Abstract
This study sought to understand the ways that adult daughters and their parents make sense of the older adult’s aging and one another’s changing roles within the context of the decision to move a parent to a care-related facility. In particular, the decision to move a parent to a care-related facility provides a context for the study of uncertainty, ambivalence, and other concerns connected with role transitions and decision-making difficulties. How older parents and adult daughters communicate about and cope with these challenges was compared. Babrow’s problematic integration theory provides a framework for this research. A qualitative study employing in-depth interviews with 44 residents at continuum-of-care facilities and 12 adult daughters of residents was conducted. Findings indicate that both parents and daughters experience significant problematic integration. However, their attempts to cope are in marked contrast to one another. These differences, along with theoretical and practical implications, are discussed further.
The bond between parents and children is significant and long lasting (Birditt, Miller, Fingerman, & Lefkowitz, 2009). Their relationship is a primary source of emotional and instrumental support and typically remains high in quality across the life span (Carstensen, 1991, 1992). Yet, parents and children are no strangers to conflict, and the closeness of their relationship yields more ambivalence than any other interpersonal relationship (Fingerman & Hay, 2004; Fingerman, Hay, & Birditt, 2004). Older parents and their children, in particular, undergo role transitions and may struggle to negotiate one another’s complex and divergent concerns. In short, closeness and strain coexist within parent–child relationships in mid- and late life (Lang, 2004).
Potentially increasing the difficulty in negotiating these changing relationships is the struggle between autonomy and paternalism (Morgan & Hummert, 2000; Smelser, 1998). Aging is often accompanied by an increased need for assistance. This is a likely source of ambivalence and uncertainty as the pair faces contradictory pressures to satisfy a parent’s need for autonomy while also fulfilling a child’s need to paternalistically help/overhelp and protect/overprotect the parent (Cicirelli, 1992). Older parents may face a struggle between gratitude and frustration with one’s children, and between losing independence for the sake of personal safety and accepting the risks associated with living alone. Children experience conflicting emotions as they weigh the potential positive and negative outcomes that may result from either working to maintain the older adult’s independence or acting paternalistically. Adult children also wrestle with being both a child and a caregiver to their parents; maintaining parental authority while keeping their parents safe from harm (McCullough, Wilson, Teasdale, Kolpakchi, & Skelly, 1993; Silverstein & Giarrusso, 2010). According to Stamp (2004), acting as both child and caregiver may result in conflict and role strain.
Adding to this complexity, few clear-cut role expectations exist for parents and children as they age (Piercy & Chapman, 2001). Shifts in late life are less clearly dictated in society (Fingerman & Hay, 2004; Mancini & Blieszner, 1989) and older adults and their adult children lack socialization for how to cope with issues related to increased longevity and declining functional ability (Shanas, 1980). Research suggests that role transitions such as these may heighten ambivalence because norms for behavior are uncertain (Fingerman, Chen, Hay, Cichy, & Lefkowitz, 2006; Luscher & Pillemer, 1998).
The Aging Parent–Daughter Relationship
The bond parents have with their daughters is one of the strongest and most enduring among intergenerational relationships (Fingerman, 1996; Willson, Shuey, & Elder, 2003). Daughters are considered kin keepers (Gonyea, Paris, & de Saxe Zerden, 2008) and nurturing loved ones, particularly fulfilling the filial task, is an expectation associated with their role in the family. In fact, daughters are twice as likely as sons to become primary caregivers to their parents (Gonyea et al., 2008). However, the parent–daughter relationship has also been characterized by significant ambivalence (Pillemer & Suitor, 2002). According to Pecchioni (2001), the increasing dependency of a parent is an important transition in the parent–daughter relationship.
The Decision to Enter a Care Facility
Decision making is an area where adult daughters may experience high degrees of tension with their parents (see Pecchioni, 1999). During the decision-making process, each struggles with his or her own uncertainties and ambivalence while being confronted with the concerns of the other. Aging families face the prospect of many difficult decisions ranging from when the parent should stop driving to who should maintain control of the parent’s finances (Cicerelli, 1992). The decision for a parent to move from his or her home into a care-related facility is arguably one of the most difficult decisions for aging families to make (Eckert, Carder, Morgan, Frankowski, & Roth, 2009; Gill & Morgan, 2011). For parent and child, this decision directly calls attention to the older adult’s loss of independence, the struggle between paternalism and autonomy, and the ambiguity in relational roles.
Decision difficulties
Once the filial task of midlife is upon them, children recognize the current and future needs of their parents and must consider how best to provide support. When to bring up issues of care and dependency, how to do so in a face-saving manner, how best to care for their parents, and ultimately whether a move to a care facility is appropriate are among the myriad uncertainties adult children grapple with. Ultimately, when families must decide whether or not the parent should move to a care-related facility, they confront numerous challenges due to the social stigma associated with such facilities (Kaiser Family Foundation & PBS’s NewsHour, 2001).
Research has found that time and again older adults are not a part of the decision-making process (Castle, 2003; Myers & MacDonald, 1996; Nolan & Dellasega, 2000; Nolan, Grant, & Keady, 1996; Reinardy, 1992). Children often avoid discussions with their parents because of the negative image of institutionalization (Davies & Nolan, 2003; Nolan, Grant, & Keady, 1996). Additionally, adult children report that these conversations are extremely difficult to instigate with their parents and they avoid such conversations until they are inevitable (Eckert et al., 2009; Morgan & Hummert, 2000). In this vein, families often avoid planning ahead, choosing not to discuss a loved one’s future care needs until a crisis is imminent.
Goldberg (2004) suggests that these decisions are even more difficult because families are coping with recent changes in their loved one’s health and/or independence. The emotional challenges of ambivalence and uncertainty have not received extensive attention by researchers examining this decision-making process. Researchers, however, have hinted that ambivalence would be a likely outcome considering the context. Willson, Shuey, and Elder (2003) assert that ambivalence is a normal feature of relationships experiencing changes in interdependence, similar to the changes older parents and their children face during the decision to move to a care facility. Pillemer and Suitor (2002) agree that life course transitions are fertile periods for ambivalence.
An Application of Problematic Integration Theory
By examining uncertainty, ambivalence, and other related phenomena, Problematic Integration (PI) theory affords insight into the concerns with which parents and their adult daughters must cope when considering the need for a move to a care-related facility and discussing this topic as a family. The theory provides a framework for understanding why such experiences may be particularly problematic by exploring the intertwining of values and probabilities (Babrow, 1992, 1995, 2001, 2007). It places communication at the center of both the experience of PI and the coping with it.
Probabilistic orientations are beliefs about the likelihood of occurrences. Humans simultaneously evaluate those occurrences, determining if they are positive, negative, or neutral. Integration means that probabilities and values are reciprocally influential. Many of our integrations are unproblematic and therefore go unnoticed. However, PI theory asserts that when integration is problematic, integrative dilemmas will occur in one of four forms: uncertainty, ambivalence, divergence, or impossibility.
If we are unable to discern what the probability of an occurrence is, our uncertainty will be problematic “to the extent that we value positively or negatively whatever is at stake” (Babrow, 2007, p. 17). Ambivalence, the second form of PI, will result if we are unsure how we feel about an occurrence, have mixed feelings, or must choose between mutually exclusive options, each with positive or negative evaluations. Individuals may also experience PI through divergence, when something that is highly (positively) valued is unlikely to occur or when something is very negatively valued and is likely to occur. Finally, impossibility arises when an outcome is highly valued but has no probability of occurring.
More generally, according to Babrow and Mattson (2003), “the meaning of uncertainty [or any form of PI] . . . is profoundly dependent on the values at stake” (p. 11). As an example, the uncertainties, ambivalence, divergence, and impossibility faced by adult children while making living arrangements and long-term care decisions with/for their parents are most likely exacerbated by the high value they place on the health and well-being of their parents and the relationship they have together.
PI theory also asserts that expectations and values are integrated with the probabilities and evaluations of other objects of thought, creating a chain or web of PI. Problematic integrations are often complex and messy. We may experience multiple forms of PI simultaneously. And experiencing one form of PI can lead to the experience of other forms (about the same or other topics). For instance, an adult child may become concerned about her mother’s ability to continue to live on her own. She experiences uncertainty about her mother’s continued independence and when it may become necessary to talk to her about moving to a retirement or assisted living facility. These thoughts stimulate PI surrounding other topics of concern. She may begin to worry about whether her mother will be receptive to a discussion about such a move. And thoughts about such a discussion might also provoke ambivalence as she tries to determine whether confronting her mother about a move would be too face-threatening and damaging to her mother’s self-esteem and independence or whether such a discussion is necessary for the protection of her mother’s safety.
Communication also provides coping resources for those experiencing PI. As individuals share their concerns, they commiserate and may find ways to cope with or accept their circumstances. Individuals may also employ communication in their search for more or better information to reduce an uncertainty, reevaluate their situation, or help sort out ambivalent feelings.
Methodological Approach
For this study, it is important to understand the experiences of both older parents and adult daughters. The problematic experiences of older adults are different than those of their daughters. We cannot generalize across ages, cohorts, cultures, or historical time periods in the problems that surround our understandings of aging. We can benefit from examining the particular concerns of both cohorts, situated within their years of lived experience—a situatedness that is recognized by the interpretive perspective. Thus, this study is built upon assumptions of the interpretive paradigm, which align well with research on aging, family communication, and PI.
The interpretivist perspective views communication and relationships as central to meaning creation. The older parent–adult daughter relationship is uniquely positioned to influence the PI both parties experience. Additionally, this relationship needs to be understood in context, within the culture and life world of the family, to understand their communication about and coping with PI. To these ends, perceptivity (Eisner, 1991), or heightened sensitivity to issues that concern families when making care-related decisions, and the ability to undertake the perspectives of multiple family members, is essential for producing a deeper understanding of the communicative behaviors of both parent and daughter.
Research Questions
The general goal of this study was to illuminate in as much depth and detail as possible the ways that adult daughters and their parents make sense of the older adult’s aging and one another’s changing roles within the context of the decision to move a parent to a care-related facility. To achieve this goal, the study was designed to answer the following sensitizing and orienting questions:
Research Question 1: What are the challenges/concerns for older adults and their adult daughters as they make decisions about moving to a care facility? How do the concerns compare/contrast between older adults and their daughters?
Research Question 2: How does each cohort cope with these challenges?
Data Gathering and Analysis
In order to gain the perspectives of individuals who have already experienced the decision-making process, we engaged in purposeful sampling, recruiting participants who are currently residents (and children of residents) in the independent living sections of continuum-of-care facilities. By studying families whose parents have already moved to the facility, we were able to examine family members’ retrospective accounts of the decision as well as the decisional outcomes. This offers the benefit of family members being able to discuss their decision-making process in its entirety. Focusing on residents of independent living helped us ensure that the parent had some input or prior knowledge of the move and would also be more likely to recall his or her communication and concerns surrounding the decision to move.
Thus, the first author interviewed current residents and children of residents at two continuum-of-care facilities located in mid-sized Midwestern cities, Carrington Village and Woodberry Place. Both facilities have been given pseudonyms for the purposes of maintaining participant confidentiality. Administrators at both facilities agreed to send recruitment letters to residents and family members listed as the primary contact for each resident. Interested individuals were invited to call or e-mail the author directly. Recruitment letters were mailed with an accompanying letter from the administrator introducing the study and encouraging participation. All procedures were reviewed and approved by the appropriate institutional review boards (IRBs).
Forty-four older adults were interviewed. Of these 44 participants, 20 were residents of the first facility and 24 were residents of the second. The average age of the participants was 84.6. The youngest individual was 65 and the oldest was 94. The average length of residence for these participants was 4 years, with the shortest length being 4 months and the longest being 16 years. Additionally, 12 adult daughters of residents were interviewed. Their average age was 58.2. The average age for their parents was 87.1. The parents had lived at their respective facilities for an average of 4 years, with the shortest duration being 6 months and the longest being 6 years. Each participant was interviewed individually using a loosely scheduled open-ended format. Interviews lasted between 45 and 90 min and took place in the participants’ homes or in a public area at the care facility. The interviews were digitally voice recorded and later transcribed verbatim. Confidentiality was guaranteed for all participants.
Approach to Analysis
Rather than creating a universal theory, the goal of the analysis was to understand the phenomenon under study and identify patterns of communication and coping (Strauss & Corbin, 1998). Thus, the interview data were analyzed using techniques that are not strictly inductive or deductive but rather abductive in nature (Miles & Huberman, 1994). The abductive approach recognizes the value of understanding participants’ experiences from their perspective and through their voices. Abduction assists the researcher in moving from participant accounts to theoretical description of the observed patterns using concepts or themes derived from existing literature. The researchers can then add to, clarify, revise, or in other ways further illuminate the suggested themes based on the ideas and interpretations that emerge from the data. Thus, for this study the concepts from PI theory were understood as sensitizing concepts used to provide initial guidelines that were built upon as data analysis continued (Blumer, 1969; Miles & Huberman, 1994).
PI can be discerned in research even when it is not recognized by the research participants themselves (Babrow, 2004; Babrow & Dutta-Bergman, 2003; Gill & Babrow, 2007). The authors used both direct and indirect methods for assessing the meanings each participant attached to his or her experiences. While direct assessment refers exclusively to respondents’ recognition of contradictions, uncertainties, and so on, indirect assessment accesses a latent state by allowing the researcher to gather and link contradictory reports or concerns and then interpret the respondent as being ambivalent or uncertain (Lettke & Klein, 2004; Luscher, 2004). Both direct recognitions of PI and latent experiences of PI were elicited through interview questions and interpretation of the interview data.
The process of data analysis began with intensive and repeated readings of the transcripts. Each unit of meaning was coded. Codes were then refined and connections between codes were developed with subsequent read-throughs. The authors constantly compared the text under study to the sensitizing concepts as well as to categories already developed in the analysis. Through constant comparison more abstract connections and a framework for understanding the experiences of the daughters and older adults emerged. The authors met repeatedly to discuss interpretations and agree that saturation was achieved with the accumulated data.
Results and Discussion
In answer to RQ1, the older adults in this study indicated overall satisfaction with their family communication and their move. This satisfaction, however, does not preclude them from experiencing PI. In fact the older adults and their adult daughters share many of the same concerns and challenges related to the care facility decision. Uncertainty, ambivalence, and divergence are particularly widespread and the topics about which they experience these concerns also tend to overlap, but there are some subtle differences that arise due to role expectations in this complex transition.
Ambivalence
Older adults’ ambivalence
For both the older adults and adult daughters, ambivalence was experienced more than any other form of PI. Older adults experienced extensive ambivalence related to their independence, their relationships with their children, and the move to a care facility. In most instances older adults’ ambivalence was latent, going unrecognized or unacknowledged by the participants. This latent ambivalence often emerged when participants did not express their concerns or negative emotions at first, but these concerns slipped out late in the interview or when older adults switched back and forth within the same story, vacillating on the details of the experience (for example indicating both control and lack of control in the decision to move or being both happy and troubled by the decision).
The move itself engendered significant ambivalence for older adults. For example, one participant stated:
Most of my decisions have been of the heart and not of the head. And I didn’t have to wrestle with it. I just decided to do it. And I felt comfortable doing it. And if I had analyzed it economically, I wouldn’t be here. But I might be falling down the stairs too, that’s part of it. So I . . . I’m happy.
This participant claims he had no problems making the decision to move. However, he later acknowledges some ambivalence, particularly with regard to the cost of the facility. He vacillates between not having difficulties with the decision, revealing some ambivalence about the financial burden, and then focusing on the positives of his safety and well-being by having made the decision.
During their narratives, older participants vacillated over who had control within the relationship, and in particular who ultimately held control of the decision for the older adult to move from his or her home into the care facility. Relatedly, older adults experienced ambivalence about their independence and spoke uncomfortably about role reversals. For instance, one participant stated, “Uh well I think as you get older I mean you become the child and they become . . . oh I don’t know, no we have a good relationship, all three of em, ya know we have a good relationship.” While this participant briefly acknowledges a parent–child role reversal, she is uncomfortable with this comment and censors herself, turning to focus on the positives of her relationship with her children.
Daughters’ ambivalence
Every daughter in our sample spoke of the significant ambivalence she experienced surrounding the decision itself, her parents’ loss of independence, her relationship with her parents, and difficult but necessary role reversals. The most widespread source of ambivalence regarding these topics was the need for communicating about them with their parents. All of the daughters had thought about the possibility of moving their parents to a facility long before ever discussing it with their parents. All had weighed the positives and negatives of either letting the parent stay at home or urging the parent to move. And all have continued to weigh these positives and negatives even since the move has been accomplished. In regard to the ambivalence she experienced about communicating with her mother, one daughter stated:
It hurt me that she didn’t understand that I wasn’t putting her away. I wasn’t, ya know, that this was a good thing for her. . . . I mean, I would go home and I would just cry. Ya know, ‘cause she would feel that I would put her in this terrible place. But the people were so nice. And I knew she was going to be safe.
While this daughter knows her mother is safe, her mother’s reaction makes it difficult for her to be happy with their decision.
When the daughters spoke of their feelings about the responsibilities they have taken on as their parents have aged, they saw it as a necessity but were particularly ambivalent about reducing their parents’ independence. Several expressed their concern over doing what needs to be done but not overstepping boundaries. For instance, while one participant speaks matter-of-factly about what she does to help her father, she also expresses how much these responsibilities bother her:
I’m like . . . he’s the child and I’m the mother now. It’s a situation that has to be taken care of. So I guess I’m the mother and he’s the child at this time. I put his shoes on, I tie ‘em. I put his socks on. I do all these things. Um . . . if I didn’t have the Lord I don’t know if I could do it. It’s very difficult, it’s very hard. Um. The first time you do some of the things I’ve been doing it’s very difficult.
Uncertainty
Older adults’ uncertainty
Most of the older adults’ uncertainties centered on what their remaining years would look like, including whether they would have financial stability, whether they might become a burden to their families, whether they would be able to adjust to living in a care-related facility, and for how long they would be able to continue driving. For instance, one older adult conveyed her concerns about adjusting to the move, stating, “I thought maybe I won’t like it. Maybe I . . . maybe it’s not time to move into this type of place.” And another stated more generally, “I just hope I’m not a burden to anyone else.”
Daughters’ uncertainty
As they weighed the positives and negatives of moving their parent to a care facility, uncertainties about how to proceed with a discussion arose for the daughters in this study. Communicating with their parents was their main source of uncertainty. And the uncertainties surrounding the decision did not simply disappear once a decision had been made. Daughters subsequently experienced uncertainty about whether or not the move was the right decision and about what to do should the move not work out. One daughter says her biggest worry was “what if she didn’t want to stay there, ya know, what would I do then?”
Several daughters provided examples of how these uncertainties affected their families’ communication. Some resulted in a sense of indecision within the family, others in rushed decisions, a lack of family communication, and paternalistic behavior from the child. For example, one daughter talked about rushing her mother out of her home once she agreed to a move. She avoided all further discussion out of fear that her mother might change her mind. A second daughter’s uncertainty about whether her mother would be able to adjust to the facility led her family to engage in a “trial run.”
She couldn’t be left alone because I know she’d be opening the door to almost anybody or walking out and not knowing where she was or anything like that. So this was the only thing we could do. . . . What we thought we would do is clean the place up and get it ready for sale and then bring her back there and say ya know we thought well, worst case, we can always hire somebody to be with her during the day at least. And so ya know she’d have companionship during the day. And I did take her back to the house. And I said “Do you want to come back here and live?” And she kind of looked around and it wasn’t her place anymore, and said, “No, I don’t want to.”
Divergence
Older adults’ divergence
For the older adults in this study, highly negative issues including the potential of future illness, loss of independence and ultimately their mortality were faced head-on as they made the care facility decision. Participants described their family communication surrounding this decision as necessarily dealing with concerns about their decline and their future inability to live alone. While negative, these declines were seen as highly likely, thus necessitating the move. For example, one older participant stated:
I’m 85 and I have I know that I have lived long enough and observed enough to know that uh . . . uh the chances of my good health not staying good ya know forever, um I would wish it otherwise but it doesn’t always work that way. I just anticipate, I don’t want to be dependent on my children.
Daughters’ divergence
For the daughters, divergence occurred as they faced the difficult fact that a decision needed to be made and that they would need to have a potentially unpleasant and face threatening conversation with their parents. For instance, one daughter stated:
Well, it’s a very very hard, difficult decision to make. And as close as we have been it’s been almost devastating to me at times at the beginning of this. And . . . I lost a lot of sleep over it. I’ll tell you that. And I wondered if I had done the wrong thing.
It is clear from the preceding discussion that the older adults and their daughters both experienced divergence as well as uncertainty and ambivalence about the life transitions associated with aging and the move to a care facility. However, concerns also demonstrate subtle difference in focus, with the older adults more concerned about potential illness and loss of independence while the daughters were most concerned about the communication surrounding care-related discussions and the decision’s effect on the parent–child relationship. This supports Fingerman’s (1996) theorizing about the developmental schism, which explains life stage differences between adult daughters and their parents. While they share some similarities, the subtle differences presented here underline parents’ and daughters’ unique perspectives and concerns regarding this transition.
Impossibility
Differences between parents and adult daughters were further highlighted through the experience of impossibility. The older adults in this study did not speak in terms of troubling impossibilities. While we might expect older adults to experience impossibility at the loss of their independence, instead they acknowledged and accepted these potential changes. However, the daughters in this study frequently exhibited a deep sense of loss in their interviews. They saw no chance of retaining the highly valued parent–child relationship as they had known it for so many years. The changes to their parents’ mental and physical capacities and ultimately to their independence meant to these daughters that the parent they had previously known would never come back. For example, one daughter remarked:
Everything has changed. You lose your mother. Uh, because you end up being the mother and this ends up being your child. And you have to make the decisions and pay the bills because she’ll get mixed up or she won’t do it. And everything changes. It bothers me uh but I understand that that’s the way it is and I can’t do anything about it. So that’s, ya know, the relationship has changed. And you just don’t have your mother anymore.
Coping
In answer to Research Question 2, the parents and daughters in our study exhibited vastly different methods for coping with PI. Some methods were more successful than others, allowing the individual to better adapt to the challenges she or she faced. The methods that were found to be less successful inhibited the individual from fully expressing his or her concerns with family members and ultimately from adapting to the challenges faced, leaving the individual in a continued struggle with PI. Overall, the older adults in this study were satisfied with their move and their family communication. However, the daughters we spoke to demonstrated continued angst, guilt, and concern over whether their parent’s move was the right decision. These differences can be better understood through an examination of the focus of their coping efforts through the lens of PI. The older adults focused on evaluative orientations and seeing their circumstances in a positive light. However, the daughters focused heavily on attempts to change their probabilistic orientations.
Older Adults’ Coping
The older adults in this sample engaged in several successful coping measures. These measures fell into three categories: focusing on the positive, framing the situation, and facing the negatives with a mind-set of acceptance and adaptation. Each of these coping measures is accomplished primarily through communication with family members, friends, and other residents at the facilities.
Focusing on the positive
Older adults often referred to positive communication with their children as a source of hope for the future. When discussing the uncertainties surrounding how their children may care for them in the future, several participants referred to current or past examples of positive communication with their children. They used these as a means for justifying hopeful uncertainty about future communication and decision making, in essence placing a positive value on the uncertainty itself. For instance, one older adult stated, “[My daughter and I] talk mostly about hope . . . that I can live here until my dying days. She wants me to stay healthy.”
When dealing with ambivalence or divergence, some participants chose to reevaluate the occurrence in a positive light rather than live with mixed or negative evaluations. Over the course of their talking, these participants verbally eliminated their negative feelings, focusing only on the positives. For example, in reference to the loss of her husband, one participant stated:
But even with his loss, I’m happy here because I’m well taken care of, I have wonderful neighbors. The gal next-door, she’s a jewel. And all the people on the floor and in the building have been very supportive of me. I feel like I have a big family here. And of course I have the view out here of the entrance. And there’s one tree out here that always just turns so red and it’s beautiful.
In this excerpt, the participant forgoes dwelling on her sorrow over the loss of her husband in favor of focusing on small but vital positive experiences.
Another widely employed method for positive evaluation was the use of comparisons and contrasts. Participants frequently compared their situations to past family experiences, other older adults who are worse off than they are, others who have not made the decision to move (and are thus also worse off), and others who have similar concerns (to indicate that they are not alone). They also made comparisons to their struggles of living alone before moving to the facility. The purpose of pointing out such similarities and differences was to place themselves and their decisions in a positive light.
Framing
Another means for viewing the decision positively occurred through framing. Specifically, the participants in this study framed their decision to move to a care facility as a benevolent gift to their children. In fact, many stated that they had moved for their children’s sake more than their own. They saw the decision as a means for preventing their children from having to make that decision for them and also as a means for relieving some of the care giving responsibilities their children would have had to perform had they remained in their homes. Additionally, some participants saw themselves as being an example of successful aging for their children. Moreover, this framing allows them to retain a sense of control in their relationships by making a choice that benefits their children. In essence, making this decision as a means to assist their children maintains the traditional parent–child roles.
Older participants also framed their lives at the facility in ways that allowed them to maintain a positive evaluation. In particular, participants framed the facility as allowing them to maintain their independence rather than limiting it. They viewed the provision of assistance and the facility’s restrictions as just the right amount of help they need to continue to do everything they want to do. Thus, even though they are receiving help from the aides at the facility, they frame this help as independence-maintaining rather than limiting.
Acceptance
Older adults also chose to cope through simple acceptance or adaptation to what they could not change. Rather than worrying about what might occur in the future or complaining about current circumstances, these individuals focused on accepting changes in the parent–child relationship, their level of independence, and ultimately their own passing. They also underlined the importance of adjusting to the care facility. Acceptance usually occurred when framing and reevaluation would not have been reasonable responses. Rather than trying to put an exclusively positive orientation on death, for example, older adults were realistic in their assessments. In reference to the declines that often accompany aging, one participant commented matter-of-factly, “It’s a natural progression.”
Daughters’ Coping
Shoring up
When coping with uncertainty, the daughters in this study most often attempted to support or justify their decision, in essence shoring up any potential questions in their own minds of whether or not they had done the right thing for their parent. The participants chose to justify their decisions and actions through the provision of multiple facts and reasons. To eliminate their guilt and uncertainty about whether this was in fact the correct decision, they attempted to minimize alternative options such as home care, used examples of the older adult’s need for increased assistance which the child was unable to provide and examples of the older adult’s successful adjustment to the new facility. Focusing on the fact that this decision was the right decision and the best decision also helped daughters cope with ambivalence. Whether or not the daughters presented the decision as a positive one, they always presented it as a necessary one.
Employing certainty
The experience of PI is particularly difficult to cope with because of the dynamic and shifting constructions that underlie participants’ attempts to understand their situation. Daughters’ efforts to grapple with the changing meanings of their own experiences are demonstrated through their use of certainty. More than any other means for shoring up their uncertainties and eliminating negative evaluations, the daughters in this study employed certainty. They focused on the necessity of the move and other care giving responsibilities. They spoke with assuredness about issues that in reality are far less certain. Every daughter in this study simplified her concerns and avoided communication concerning the messiness of uncertainty, ambivalence, and divergence altogether. For example, one daughter, who had quickly moved her mother from her home after her mother’s surprising agreement, stated, “The only thing is I regret rushing her so much.” However, later in her interview, any sense of concern had been eliminated. She stated, “I’m thrilled. I have absolutely no regrets. This place is absolutely fantastic.” Thus, she chose to avoid further discussion of her concerns. Rather she claimed with certainty that she had no regrets. This shift from regret to certainty of no regrets is exemplary of the grappling with meaning that is so characteristic of experiencing and coping with PI.
Avoidance
While the daughters in this study were open and explicit about their concerns and frustrations with the researchers, they avoided any communication with their parents that would provoke PI for either party. Whether by focusing on only the practical aspects of the move in their discussions with the parent, limiting communication with the parent prior to making a decision, or continuing to avoid communication about difficult topics after the move had been made, daughters engaged in communication avoidance in order to cope with what they knew might be emotional or face threatening topics. When speaking to her mother about a potential move, one daughter focused on the repair work her old home needed rather than discussing her mother’s declining hearing and eyesight. In the following excerpt, Maria recounts what she said to her mother:
The house is getting older, it’s going to need major repairs, ‘cause you haven’t put a roof on it in forty years and the electrical work that you and dad redid in 1940 and this is 1999, ya know I mean it’s shorting out. Her refrigerator that she had for 46 years finally died.
Conclusions
The older adults and adult daughters in this study conceptualized and communicated about age-related challenges differently. While older adults were ambivalent about topics such as the parent–child relationship and sharing control of the decision to move to a care facility, they often did not directly discuss that ambivalence. Alternatively, the daughters in this study readily acknowledged and openly discussed their ambivalence. The daughters were highly bothered by the care facility decision and experienced ambivalence before, during, and after the decision-making process. The daughters also expressed ambivalence about the role transitions they faced, particularly because of the negative effect these transitions had on their parents.
The uncertainty experienced by older adults centered on aspects of their future well-being. Their concerns exhibit the complexity of uncertainty that is ontological in nature (see Babrow, 2001). More specifically, each older adult’s well-being and future circumstances are currently unknown. While information may help individuals to reduce their uncertainty, these uncertainties ultimately cannot be eliminated via information seeking. They simply cannot be known until they are lived. Daughters’ uncertainties were ontological as well but were rooted in communication. In fact, communication was a major source of ambivalence and uncertainty for the daughters as they grappled with how best to discuss difficult issues with their parents. Communication was also affected by ambivalence and uncertainty, resulting in avoidance, indecision, and rushing to a decision.
Potential illness, loss of independence, and mortality were experienced by older adults in terms of diverging values and expectations. Discussions about the move to a care facility were a major source of this divergence. The decision forced older adults to confront their mortality and declining independence. Older adults did not, however, experience problematic or bothersome impossibilities. For the daughters in this study, it was the care facility decision that was constructed in terms of diverging values and probabilities. Daughters seemed to see the writing on the wall. Facing the fact that their parents were declining and in need of greater assistance and that they would have to initiate a discussion about future care was the single largest form of divergence discussed by the daughters. Daughters also experienced impossibility, referring to their parents’ declines with a deep sense of loss.
On the whole, older adults in this study were more successful in coping with PI than their younger counterparts. The older participants held a more positive outlook and were well adapted to their move. Much of their coping focused on evaluative orientations. Older adults successfully employed hopeful uncertainty, comparisons and contrasts, and framing in their quest for a positive outlook. They also accepted negatives when necessary. These coping mechanisms were often accomplished through communication.
The daughters’ coping was less optimistic in tone and less constructive. Rather than taking a positive outlook, daughters seemed to dwell heavily on the negative. They also focused their coping on probabilistic orientations, attempting to view their parents’ circumstances with more certainty than was warranted. These participants seemed quite unwilling to accept uncertainty and were uncomfortable with negative evaluations. They justified their decisions by shoring up and tended to avoid any communication that would potentially provoke PI for themselves or their parents.
Theoretical Implications
The findings of this study complement theory and research in communication, gerontology, and psychology. The use of communication theory illuminates the coconstruction of meanings of the move by parent and child. The meaning of the move and its associated life transitions are socially constructed and cannot be understood without examining how people jointly work out those meanings via communication. More specifically, these constructions are challenging in ways that can be explained by PI theory. PI theory captures the dynamic and shifting constructions of the experience as well as ways communication creates both the challenges and the coping with them. As we have demonstrated, PI theory aids in understanding and organizing the concerns of both older parents and their adult daughters surrounding the care facility decision.
Moving beyond communication theory, the findings from this study support existing social and psychological research and theory on aging. Socioemotional selectivity theory (Carstensen, 1987, 1991, 1992) and the positivity effect (Carstensen & Mikels, 2005; Carstensen, Mikels, & Mather, 2006; Mather & Carstensen, 2005) focus on the differences in the expression of concerns and methods of coping demonstrated by parents and daughters. Socioemotional selectivity theory posits that with age older adults value and become more adept at emotional regulation as a means for maximizing positive affect and minimizing the amount of energy expended on negative outcomes. Older adults tend to regulate their emotions using attention allocation strategies that allow them to focus on positive rather than negative stimuli. In fact, while younger individuals tend to focus their attention on negative stimuli, the ratio of positive to negative shifts with age. This shift, referred to as the positivity effect, helps to explain why the older adults are vastly more positive in their outlook and coping methods than their daughters.
The older adults in this study demonstrate emotion regulation more skillfully than the adult daughters. While they did experience PI, those concerns were most frequently expressed latently as they foregrounded the positive aspects of their decision-making experiences. Additionally, the absence of troubling impossibilities in the older adults’ narratives again demonstrates a positivity effect that is quite different from the impossibilities and loss that were a focus of the daughters’ discussions.
In their coping, the older adult participants focused on evaluative orientations while the daughters focused on probabilistic orientations. Again, this supports the positivity effect. The older adults focused on the positive elements of their experiences or framed their experiences so they could be viewed in a wholly positive light. On the other hand, the daughters continued to ruminate about the emotionally difficult experiences they have had surrounding the decision for their parents to move. Perhaps in an effort to justify their decisions, the daughters focused on certainty (attempting to eliminate any questions for themselves or others about whether this was a good decision, and also employing certainty about the positive outcomes of such a decision). This certainty helped the daughters to circumvent further discussion of issues that might have been messy or unresolved.
Practical Implications
The findings from this study demonstrate that the experience of PI surrounding the care facility decision and one’s means of coping with PI impact the quality and quantity of older parent–adult child communication. For instance, in their attempts to cope with their own uncertainties and ambivalence about the move, daughters engaged in avoidance, rushing to decisions, and other paternalistic behaviors that limited their parents’ involvement in the process. The means for coping and the resulting communication may have significant impacts on parent–child relationships and adjustment to the parent’s move.
Thus, this study’s findings benefit both families as they enter this period of transition and health care professionals and care facility administrators assisting families in the decision-making process. Specifically, these findings delineate some of the major concerns surrounding the decision to move to a care facility for both older adults and their daughters. Anticipating such concerns and knowing how those concerns differ between parents and children could assist families in addressing the concerns early in the decision-making process. Professionals are encouraged to address these specific concerns with families as well. Moreover, the findings of this study delineate various methods of coping and their relative success in helping individuals adapt. While the differences in coping may be a function of life stage (i.e., older individuals focusing on evaluative orientations and positive outlook), adult children and other family members assisting with the decision may be encouraged to utilize similar methods.
Limitations and Future Directions
This study focused on parent–adult daughter communication surrounding the decision to move the older adult to a care facility. While daughters are significantly more likely than other family members to act as primary caregivers for their parents (Gonyea et al., 2008), future research would benefit by examining the communication and coping between older adults and their broader family networks. Additionally, interviewing daughters and parents separately may have dampened the dynamics this study set out to examine. Interviewing families together in future studies could provide a rich context for unearthing the influence of communication on both parties’ constructions of the move and challenges associated with it. It should also be noted that this study explored the western perspective on residential care for older adults. Family communication and methods of coping with a move to a continuum-of-care facility in more collectivistic cultures, for instance, may be vastly different.
Additionally, while we did not set out to study only well-adjusted older adults, our sample did end up consisting of care facility residents who were generally satisfied with their move. Future research should examine the concerns and coping of older adults who are not satisfied with the move. What role might methods of coping play in overall satisfaction? How do maladjusted or unsatisfied residents differ in their coping from satisfied residents? And how did their communication with their children and their children’s coping play a role? These questions currently remain unanswered. Findings from the current study, coupled with future research aimed at answering these questions, could help families improve their communication and their coping with the challenges of the care facility decision. At a minimum, it could help individuals to anticipate the challenges and better understand how both parents and children attempt to deal with them.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.