Raymond T. Coward

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.

Dental health attitudes among dentate black and white adults.

OBJECTIVES Blacks and poor persons share a greater burden of oral disease and are less likely to seek dental care on a regular basis. The role of dental attitudes and knowledge of services on this circumstance is unclear. The authors quantified group differences in dental attitudes and knowledge of services and related them to regularity of dental care use. METHODS As part of the baseline phase of The Florida Dental Care Study, a longitudinal study of oral health, 873 respondents who had at least one tooth and who were 45 years or older participated for an interview and a clinical dental examination. Dental care use, seven dental attitudinal constructs, and knowledge of dental services were queried. RESULTS Forty-five percent of respondents reported going to a dentist only when they have a problem, and 17% of respondents had not seen a dentist in more than 5 years. Ten percent of respondents reported that they had at least one permanent tooth removed by someone other than a dentist (typically, the respondent himself). Blacks and poor persons had more negative attitudes toward dental care and dental health and were less knowledgeable of dental services. Multivariate analyses suggested that dental attitudes were important to understanding the use of dental care services for this diverse group of adults, and that race and poverty contributed independently to dental care use even with dental attitudes taken into account. CONCLUSIONS Dental attitudes contribute to race and poverty differences in dental care use among adults. The persistence of race and poverty effects with attitudes taken into account suggests that additional explanatory factors contribute as well. These differences may contribute to more prevalent and severe oral health decrements among the same adults who also are more likely to suffer from other health decrements.

Race, Aging, and Care Can Differences in Family and Household Structure Account for Race Variations in Informal Care?

There are substantial uncertainties about key dimensions of the caregiving process as it is experienced by older adults from different racial groups. This investigation explores the care received from family members among a stratified random sample of community-dwelling older (65+) African Americans and Whites who reported difficulties performing daily living tasks. Findings support past research indicating that older African Americans are more likely to receive help from family members than are Whites when in need of assistance. However, this advantage does not extend across all types of family members but, rather, is only statistically significant in the final models with regard to the care received from grandchildren. Evidence is presented that indicates that the observed race differences in the receipt of care from children can be attributed to variations between racial groups in family and household structure. The findings suggest that coresidence may be a form of family caregiving among older African Americans.

Gender Differences in the Risk of Developing Disability among Older Adults with Arthritis

Objectives:Although older women are disabled from arthritis at higher rates than men, there is an inadequate understanding of the factors that place women at higher risks. The purpose of this research is to improve understanding of gender differences in the process of becoming disabled among older adults with arthritis. Methods: Gender differences in risk factors associated with developing a disability during a 30-month period are examined among a sample of noninstitutionalized elders with arthritis (N= 749). Results:Results from discrete time-hazard models indicate that sociodemographic factors account for gender differences in disability with activities of daily living (ADLs). However, for difficulties performing instrumental activities of daily living (IADLs), gender differences remain unexplained by variations in demographic and health factors. Discussion:More descriptive and explanatory work needs to focus on gender differences in IADL disability; however, these findings suggest that the gendered nature of the IADL tasks influences gender differences in IADL disability.

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.

The Changing Caregiving Networks of Older Adults

One of the dominant features of caregiving networks, their propensity to change over time, continues to be incompletely described and inadequately understood. The purpose of this study is to illuminate the complex patterns of change that shape the evolving caregiving networks of older adults. Using data from the Longitudinal Study of Aging (LSOA), a transition matrix approach is used to describe the changes older adults experience in their caregiving arrangements over time. These caregiving networks are characterized by both stability and change. At any given time, most elders are able to live independently without the help of a caregiver. The caregiving network, once activated, appears to be characterized by a great deal of change in care configurations. Finally, beyond a certain threshold off frailty, extensive care is required in either a community or an institutional setting. Variation in transitions by age, gender, race, and place of residence are examined.

Racial differences in the household composition of elders by age, gender, and area of residence.

Using census data and an innovative technique for describing the composition of households from the perspective of elders, this research provides a more detailed description of race differences in living arrangements of older persons than has previously existed. In addition, cross tabulations of race with other factors known to influence household composition (gender, age, and area of residence) are examined. While white women are more likely than black women to live alone, the reverse is true among men. Whites are more likely than blacks to live in married-couple-only households, and blacks are more likely than whites to live in multigenerational households, although these differences decrease with advancing age. Blacks are also more likely than whites to live with collateral kin or nonkin only, although these categories comprise small proportions of the population. Implications of these differences for caregiving and quality of life among older persons are discussed.

Race Differences in the Health of Elders who Live Alone

This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 measures of health were collected in telephone interviews with a stratified random sample of community-dwelling elders (n = 1,189). Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others. Where racial differences in health did exist among older adults who lived alone, the differences could only sometimes be accounted for by population composition factors that are known to influence health.

Diabetes knowledge and sources of information among African American and white older women.

African American women have a disproportionate risk of diabetes-related morbidity and mortality. Despite this risk, evidence indicates that educational interventions are not aimed at this population. We also currently lack basic information about the source of diabetes information for African American women and how such sources might affect their knowledge of the disease. We interviewed 51 women with diabetes to address such deficits in our understanding and, conceivably, to contribute culturally sensitive recommendations to enhance glucose control. To detect ethnic variations in knowledge and information source, half of our selected sample was African American and half was white. Results indicate that African American respondents achieved lower scores on the Diabetes Knowledge Test than their white counterparts. However, few differences were noted in the source of diabetes information, with both groups receiving their information from a wide variety of sources. Implications for health providers and educators are discussed.