on the caregivers and children. However, no systematic review has been conducted to summarize findings related to parenting interventions targeting kinship care.

OBJECTIVES

This study systematically summarizes the effect of parenting interventions on kinship foster caregivers and their cared for children, and examines the intervention strategies and research methods used in order to provide a context in which to better understand effects of interventions.

METHODS

From six academic databases, 28 studies were identified for review. A data template was used to extract the following information from each study: intervention targets, research design, settings, intervention description, outcome measures, and main results for each study.

RESULTS

Various parenting interventions targeting kinship foster care families have been developed to improve parenting capacities and reduce parental stress. Most of the interventions had a positive impact on the outcomes of both caregivers and children, although the assessed outcomes often differed across studies. Parenting interventions improve caregivers' parenting competency, reduce parental stress, and advance child wellbeing. However, some interventions appear less promising in achieving targeted goals.

DISCUSSION

The findings suggest that promoting evidence-based parenting interventions with a special focus on kinship care is important for child welfare. Future directions for research are also discussed in this study.

How Do Nurses Keep Children Safe From Abuse and Neglect, and Does it Make a Difference? A Scoping Review

OBJECTIVES

To explore the extent of child protection work performed by nurses and identify which interventions hold the strongest evidence for future practice.

DESIGN

This scoping review was guided by Arksey and O'Malley's framework for scoping reviews.

DATA SOURCES

Electronic databases (CINAHL, Medline, Scopus, Web of Science) and grey literature were searched in August 2017. Further studies were identified through manual literature searching.

RESULTS

Forty-one studies from seven countries met the inclusion criteria. The studies showed nurses keep children safe primarily through the prevention of abuse (n = 32), but also through detection of abuse (n = 1) and interventions to mitigate the effects of abuse (n = 8). Nurses' specific interventions most frequently involved post-natal home visiting (n = 20), parent education (n = 10) and assessment and care of children or adolescents following sexual abuse (n = 4). The main findings showed that although nurses did have positive impacts upon some measures of abuse and neglect, results were not consistent across studies. In addition, some studies used indirect measures of abuse and neglect, which may not impact children's experiences of abuse. It is difficult to extrapolate these findings to the broader nursing profession as literature did not accurately represent the range of ways that nurses keep children safe from abuse and neglect.

CONCLUSIONS

This review demonstrated nurses prevent, detect and respond to abuse and neglect in many ways. However, given mixed evidence and absence of some nurse interventions in the literature, further research is needed to represent the range of ways that nurses keep children safe and determine their effectiveness.

Permanency and Safety Among Children in Foster Family and Kinship Care: A Scoping Review

Over the past 25 years, kinship care placements have risen dramatically, such that when a child enters into care, child welfare agencies must first attempt to identify safe living arrangements with relatives or individuals known to the child before searching for alternatives. Despite the growing emphasis on kinship care, little is known about its impact on child outcomes in comparison to other placement types (e.g., foster family). Therefore, the aim of this scoping review was to evaluate quantitative research on children in out-of-home care from 2007 to 2014 with regard to the following outcomes: (1) permanency (i.e., reunification, reentry, placement stability, and adoption/guardianship) and (2) safety (e.g., additional reports to child welfare). Based on these objectives, the review identified 54 studies that examined permanency and safety among children in two major placement types, namely foster family and kinship care. Across studies, children in kinship care experienced greater permanency in terms of a lower rate of reentry, greater placement stability, and more guardianship placements in comparison to children living with foster families. Children in kinship care, however, had lower rates of adoption and reunification. The findings also indicated that differences in these variables diminish over time. Findings for safety outcomes were mixed. Study methodological limitations and recommendations for future research are considered.

Interventions to Improve Grandparent Caregivers’ Mental and Physical Health: An Integrative Review

The aim of this integrative review is to appraise grandparent caregiver interventions that are designed to improve their physical and mental health. A database search was performed to identify relevant studies published between January 1, 1980, and December 31, 2014. Thirteen publications, including 11 studies, met all inclusion and exclusion criteria. All studies included grandparent mental health outcomes with fewer focusing on physical health and social relations. Improvements were found in all three areas with fewer improvements seen in physical health. However, small effect sizes were seen with most measures of these outcomes. Although the interventions led to positive grandparent caregiver outcomes, the studies were limited by their design, only one of which was a randomized controlled trial. Also, interventions did not consider variations in the grandchild’s or parent’s ages or if the grandparent provided primary or shared care. These gaps should be addressed in future research.

Impact of Grandchild Caregiving on African American Grandparents

The aim of this study was to describe the context and impact of caregiving for grandchildren with health concerns on grandparents. The study sample comprised 391 African American grandparents aged 55 or older. Logistic regression analysis indicated that grandparent caregivers of grandchildren with psychiatric or behavioral problems were more likely to experience a negative impact on their health (AOR = 7.86, p =.008) and leisure (AOR = 14.31, p =.024) than grandparent caregivers of grandchildren with no or other types of health problems. The findings underscore the need to support African American grandparent caregivers, particularly those raising grandchildren with mental health problems.

Grandparents Raising Grandchildren: A Synthetic Review and Theoretical Model for Interventions

The number of custodial grandparents has increased significantly over the past decade. Building on Hayslip's and Kaminski's comprehensive review of the literature on custodial grandparenting, we conducted an updated review of the literature, in particular peer-reviewed journal articles published since 2004. We have developed a conceptual model to contribute to understanding the causes and consequences of custodial grandparenting, using the stress-coping framework while highlighting the emerging issues related to contemporary grandfamilies such as cultural and ethnic heterogeneity in grandfamilies. We also emphasized loss, grief, and trauma among grandfamilies and provided the implications for effective public and community health programs.

Biofeedback in Grandmothers Raising Grandchildren: Correlations Between Subjective and Objective Measures

Research shows that 20% of grandmothers raising grandchildren experience stress and depression. Heart rate variability (HRV) biofeedback may help grandmothers track and regulate their physiological response to stress. This study therefore examined correlations between coherence scores reflecting HRV and self-report measures of stress, negative emotions, and depressive cognitions in 20 grandmothers raising grandchildren. Higher coherence scores were inversely and significantly correlated with self-report measures, suggesting the need to examine the effects of HRV biofeedback on biomarkers reflecting stress and depression.

Health and Functioning in Grandparents After a Young Grandchild's Death

This cross-sectional study examined the physical and mental health, grief and role functioning of 136 grandparents in the first year after death of their young grandchild (newborn through 6 years). Grandparents were 36-77 years old; 73% female; 24% Hispanic, 38% Black/African American, and 38% White. Mean age of the 115 deceased grandchildren was 12.8 months (SD = 20.71) with 37% <1 month old; 65% were male, 77% died in the hospital. Grandparents were recruited through state death records and interviewed by telephone. Grandparents experienced: clinical depression (31%), PTSD (35%); illnesses (28%), hospitalizations, new chronic health conditions (mental disorders, hypertension, angina, cancer), and medication changes. Grandparents who provided care for the deceased grandchild had more intense symptoms of grief, depression and PTSD and more trouble focusing at their jobs. Severity of depressive and/or PTSD symptoms were more likely to be at clinically important levels for grandparents who had provided childcare for the deceased grandchild than for non-caregiving grandparents. Black grandparents had more severe symptoms of PTSD and thought more about their deceased grandchild on the job than White grandparents. The interaction effect of race/ethnicity and provision of child care was significant for PTSD and Blame and Anger. Hispanic grandparents who provided some child care for their deceased grandchild had less severe PTSD symptoms than caregiving Black and White grandparents. Caregiving Hispanic grandparents also experienced less Blame and Anger than White caregiving grandparents.

Health Characteristics of Solo Grandparent Caregivers and Single Parents: A Comparative Profile Using the Behavior Risk Factor Surveillance Survey

Objectives. To describe the health characteristics of solo grandparents raising grandchildren compared with single parents. Methods. Using the 2012 Behavioral Risk Factor Surveillance System, respondents identified as a single grandparent raising a grandchild were categorized as a solo grandparent; grandparent responses were compared with single parents. Descriptive analysis compared health characteristics of 925 solo grandparents with 7,786 single parents. Results. Compared to single parents, grandparents have a higher prevalence of physical health problems (e.g., arthritis). Both parent groups have a high prevalence of lifetime depression. A larger share of grandparents actively smoke and did no recreational physical exercise in the last month. However, grandparents appear to have better access to health services in comparison with single parents. Conclusion. Solo grandparents may be at risk for diminished physical capacity and heightened prevalence of depression. Health professionals can be an important resource to increase grandparents' physical and emotional capacities.

The pathway to grandparenting stress: trauma, relational conflict, and emotional well-being

OBJECTIVES

This paper examines the mediating effect of child-grandparent conflict on the relationship between child trauma exposure and grandparenting stress.

METHODS

Data was collected from a sample of custodial grandparents who participated in kinship care or relative caregiving programs (n = 251). Grandparenting stress was measured with Parenting Stress Scale (Berry & Jones, 1995 ) modified for grandparents. A series of regression models and structural equation models (SEM) were used to test the relationship between the number of different types of child trauma exposures and grandparenting stress, and to examine the mediating effect of child-grandparent conflicts on the relationship.

RESULTS

Almost three-fourths (72%) of children had experienced at least one type of traumatic exposure. The SEM model shows that child's trauma exposure indirectly affected grandparenting stress, mediated by child-grandparenting conflicts though no direct path between the child's trauma exposure variable and grandparenting stress was found. A higher level of child-grandparent conflicts was also associated with a lower level of emotional well-being among custodial grandparents.

CONCLUSION

Based on these findings, recommendations are made about how to tailor a trauma-informed approach to the needs of custodial grandparents.

The health of grandparents raising grandchildren: a literature review

Around the world, an increasing number of grandparents are raising grandchildren in households without a biological parent. This is no less true in the United States, where grandparents raising grandchildren are at increased risk for depression and declining physical health. The purpose of this article is to explore the recent literature as it relates to the psychological and/or physical health of grandparents raising grandchildren. On reviewing 19 articles from the past 10 years, it is clear that the literature consistently verifies the health risks, especially depression, for grandparents raising grandchildren; however, the lack of research regarding grandfathers and non-African American caregivers is apparent. The factors influencing grandparents raising grandchildren are numerous, which calls for care providers to assess the needs, situations, and perceptions of grandparents individually. Finally, a need has arisen for more research suggesting and validating interventions that health care providers can use to support this population of older adults.

Resourcefulness training for grandmothers raising grandchildren: establishing fidelity

Over one million American grandmothers raise grandchildren, and many experience stress that adversely affects their mental health. Teaching resourcefulness skills can minimize this stress. However, before testing effectiveness of resourcefulness training (RT), its fidelity must be established. This pilot intervention trial examined the fidelity of two methods of RT: expressive writing (journaling) and verbal disclosure (voice recording) using a quasi-experimental design with random assignment of 80 grandmothers to RT-expressive writing, RT-verbal disclosure, or expressive writing or verbal disclosure alone. Quantitative data (Resourcefulness Scale) and qualitative data (journals, recordings) were collected. Grandmothers with RT showed greater resourcefulness over time than those without RT, with similar effects for RT-expressive writing and RT-verbal disclosure. Evidence for the use of RT skills was found in journals and recordings. The findings provide support for RT intervention fidelity and support moving forward to test RT effectiveness in reducing grandmothers' stress and promoting their mental health.

Resourcefulness training for grandmothers: preliminary evidence of effectiveness

In this pilot study of 102 grandmothers raising grandchildren, we used a quasi-experimental, repeated measures design to examine effects of resourcefulness training reinforced by expressive writing (journaling) or verbal disclosure (digital voice recording) in reducing stress and depressive symptoms and enhancing quality of life. Resourcefulness training was compared with expressive writing, verbal disclosure, and attention control conditions. Both the expressive writing and verbal disclosure methods for reinforcing resourcefulness training were more effective than the other three conditions in reducing stress and depressive symptoms and improving quality of life. No difference was found between the two reinforcement methods. Grandmothers may benefit from learning resourcefulness skills and from practicing them in ways that best fit their needs and lifestyles.

Longitudinal analysis of resourcefulness, family strain, and depressive symptoms in grandmother caregivers

BACKGROUND

Grandmothers living with grandchildren face stressors that may increase depressive symptoms, but cognitive-behavioral strategies, such as resourcefulness, may reduce the effects of stressors on mental health.

PURPOSE

This analysis examined the contemporaneous and longitudinal relationships among intra-family strain, resourcefulness, and depressive symptoms in 240 grandmothers, classified by caregiving status to grandchildren.

METHODS

Grandmothers raising grandchildren, grandmothers living in multigenerational homes, and non-caregivers to grandchildren reported on intra-family strain, resourcefulness, and depressive symptoms using mailed questionnaires at three time points over 5 years. Structural equation modeling was used to evaluate the mediating effects of resourcefulness and the relationships between variables.

DISCUSSION

Grandmother caregiver status had significant effects on depressive symptoms and intra-family strain but not on resourcefulness. At all waves, higher resourcefulness was associated with fewer depressive symptoms, which reduced appraisals of intra-family strain.

CONCLUSIONS

Interventions focused on strengthening resourcefulness could reduce depressive symptoms over time.

Resourcefulness training for grandmothers: feasibility and acceptability of two methods

Grandmothers raising grandchildren may benefit from interventions to minimize stress and promote mental health. This pilot intervention trial with 40 grandmothers examined the acceptability and feasibility of resourcefulness training (RT) using expressive writing (EW) or verbal disclosure (VD). Grandmothers in RT-EW reported challenges with the daily journaling, facing reality, and not using names; those in RT-VD listed daily recording, sharing feelings, and device failures as challenges. Word counts were greater with VD than EW, but EW was used more frequently than VD. However, both EW and VD were found acceptable and feasible for practicing RT skills in grandmothers raising grandchildren and warrant further evaluation.

African American caregiving grandmothers: results of an intervention to improve health indicators and health promotion behaviors

The purpose of this study was to examine the efficacy of an intervention to improve the health of grandmothers raising grandchildren. A pre- and post-test design was employed with 504 African American grandmother participants. The intervention included monthly home-based visitation by registered nurses (RNs) and social workers, participation in support groups and parenting classes, referrals for legal services, and early intervention services for children with special needs. The Health Risk Appraisal was used to assess health indicators and health promotion behaviors. A comparison of pre- and post-test scores indicated significant (p < .002) changes in the desired direction for a number of health indicators and health promotion behaviors, including blood pressure, annual routine cancer screenings, frequency of weekly exercise, and improved dietary intake, as well as participants' perception of their health and life satisfaction. No improvements were observed in the proportion of participants who were obese or overweight.

Cushioning, weathering, place, and community in rural grandmother-mothering

Place influences rural women's health when distance and lack of anonymity contribute to a reluctance to seek care. A qualitative design was used to explore relationships between place and the health of rural grandmothers raising grandchildren. The study generated findings concerning theory related to perceptual experience of rurality, identifying "Cushioning," as a basic social concept and "Weathering," "Paradoxical Place," and "Community Mothering" as subconcepts. Physical and mental wear and tear, distance, isolation and unraveling community mothering undermined "Cushioning" and reflected in self-health neglect narratives. Findings underscore the importance of place to the health of rural women raising grandchildren.