Jeffrey W. Dwyer

Gender, families, and elder care

PART ONE: PERSPECTIVES ON GENDER AND FAMILY CAREGIVING Gender, Family and Long-Term Care of the Elderly - Jeffrey W Dwyer and Raymond T Coward Demographic Perspectives on Gender and Family Caregiving - Raymond T Coward, Claydell Horne and Jeffrey W Dwyer Conceptual Perspectives on Gender and Family Caregiving - Alexis J Walker PART TWO: THE STRUCTURE OF CAREGIVING RELATIONSHIPS Gender Differences in the Experiences of Caregiving Spouses - Eleanor Palo Stoller Gender Differences in Patterns of Child-Parent Caregiving Relationships - Rhonda J V Montgomery Siblings as Caregivers in Middle and Old Age - Victor G Cicirelli PART THREE: THEORY AND RESEARCH Filial Responsibility - Rosemary Blieszner and Raeann R Hamon Attitudes, Motivators, and Behaviors Gender Differences in Family Caregiving - Gary R Lee A Fact in Search of a Theory Methodological Issues in the Study of Gender Within Family Caregiving Relationships - Amy Horowitz Gender and Family Care of the Elderly - Jeffrey W Dwyer and Raymond T Coward Research Gaps and Opportunities PART FOUR: IMPLICATIONS FOR POLICY AND PRACTICE Employment, the Family and Employer-Based Policies - Karen Seccombe Social Policy and Gender Inequities in Caregiving - Nancy R Hooyman Research on Gender and Family Caregiving - Lisa P Gwyther Implications for Clinical Practice

The Association of Gender, Sibling Network Composition, and Patterns of Parent Care by Adult Children:

Based on matched data from the 1982 National Long-Term Care Survey and the National Survey of Informal Caregivers, this article explores the degree to which separating adult children (N = 3,742) by the composition of their sibling network (i.e., only children, single-gender networks, and mixed-gender networks) provides insight into the association between gender and patterns of parent-care. Caregiving participation was calculated as a proportion of the availability of all children of a specific gender. The data reveal that, within all sibling network categories, daughters were more likely than sons to be providing care to an impaired parent; however, the repercussions of being a caregiver were not similarly uniform. Specifically, sons and daughters from only-child and single-gender networks reported a similar number of hours per day spent in parent-care and experienced comparable levels of stress and burden. In contrast, daughters from mixed-gender networks reported significantly higher levels of stress and burden and more hours per day spent caregiving than sons. These findings demonstrate that differentiating children by sibling network type does offer some clarity to our understanding of the complex association between gender and patterns of parent-care.

The effect of religious concentration and affiliation on county cancer mortality rates.

Previous research has documented lower cancer mortality rates among religious groups characterized by doctrinal orthodoxy and behavioral conformity. In addition, there is evidence that the general population in an area with a high concentration of religious participants may experience health benefits resulting from diminished exposure to or increased social disapproval of behaviors related to cancer mortality. This research examines the effect of religious concentration and denominational affiliation on county cancer mortality rates. Our findings suggest that religion has a significant impact on mortality rates for all malignancies combined, for digestive cancer, and for respiratory cancer when we control for demographic, environmental, and regional factors known to affect cancer mortality. These results provide new insight into the relationship between religion and health at the macro or community level and suggest that the influence of religion on social structure warrants further attention.

Elder Care as Family Labor The Influence of Gender and Family Position

This research indicates that gender differences in the performance of specific caregiving tasks and the amount of time spent providing care by family caregivers of frail elders should be considered in the context of family position-related norms and expectations. Using a nationally representative sample of noninstitutionalized impaired elderly people in the United States (N = 813), the results show that husbands (when compared to wives) and daughters (when compared to sons) report spending more time and performing a greater number of caregiving tasks. The authors suggest that family position may confound interpretations regarding the association between gender and family caregiving.

Structure of a depression measure among American Indian elders: Confirmatory factor analysis of the CES-D scale

This research examines differences in depressive symptomology among urban, rural off-reservation, and reservation-residing American Indians, age 55 years or older, of the eastern Great Lakes region. It analyzes the measurement structure of one commonly used depression scale, the Center for Epidemiological Studies Depression Scale, and tests alternative models for the full sample (N = 277) as well as the three residential strata. Findings show that a 12-item version developed by Liang et al. for use with Mexican Americans provided a superior fit over the original 20-item version. The shortened scale included items more conceptually valid for this American Indian population. Furthermore, tests of invariance revealed that only the 12-item version had similar factor structures and factor loadings across the three residential strata.

Differences in Characteristics of the Caregiving Network by Area of Residence: Implications for Primary Caregiver Stress and Burden.

The objectives of this research are to (a) compare characteristics of impaired elderly care receivers, primary caregivers, informal networks, and formal networks likely to impact primary caregiver stress and burden by area of residence and (b) fit a conceptual model explaining primary caregiver stress and burden in rural, small city, and urban samples. The data are from a matched sample of 1388 noninstitutionalized functionally limited elderly people and their primary caregivers drawn from the 1982 National Long-Term Care Survey and the National Survey of Informal Caregivers. Results show that there are significant residential differences in characteristics of the caregiving network in general, but minimal variation in primary caregiver stress and burden. Furthermore, there are some structural differences in the ability of the conceptual model to explain stress and burden by area of residence. These findings suggest that residential differences in the complex factors associated with primary caregiver stress and burden should be considered when formulating public policy, designing intervention strategies, and conducting future research.

Changes in the Helping Behaviors of Adult Children as Caregivers

This research uses data from the longitudinal file of the 1982-1984 National Long-Term Care Survey to (a) describe changes in the caregiving responsibilities of adult children over time and (b) estimate the effect of adult child, impaired elder, and sibling participation characteristics on changes in the participation of adult children as providers of ADL and IADL assistance. The results show that 5.2% of adult children who did not provide ADL help and 12.6% of those who did not provide IADL help at Time 1 were helping with these tasks at Time 2. Conversely, 50.7% of adult children who provided ADL assistance and 29.9% of those who provided IADL assistance at Time 1 had stopped providing such care by Time 2. Logit models used to predict changes in the helping behaviors of adult children indicate that there are both differences and similarities in the factors that affect the likelihood of becoming a caregiver and of discontinuing assistance over time.

Home-based management of urinary incontinence: a pilot study with both frail and independent elders.

Objective The participation of older rural women and their caregivers in a pilot research study on behavioral management interventions for urinary incontinence is described. Design A quasiexperimental design was used. Setting and Subjects Women 55 years old and older and living in a rural county in North Florida who had episodes of urinary incontinence twice or more per week were included. Outreach was directed at two groups of elders with incontinence, those who were functioning independently and those who were frail and dependent on caregivers for assistance with activities of daily living. Methods Behavioral management of continence comprised three techniques for the management of urinary incontinence: self-monitoring, scheduling regimens, and pelvic muscle exercise with biofeedback. Main Outcome Measures The main outcome measures were episodes of urine loss and amount (in grams) of urine loss with time, determined with a weighed pad test. Results Behavioral management of continence resulted in significant decrease in urinary incontinence; decreases in frequency and volume of urine loss were found among all study participants when data were analyzed. Conclusions Although behavioral management of continence was effective in reducing incontinence among independent, community-dwelling elderly women, there was a marked lack of response to this project by frail elders and their caregivers. The same barriers to implementing time-intensive behavioral management interventions among frail elders in long-term care facilities may operate in the home setting.

The Depressive Symptomatology of Parent Care Among the Near Elderly The Influence of Multiple Role Commitments

This article investigates the independent additive and the interactive effects of being an informal caregiver of an elderly parent and three role commitments (being married, having a child or grandchild coreside, and being employed) on depressive symptomatology. For the respondents with a living mother, being a caregiver to their mother was not associated with the level of depressive symptoms. For the respondents with a living father, being a caregiver to their father was associated with higher levels of depressive symptoms. Respondents who were caregivers to their father reported lower depressive symptom scores due to being married and due to being employed. Being married and being employed may provide an alternative source of integration and thus buffer the detrimental effects that caregiving for a father has on depressive symptomatology. The findings are discussed in the context of role strain and role enhancement perspectives.

Siblings as Caregivers for Impaired Elders

Most older people regard their siblings as a caregiving resource, but only small percentages actually receive sibling help. The purpose of the present study was to determine what elder characteristics are associated with receiving sibling care, and what causes its initiation and cessation over time. Using longitudinal data from the 1982-1984 National Long Term Care survey, 293 elders were identified who received sibling help in either 1982, 1984, or both, and 146 elders were sampled who received no sibling help at either time period. The elder characteristics examined were age, gender, race, education, income, marital status, number of living children, perceived health, and ADL and IADL impairments. In LOGIT analyses, those receiving sibling help at Time 1 were more likely to be younger, to be maritally disrupted or never married, to have fewer living children, and to reside in small cities. Those reporting the onset of help by Time 2 were more likely to be younger, never married, and living in rural areas, and those reporting cessation of help were more likely to be older, to have a decrease in IADL impairment, and to have changed their area of residence. The findings support the concept of a substitution hierarchy where sibling help is given when the elder has functional impairments and support from a spouse or adult children is unavailable.