Transferring Control to Others

Abstract

This study examines qualitative data describing transfers of control over life tasks (e.g., managing money, overseeing care) to close others in terms of the control by and outcome for the older person. The extant caregiving literature includes limited focus on how such task transfers occur, who controls them, and the reactions of older adults. The literature on control, however, provides extensive data that declining control has negative outcomes. Employing data from interviews with 77 adults in assisted living settings, narratives were identified where task transfers were discussed. These 26 instances were reviewed by the authors and categorized as chosen or not chosen by the older adult and their reactions categorized as positive, negative or neutral; if the initial narrative segment was ambiguous, further reading of the informant’s interview or that of a family member were added to better understand these cases. Findings show that chosen transfers of tasks to children or others were linked with a positive reaction in all instances identified, while a majority of cases where tasks were taken over by others, the reactions were negative. While literature suggests that declining control is linked to negative outcomes, our findings suggest that the process involved when tasks are transfer to others (delegated or taken by them) may be an important, under-investigated element with potential implications for future research and practice.

Keywords

control family caregiving well-being long-term care

One challenge facing older adults, as well as kin and professionals who assist them, is supporting a sense of personal control in the face of diminishing physical, cognitive, or social resources. A long research tradition examining linkages of aging with autonomy, efficacy, and control attempts to better understand these challenges to control in advanced old age (Wolinsky, Wyrwich, Babu, Kroenke, & Tierney, 2003), particularly when these challenges endanger the accustomed exercise of and subjective sense of control (Lachman, 2006; Mirowsky, 1997). The research literature on diminished control largely demonstrates its associations with negative outcomes, including diminished self-esteem and lower general well-being, indicating the importance of continued control to older adults (Heckhausen & Schulz, 1995) and prompting questions about strategies to enhance subjective control in the face of these challenges.

Several decades of research literature demonstrate that, when health or cognitive challenges arise for older adults, family members are the first line of assistance, increasing care as needed and continuing their support after relatives move into long-term care settings (Janzen, 2001; Kassner, 2011; Kemp, 2008; Port et al., 2005; Qualls & Zarit, 2010; Stone, Cafferata, & Sangl, 1987). The caregiving literature has not focused extensively on the connections between the elder’s sense of control and receipt of family care. This limitation derives from that literature’s primary focus on outcomes for care providers, rather than recipients (Martire, Schulz, Wrosch, & Newsom, 2003). Lessened personal control is, however, clearly implied in long-established concepts in the family caregiving literature, such as role reversal (Arling, 1976; Glasser & Glasser, 1962; Matthews, 2002) and learned dependency, each of which describes the largely unwanted transfer of control to others pursuant to real or perceived reductions in the older person’s capacities to manage tasks of daily life (Baltes & Carstensen, 1999; Baltes & Wahl, 1996).

Aging, Control, and Well-Being

The topic of control carries a rich history in aging research, under many terms and conceptual constructions (Pearlin, Lieberman, Menaghan, & Mullan, 1981; Skinner, 1996; Smith et al., 2000). Discussion of control, mastery, autonomy, agency, self-efficacy, and age-related threats to them has flourished for decades in both sociological and psychological research (Heckhausen & Schulz, 1995; Lawton, 1991). This literature establishes associations between loss of one’s personal sense of control and negative life events (Cairney & Krause, 2008), declines in functional capacity or physical health (Mendes De Leon, Seeman, Baker, Richardson, & Tinetti, 2004; Rodin, 1986; Seeman & Lewis, 1995), and diminished psychological well-being (Avison & Cariney, 2003; Heckhausen & Schulz, 1995; Pearlin et al., 1981) among other important psychosocial outcomes. This literature suggests that a continuing sense of personal control, reflecting strongly held cultural values (Goldsmith & Heiens, 1992; Mirowsky, 1975), is pivotal to well-being as people age although modes of achieving this control may change over time (Heckhausen & Schulz, 1995).

Age-related decline in sense of control or mastery is also well-established in the literature although the specific process underlying this loss remains unresolved (Cariney & Krause, 2008). Rodin (1986) identified negative life events (e.g., social role losses), health problems, and increased contact with the health care sector as probable explanations for declining subjective control. Other studies focus on diminished physical and cognitive functioning as reducing the potential for the effective exercise of personal control in daily life, resulting in altered subjective views (Schulz, Wrosch, & Heckhausen, 2003; Wolinsky et al., 2003). Although causality is not clear, due to predominantly cross-sectional research, the literature on older adults clearly establishes lower subjective control as associated with poorer physical and cognitive health, negative life events, and lower scores for general well-being.

Control and Receipt of Family Care

There are limited research findings on the effects of being a recipient of informal care on sense of personal control or autonomy (Martire, Stephens, Druley, & Wojno, 2002; Newsom, 1999), mostly focusing on spousal care of elders residing in the community. Newsom and Schulz (1998) found control to be connected to both self-esteem and emotional distress experienced by care recipients. Noting negative reactions to receipt of care, Martire and colleagues suggest that the importance of independence to the recipient, linked with level of spousal support received, influences whether women in their sample felt powerless in dealing with chronic health problems (2002). Spousal help and support can either enhance or erode one’s sense of powerlessness (Martire et al., 2002). Newsom suggests that the amount of help (over/underhelping) or appropriateness of care provider choices also relate to negative reactions, including those relating to self-esteem (1999; Newsom & Schulz, 1998). A low level of control was also associated with negative reactions to receipt of care (Newsom & Schulz, 1998).

Receipt of care and care recipient control have, in turn, been linked to negative psychological outcomes. Newsom and Schulz (1998) found some degree of emotional distress in nearly 40% of disabled, spousal care recipients. Furthermore, receipt of instrumental support from kin is more closely linked with threats to psychological well-being than either anticipated levels of support (Krause, 1997) or receipt of emotional support (George, Blazer, Hughes, & Fowler, 1989). Despite this, family care providers bring a unique and nuanced knowledge of their older relative’s needs and preference, making them potentially well-suited to make appropriate and relevant choices for them. Appropriateness in such choices is suggested as a potential moderator of negative outcomes from diminished control (Collins & Smyer, 2007; Wolff & Agree, 2004), given that priorities of family members may not always align with those of their relative receiving care (Williams, Desai, Rurka, & Mutran, 2008).

Relatively little attention has been paid to date to understanding the processes through which the responsibility for particular tasks of daily life, such as managing money or choosing where and with whom to live, move into the hands of others. Resistance to transitions such as turning over the car keys or receiving home-based services is described when kin assume control that the older relative is not prepared to relinquish (Clark & Stephens, 1996; Matthews, 2002; Pruchno, Burant, & Peters, 1997). Negative outcomes have been found when dependency results in violations of the norm of reciprocity, when care involves negative interpersonal interactions (Rook, 1984; Wolff & Agree, 2004), or when care relationships lack respect and responsiveness to the wishes of the older person (Wolff & Agree, 2004). These studies suggest that attention to the processes through which control over tasks is transitioned into the hands of others, as well as the sensitivity of those others in making choices suitable to the wishes of the older adult, may moderate what may otherwise be predominantly negative psychosocial outcomes.

Proxy Control as a Framework

“Proxy control is a socially mediated form of perceived control that involves the relinquishment of all or some personal control to an intermediary to help achieve specific desired outcomes” (Bray, Gyurcsik, Culos-Reed, Dawson, & Martin, 2001, p. 426). Granting proxy control both avoids the demands of completing a task oneself and diminishes downside risks of failing to meet the delegated goal (Antonovsky, 1979; Bandura, 1986). While some research has defined proxies as individuals with specialized expertise, other descriptions require only that the proxy have sufficient skill, knowledge, or energy to achieve the task delegated to them (Bray et al., 2001; Smith et al., 2000; Yamaguchi, 2001).

Proxy control suggests that older adults who actively choose to turn over management of their finances or their health care to a relative or close friend may minimize negative consequences, such as diminished sense of efficacy, if this choice is freely undertaken (Bandura, 1977). If consumer-directed care has a goal of empowering older adults in care settings “to make decisions about the care they receive” fruitful (Stone, 2000, p. 5), expansion of that definition to include decisions of selected proxies may be useful. Proxy control fits well with other interpersonal control approaches, such as collective efficacy or interpersonal agency (see Bandura, 1986; Skinner, 1996; Smith et al., 2000), but these approaches have been largely ignored in the caregiving literature.

This article examines older adults’ transfers of control over tasks to others in response to physical and cognitive challenges, focusing in particular on the manner in which control is shifted. Information is drawn from semistructured interviews with older adults residing in assisted living, whose physical health, cognition, or life circumstances have required them to relocate to a more supportive residential environment. This population, characterized by moderate to severe physical and cognitive limitations (Morgan, Gruber-Baldini, & Magaziner, 2001), is one subgroup within the larger population of older adults challenged to manage tasks of their daily lives. Despite living in a less challenging physical environment, assisted living residents require substantial, ongoing support from family or friends, beyond the standard services (i.e., meals, oversight, housing, and personal assistance) provided there (Assisted Living Working Group, 2003; Mollica & LaMarche, 2004). Responsibilities such as managing money, arranging medical care, shopping, transportation, and managing/disposing of property and furnishings remain the responsibility of assisted living residents, their kin, and close others. Given the circumstances leading to their moves into assisted living (Frank, 2002), support with these tasks is often undertaken by (or continued by) family members and close friends.

This investigation arose serendipitously, within the context of a larger study focusing on views about quality in assisted living. During examination of the narrative database, we noted a number of segments discussing control, loss of control, transfer of tasks and responsibilities to others, and in some instances, clearly described reactions to these transitional events. Given the tenor of the literature, consistently linking diminished control with negative outcomes, it was surprising to us that some of these events were described by older adults we interviewed as positive or welcomed. Our exploration began with a basic question of the meanings that older adults attached to experiences when control of tasks moved into the hands of kin and quasi kin. Two more specific aspects came to organize this inquiry: first, how did older adults describe transitions of these tasks to others—as voluntary or involuntary, chosen or forced? The second examined whether these transfers of control were described positively or negatively in the interviews.

In examining these transition points, the specific task of selecting the assisted living setting was not our focus since that choice often occurs when the older adult is receiving inpatient treatment or rehabilitation services (Frank, 2002). Given fragile health and limited travel capacity, family members or friends are often required to quickly select an AL setting with limited input from the older adult. Ball, Perkins, Hollingsworth, Whittington, and King (2009) estimated that only 21% of older adults in their small sample were “proactive” (i.e., in full control) in selecting their residential care setting. In addition, we include some tasks transferred to quasi kin, given that some older adults lack or are estranged from close kin or simply choose to rely instead on nonkin supporters. Here we include as quasi kin those individuals with long-standing relationships who undertake tasks typically performed by family members. An exemplar is Ms. Brubaker, who, despite having three biological children, told us that her care in AL was directed by her “niece” Nicole, whose mother was Ms. Brubaker’s best friend.

Study Design and Method

The narrative data are drawn from a larger study, “Stakeholders Models of Quality in Assisted Living,” led by the first author. The goal of the overall study was to gain a grounded understanding of the criteria on which the varied participants in assisted living settings, in particular older adults residing there, make their judgments of quality. The analysis here focuses on resident interviews (N = 77), drawn from seven assisted living settings in Maryland (see Table 1). Most of those interviewed were cognitively able to respond to open-ended questions, including some individuals identified as having mild to moderate dementia. The study also included family members, direct care staff, and administrators (N = 109); family interview material was included in select cases to better understand a transfer of control described by a resident. Although the sampling approach was not designed to generate a sample representative of overall resident population, residents were demographically similar to samples in prior studies. Participants were predominantly female (70.1%), White (85.7%) and well-educated (58.9% with some education or training beyond high school; 28% had a college degree or more; Hawes, Rose, & Phillips, 1999; Morgan et al., 2001). Ages ranged from 59 to 99, with a median of 85. All residents’ were assigned pseudonyms to assure confidentiality.

Table 1.

Characteristics of AL Settings Participating in the Study.

Pseudonym	Beds	Chain	Profit status	Locale	Religious	% Non-White
Boxwood Gardens	104	Yes	For-profit	Suburban	No	14
St. Brigid	18	No	Nonprofit	Suburban	Yes	10
Murray Hills	36	No	For-profit	Rural	No	0
Wetherby Place	48	Yes	For-profit	Suburban	Yes	3
Greenbriar	92	Yes	For-profit	Suburban	No	75
Arcadia Springs	45	No	For-profit	Suburban	No	9
Winter Hills	75	Yes	For-profit	Rural	No	0

Data Collection and Processing

Interviewers approached individual residents and gained taped verbal consent prior to interviews, typically undertaken in residents’ rooms or suites. The semistructured interviews, which ranged from 20 to 120 min, were audio recorded in most cases; if residents declined to be recorded, extensive notes were taken. In addition to describing how and why they came to live in assisted living, questions addressed things that made for a good day or bad day, and elements of the current setting and care they would keep or change if they were in charge. Quality as a concept was left open to interpretation and could include elements of quality of life or quality of care, as defined by the individual.

Interviews or notes were transcribed and entered into an Atlas.ti database (Muhr, 2008). Development of coding categories began with detailed reading of interviews by all members of the research team. Bimonthly meetings to discuss emerging concepts led to codes, which were further refined by additional reading and retested through ongoing coding review. Once the code list was established, coding was completed by rotating two-person teams to enhance code-use reliability; team members first coded individually and then met to reconcile their results (Morgan et al., 2011).

Analysis

The analysis was prompted by the senior author’s notice of cases in the narrative database where transfers of control were described as proactive and positively viewed by older adults in assisted living, contrary to the predominant findings of studies on control. This mismatch led to a further search to examine these contrary cases and elements that differentiated them from the standard narrative of declining control with negative psychosocial outcomes. This more systematic examination of narratives involved two steps. The first step involved identifying quotes discussing the transfer of control of a task or set of responsibilities to a relative or another person acting in a quasi kin role. We searched on two codes closely aligned to our research goals, “kin support” and “keep/delegate control,” as well as conducting word searches for “takes care” or “taking care,” as in “my cousin takes care of my finances these days.” These search strategies generated an array of overlapping quotations from interviewees from all seven research sites.

The authors read identified narrative segments in detail for 26 cases where a resident discussed control of tasks having been turned over to or taken by kin or quasikin, despite no questions eliciting these stories. The second step was independent review of the identified narratives by the coauthors to assess (a) process: whether the transfer of control was granted or sought by the older adult, taken by the other person, and (b) reaction: whether the reaction by the older adult to this transfer of control was positive or negative. In most cases the authors agreed on both items. In the few cases of ambiguities or disagreement, we read or listened to full resident interviews to clarify how the quotation should be categorized, or reviewed family members’ interviews to seek additional clues about these transfers of control. After these steps, only 15 of the initial 26 instances could be categorized on both process and reaction. After a brief review of more general orientations toward control and changes in control, we focus our attention on the typology of chosen versus unchosen transfers of tasks and their associated positive or negative reactions by interviewees.

Findings

General Orientations to Reduced Control

During our review of the narrative database, we noted that interviews often touched on how the challenges of diminished health, cognition, or social support (e.g., loss of a spouse) altered the accustomed patterns of control that participants had exercised earlier in life. There were variations in the degree to which interviewees acknowledged current limitations on their exercise of control or accepted them. A mixed pattern is shown in the interview of Martha St. John, who first told us “I’m completely independent [in terms of relying on the services of assisted living] . . . I’m one of the few that is,” proudly recounting all the tasks she did for herself on a daily basis. But later she admitted, “I do need help, too—because I don’t have stamina and I tire very easily.” Greater acceptance appeared in the interview of Ms. Larson, who described giving up her house to move to AL as, “a case of necessity as far as I was concerned. Because I couldn’t stay by myself and I didn’t want to go live with any of my children.” The wish to avoid living with children, voiced by a number of people, was not necessarily indicative of strained relationships and may, in fact, have represented a positive exercise of control. For example, Carole Isaacs said,

I’ll stay here as long as I can, because my daughter wouldn’t want me, and my son wouldn’t want me. And I don’t want them. I mean I love them dearly, and they love me—but I don’t want to go live with them, I don’t want that. I had that experience with my own family. My [father-in-law] came to live with us for a short while, and . . . I was [a] most unhappy person.

Although the stories varied, a number of those we interviewed had been proactive in planning for their later years. Calvin Epworth, when asked whether granting Power of Attorney to his sister-in-law was his choice said,

Oh, yes. I talked to a lawyer about it. I said, I can’t drive—I can’t drive my car. I’ve got a house—I can’t go back to the house, can’t walk up and down the steps, so I’ve got to turn it over to somebody. And she’s [sister-in-law] good—I’ve known her since she was 14 years old.

In contrast, Ms. Spivey was less accepting, stating “I’m plenty old, but I guess I just can’t catch up to my age.” Having been a highly autonomous, single, working mother, she expressed how much she missed having a car, going out with friends, and controlling her own money. As expected, many people described changes in their capacity to directly exercise control, with some strong emotion and distinctly varied levels of acceptance.

Transfers of Control

Chosen task transfers

In six transfers of control, the older adult described this as an instance of active delegation or as their choice. Their descriptions indicated they had selected a close other to undertake a certain task. All six of these “chosen” transfers were paired with positive reactions from the interviewee. Notably, there were no instances when the narrative description of the use of proxy control (via actively granting tasks to kin or quasikin) where the reaction was negative.

Examples of the chosen task transfer/positive reaction included the opinionated Ms. Carson. She told us that she chose to give control over her finances to a daughter, living out of state.

So anyway, I’m in here and I turned over all the paying to my daughter; and I know it’s over $4,000, but I’m not sure how much it is—a month . . . . So I said, I can’t—I can’t fathom this; I can’t manage it—I gave it to my daughter, because she’s a CPA.

Another positive evaluation connected with active delegation of a task came from Mrs. Wyler, who never had children but had numerous “adopted granddaughters” from her years of teaching. These “girls,” now in their 50s, assisted her in relocating to AL by moving her belongings into her suite and, later, disposing of surplus furniture, all with Mrs. Wyler’s blessing. She also relied on a longtime friend to handle her finances.

The man with the Power of Attorney . . . was a friend of my husband’s since they were boys. And they were our friends and I trust him with my life. And he asked me—he didn’t do it on his own, he asked me about it. There was no one else I would have wanted to do it. And he checks with me; he never pays a bill that he doesn’t check with me first. The end of the year he gives me a complete account . . . of what I had in the bank at the beginning of the year, what came in, what goes out a month, what I have at the end of the year. I get that all given to me every year. That’s how conscientious he is, so I don’t have to be afraid . . . God has been too good to me.

Mrs. Gentile chose to rely on friends rather than her children to address her pragmatic needs while in assisted living. In affirming this self-described independence, she said (with a grin), “The day that my children tell me what I’m going to do, they are out of the will! . . . I don’t ever expect that my children will have any control over my life.” Instead, she relies on former neighbors, including one who she described as her “personal shopper.” A final exemplar of a person who still feels in control of aspects of her life while having others handle important tasks is Ms. Jacobs, who told us that her relatives except one brother were “six feet under.” She was preparing her “Irish temper” for a battle with the management over a proposed fee increase at the time of our interview. She also relied on two of her friends, who are “like family members.” They alternate in taking her to medical appointments or to the hairdresser, tasks often undertaken by kin. Both had long ago been added as signatories to her checking account. What limited tasks Ms. Jacobs was unable to complete herself were handled by her two friends, acting on her behalf.

Unchosen task transfers

Among the narrative descriptions we identified, nine were instances where the older person described tasks as being taken by others, either with their passive assent or against their wishes. These stories lacked the connotations of choice or agency of proxy control, as seen in the earlier examples. We classify these as unchosen transfers of control. Among the nine, seven were described in the interview using negative language and two reactions were positive. The preponderance of interviewee descriptions where tasks had been taken by—rather than granted to—others recalled these as negative, unwanted events. Three examples below clearly demonstrate this unchosen/negative reaction pattern.

Bruce Goddin had been living in an apartment as his health declined, getting some assistance from a woman who lived with him. He described her as having a drug problem and stealing from him to support her habit. Mr. Goddin’s daughter, despite having been abandoned, along with two siblings, by her parents at age 11 nonetheless took action when she learned her father was in a rehabilitation center after a serious health episode. According to Mr. Goddin’s description of events, the daughter “took over” his life and moved him to Arcadia Springs without his advanced knowledge or consent. Mr. Goddin told us that she “tore my apartment apart and took the furniture out of it and give it up while I was down at [the rehabilitation center].” He continued, “She took over everything I have,” including his beloved automobile. The daughter now holds Power of Attorney, and, much to his frustration, control of his money.

I have a bank over on Bloomfield Road with $1,000 in. [She] drew it out, closed it out. Just like my wife did one time. . . No, she ain’t spending the money on me—she’s got a house down there and a husband.

His sense of losing control was extensive in the overall interview. However, Mr. Goddin’s daughter described him as both illiterate and suffering from Alzheimer’s disease, and consequently confused about the events surrounding his move into AL and her other steps to, in her view, support him since that move. Lacking any recent, prior relationship, Mr. Goddin defines the steps taken by his daughter as an undesired and unwarranted takeover.

Dr. Luckinbill, who had previously enjoyed the assisted living’s bus trips out for lunch where he could enjoy a drink with his meal, was no longer able to get on the bus for outings. Unable to go out shopping for himself, he lived in an assisted living that does not serve alcohol. Disappointed that his family would not support his preference to have a drink from time to time, he said, “No, my kids would never agree to bring me a bottle of whiskey to keep here, to take out of as I want to. And I miss the booze.” This seemingly minor element of control was important to him. Dr. Luckinbill also indicated that his children provided a lot of support—perhaps overhelping. “I keep saying to my daughter ‘You do too much.’ . . . She took charge of me when my wife couldn’t do it anymore.” Dr. Luckinbill felt that his children had perhaps too much control, with a daughter who “took charge” of him and kin who limited a lifelong pattern of drinking alcohol.

Our third example comes from Ms. Volbrecht, who began on a clearly negative note by telling us that her son drove the decision making in her move to assisted living. “My son wanted me to live here . . . He made it [the decision] for me. I agreed.” His control extended after she settled in to her AL. She continued, “My son takes care of all my financial . . . and he don’t give me any money.” She went on to inform us that she was a smoker, but that her smoking was constrained by both her son and the rules at Boxwood Gardens. Her son’s strictness with money was because, “he’s afraid I’ll buy cigarettes with it,” but lack of funds also kept her from being able to go on outings offered by the assisted living. When asked how she got her cigarettes, she replied that her son brought them to the AL, but that she was not able to have free access to them. Her daily routine was driven by the rules. “I get 6 a day . . . I get one at 6:00 o’clock, one after breakfast, one after lunch, one at 3:00 o’clock, one after dinner and one at 7:00.” Ms. Volbrecht, who had reluctantly adapted to the regimen to receive her cigarettes, was planning to move to another, smaller AL setting along with a male friend.

There were two instances where it appeared that control was taken by the proxy relative, but a relatively positive description of this change was given by the resident. One was Mr. Leland, who had been deeply disappointed at never having had children. He consequently relied heavily on his younger brother, who had, in his view, been the force behind his initial move into one assisted living and then to move to another, less expensive place. Mr. Leland said his brother, “enticed me to leave” the first place, which had a larger room. Despite being unhappy about the cramped quarters and missing his former life, Mr. Leland valued the ongoing support of his brother, who continued to take care of many things on his behalf.

[T]hank God that one brother takes care of me—if he didn’t I wouldn’t have that. That’s all I got you know to live for, [if] you put it that way. And if he weren’t doing it—I wouldn’t have anything—you know. You appreciate that he’s giving his time and energy and all the help.

Discussion

The extensive literature on control and autonomy in advanced old age suggests that diminishing control is connected with negative outcomes, such as lower self-efficacy, self-esteem, or psychological well-being. The focus here has been on the process by which tasks are transitioned to the control of kin or quasikin from older adults residing in assisted living settings, rather than the current amount of or changes in control being exercised by the older person. The findings suggest that the process through which control shifts into the hands of others, rather than simply the fact that the older adult’s personal control is decreasing, may be a pivotal factor in psychosocial outcomes.

The interview segments linked the older adult’s active choice to delegate tasks to close others with positive reactions in all cases examined and negative reactions to descriptions where control was taken in most cases, suggesting that the process, not just the fact of diminished control, is important to examine in more detail. Both those who delegated control to others and those who perceived that control was taken were exercising less control in their everyday lives; from their narrative descriptions, however, negative reactions to these changes were typically voiced when control was perceived as having been taken by, rather than delegated to others. Exercising agency, via choosing to delegate a task and determining to whom it is given, may mute some of the negative outcomes described in the literature arising from diminishing control.

The descriptions by older adults in assisted living also support the family caregiving literature in reinforcing that not all support offered or given is welcomed. Elements of overhelping or making what were deemed to be inappropriate choices by the care recipient are also evident in these narratives, potentially contributing to negative views. Well-intentioned actions, such as those made by Mr. Goddin’s daughter to remove him from an unsuitable living environment and from an unreliable female companion without his consultation, were described by him as usurping his adult rights, and remained a source of contention. Despite the likelihood that objective others might have viewed Mr. Goddin’s living situation as precarious, in his view his daughter’s actions and choices reflected none of his preferences, as she had, in his view, unfairly taken over his life.

Proxy Control as an Adaptive Strategy

The narrative analysis suggested to us that the concept of proxy control may be pertinent to a better understand the process of transitioning control to others in later life. Finding ways to perceive oneself as still agentic in the face of diminishing personal capacity to manage all aspects of one’s life may mute the impact of diminished control (Baltes & Smith, 2003). Drawn from the Selective Optimization with Compensation (SOC) perspective (Baltes & Baltes, 1990; Bandura, 1986; Hyer & Intrieri, 2007), compensation choices, including proxy control, become operative when older adults select alternative means to accomplish important goals. Rather than resulting in a diminished sense of control, the SOC framework suggests the addition of alternative, compensating approaches, such as proxy control, limit the risks to one’s subjective sense of control and well-being (Baltes & Baltes, 1990). The element of proxy control, added to other identified factors in the study of control and well-being in later life, expands the options to understand and derive potential strategies to improve outcomes for care recipients.

This study has a number of limitations. First, since this study was designed to focus on questions other than loss of control, our findings are both tentative and suggest the need for further research. We did not systematically observe or ask detailed questions regarding process through which tasks were handed over to others; nor did we evaluate respondents’ general sense of control or well-being in a systematic way. Descriptions of these transitions were offered as part of larger interviews focusing on other, albeit related topics. While not solicited, the spontaneous telling of these events during our interviews may indicate their importance in the eyes of the speakers. Second, many transfers of control described in interviews provided limited insights as to who initiated the process or provided no evaluative statements regarding these events. Norms of social desirability may constrain respondents’ speaking frankly or in detail about unwelcome challenges to their control to “save face” for themselves or close kin. Third, those who spoke about these issues in our interviews may also selectively represent families where relationships were already particularly strong or particularly troubled, shaping the findings in unknown ways. Positive or negative aspects of these relationships, which predated the move into assisted living may be surfacing in these stressful circumstances (Newsom & Schulz, 1998), or these transfers of control may have shifted earlier interaction patterns in either positive or negative directions.

Fourth, a few residents interviewed had some degree of cognitive impairment, which may have influenced whether they accurately recalled details of these events. Accurate or not, however, their current recall of what occurred and how control moved into the hands of others may, nonetheless, be what matters to contemporary psychosocial outcomes. The cross-sectional nature of our interviews also limits our understanding of respondents’ orientations to control earlier in their lives, except for the few individuals who described these orientations. Consequently, it is not possible to provide any rigorous test of proxy control from this study. Further research, particularly designed to examine transfers of control and instances of proxy control more directly, should test the usefulness of proxy control in ameliorating negative outcomes following decline in the exercise of control in later life.

Conclusion

Narratives drawn from interviews of a sample of older adults residing in seven assisted living settings provide insights into the potential importance of process as a key mediating influence in consequences arising from the transfer of control to others. Findings from this analysis provide suggestive support for the importance of proxy control in particular, and argue for a stronger connection of the control and family caregiving literatures. The action of delegating tasks to kin/quasikin co-occurs in interviews with positive evaluative statements; control that was perceived as “taken” by others was most often described negatively. Negative views were most emphatic when choices made by these others also differed from the preferences of the older adult. Further research is clearly needed to provide explicit tests of the relevance of proxy control as a strategy in age-related adaptation, and ways to encourage its use, when possible, in families and in professional practice with older adults.

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 the following financial support for the research, authorship, and/or publication of this article: Support for this research came from the National Institute on Aging (1 R01 AG022563-01A2).

Author Biographies

Leslie A. Morgan, PhD, is Professor of Sociology and researcher in the Center for Aging Studies at University of Maryland, Baltimore County.

Michael A. Brazda, MA, in Applied Sociology, is a student in the Doctoral Program in Gerontology (University of Maryland, Baltimore County and University of Maryland Baltimore) and a student researcher in the Center for Aging Studies.

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