Deborah M. Whitley

Grandmothers Raising Grandchildren: Results of an Intervention to Improve Health Outcomes

PURPOSE To examine the impact of an intervention to improve the health of grandmothers raising grandchildren in parent-absent homes. DESIGN A longitudinal, pretest-posttest design. METHODS The sample was composed of 529 female caregivers with a mean age of 56.7 years (range 38-83) who were predominantly low-income African Americans. Data were collected prior to the intervention and again at 12 months when the intervention was complete. The intervention involved home visitation by registered nurses and social workers, as well as other support services. The Short Form-36 was used to assess physical and mental health, using eight multi-item scales. RESULTS A comparison of pre- and posttest mean scores on the SF-36 indicated significantly (p < .003) improved mean scores for vitality, physical effects on role functioning, emotional effects on role functioning, and mental health. No significant differences were found for other attributes. CONCLUSIONS These preliminary findings suggest that grandmothers raising grandchildren may benefit from a home-based intervention designed to improve health attributes. Implications for nursing practice, policy, and research are presented. CLINICAL RELEVANCE The health of grandmother caregivers is critical to their ability to parent grandchildren successfully. Nurses practicing in a variety of settings are in a unique position to identify and address the health challenges of grandmothers who are raising grandchildren.

To Grandmother's House We Go... and Stay: CHILDREN RAISED IN INTERGENERATIONAL FAMILIES

An increased incidence in child abuse and neglect has resulted in a dramatic rise in the number of grandparents raising grandchildren and great-grandchildren. Grandchildren raised by grandparents often suffer from emotional and behavioral problems due to prior abuse, neglect, and abandonment. Grandparent caregivers experience increased health problems, psychological distress, and social isolation related to their roles as primary caregivers of children. Grandparents who become caregivers of grandchildren face increased financial responsibilities at a time in their lives, close to or at retirement, when income is dramatically decreased.

Psychological distress in African American grandmothers raising grandchildren: the contribution of child behavior problems, physical health, and family resources.

Diminished psychological health has been identified among caregiving grandmothers. The intent of this investigation was to examine psychological distress levels, as well as their predictors, in a sample of 480 caregiving African American grandmothers, mean age 56 years. Almost 40% (39.8%) of participants had clinically elevated psychological distress scores. Results of hierarchical multiple regression indicated that internalizing and externalizing child behavior problems, poor grandmother physical health, younger age of grandmother, and lack of family resources predicted 31% of the variance in psychological distress. Results provide direction for nursing interventions aimed at enhancing the psychological well-being of caregiving grandmothers.

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.

Depression, Social Support, and Mental Health A Longitudinal Mediation Analysis in African American Custodial Grandmothers

Custodial grandparents raising grandchildren experience intense levels of stress that can lead to depression and other forms of psychological distress. Drawing on a coping model of family stress, adjustment, and adaptation, we explored the relationship between depression and mental health quality of life mediated by social support and moderated by grandparents age. The sample consisted of 667 African American custodial grandmothers, dichotomized into two age groupings, ≤55 (n = 306) and 55 + (n = 361). All grandmothers participated in a 12-month support intervention. The prospective analysis revealed social support was a mediator in the association between depressive symptoms and mental health quality of life for older African American grandmothers; however, this same relationship did not hold for their younger counterparts. Study limitations and future research directions are discussed.

Latino Solo Grandparents Raising Grandchildren: Health Risks and Behaviors

Introduction: The purpose of this descriptive report is to provide the first representative information on the sociodemographic profile and the prevalence of mental and physical health conditions of two “at-risk” groups of Latino caregivers: solo grandparent caregivers and single parents. Methods: The 2012 Behavior Risk Factor Surveillance System was used to compare five dimensions of health on a sample of Latino solo grandparents and Latino single parents, raising their grandchildren/children alone. Bivariate and logistic regression comparative analyses were conducted on study measures. Results: Latino solo grandparents have a high prevalence of chronic health conditions, including arthritis (51%), depression (40%), diabetes (34%), and asthma (34%). Latino single parents have lower but troubling health risks, including depression (22%), diabetes (14%), and asthma (14%). Differences between the two groups were largely due to the grandparents older age. Discussion: Latino solo grandparents have a high prevalence of several chronic medical conditions. The prevalence of disorders is much lower for Latino single parents, although they too have disturbing health risks. Conclusion: Latino solo grandparents perform their parenting role under intense physical and emotional strain. Health professionals can be instrumental in facilitating interventions that affect the well-being of this expanding family group.

The Health of the Nation’s Custodial Grandfathers and Older Single Fathers: Findings From the Behavior Risk Factor Surveillance System

Two important parent groups are solo grandfathers and single fathers raising children alone. The health of male caregivers raising children has received little attention by scholars. Investigating the health of single male caregivers raises awareness about their physical vulnerability. This study uses the 2012 Behavioral Risk Factor Surveillance System to compare health characteristics of 82 solo grandfathers with 396 single fathers aged 50 years and older. The findings suggest that grandfathers exhibited a high prevalence for various health conditions, including diabetes (44%), heart attack (27%), chronic obstructive pulmonary disease (23%), and stroke (6%). Almost half of grandfathers rated their health as fair/poor (47%), and nearly two in five had functional limitations (38%). Although older single fathers had better health characteristics than grandfathers, their health profile was poorer than population norms. Logistic regression analysis suggests that solo grandfathers are more at risk for poor health outcomes than older single fathers. Practice interventions to minimize health risks are discussed.

Recruiting and Retaining African American Custodial Grandparents in University-Sponsored Research: An Opening Dialogue

Studies on recruitment and retention of grandparents raising grandchildren into community-based research have received scant attention by scholars. The lack of attention is especially troubling considering the continuing growth of this family group, as well as the large proportion of custodial grandparents who are ethnically diverse and vulnerable to various health and psychological risks. Limited attention to recruitment and retention methods leads to reduced understanding of the full value of service interventions for custodial grandparents and the grandchildren they are raising. This article describes the recruitment and retention methods used in one longstanding research study involving African American custodial grandparents. The merits of establishing a research agenda on this topic are reviewed, along with specific suggestions for extending this line of inquiry.