Abstract
The theme of the 2016 Southern Gerontological Society Conference was “Transforming the Landscape of Caregiving: From Research to Practice,” and many of the engaging presentations and panels highlighted innovative programs for family and professional caregivers, policy considerations, scientific advancements in how we study care provision and exchange, and philosophical discussions of what caregiving means to our aging society. Families are at the core of long-term care provision for older adults in the United States, but a number of trends (sociodemographic, historical, economic, and health) have aligned to threaten our heavy reliance on families for the care of older adults in need (Gaugler & Kane, 2015). A number of efforts have attempted to better support family caregivers, but it is unclear whether such attempts are sufficient to offset the impending decrease in family caregivers, the overall shortages in the geriatric workforce, and chronic disease trends in younger cohorts (which may further reduce the number of potential family caregivers). Despite this bleak scenario, ongoing innovation in care models, information, and policy could help address these converging threats, but a more coordinated approach at various institutional and organizational levels is needed. A number of solutions are possible (Gaugler & Kane, 2015), and likely others will be outlined in the soon-to-be released Study on Family Caregiving for Older Adults from the Institute of Medicine (http://www.nationalacademies.org/hmd/Activities/Aging/FamilyCaregivingforOlderAdults.aspx). Moreover, the articles in this month’s issue of the Journal of Applied Gerontology highlight important perspectives that further our knowledge of family caregiving and its ongoing implications for how we age.
Although early research tended to adopt the stance that elder abuse is often the result of “caregiving gone badly,” more recent research has demonstrated that family caregiver stress is not a primary cause of elder abuse (Brandl & Raymond, 2012). Nonetheless, the family caregiving context may increase potential risk for elder abuse in some situations. Brank and Wylie (2016) conduct an interesting study of decision making among potential caregivers and care recipients, and how preparation among caregivers and anticipated autonomy among care recipients could have implications for subsequent abuse. Using vignettes, Brank and Wylie found that participants who were potential caregivers did not seem as prepared to assume care responsibilities as potential care recipients expected, and that caregivers also were likely to believe care recipients were more autonomous in their decision-making capacities than care recipients would anticipate. Brank and Wylie use this interesting method to demonstrate how the resulting mismatch in expectations could result in a caregiving context that is more at risk for abuse. Although not a direct study of caregiving, the 3-year analysis by Cohen and Bulanda (2016) considered the differential effects of social support on suburban, rural, and urban older adults’ nursing home admission in the United States. Relying on nationally representative data from the Health and Retirement Survey and restricting their analysis of nursing home stays to those of 30 days or longer (thus excluding skilled nursing/acute rehabilitation stays), Cohen and Bulanda reveal several interesting findings: (a) that older adults in the rural regions of the South or Midwest are 2 times more likely to enter nursing homes than those in urban areas in the Northeast; and (b) social support seems to have a similar effect regardless of region for older adults, suggesting its importance in the institutionalization process and its potential as a target for interventions or services designed to delay this transition.
Delirium is a major concern in hospitals, and up to a third of older individuals with delirium in hospitals die (Bull, Boaz, & Sjostedt, 2016). In an important contribution to the literature, Bull et al. (2016) examine family caregivers’ knowledge of delirium and how they would prefer to receive information about this condition; family caregiver assessment related to delirium in hospital settings remains under-developed, and this study is an initial step in developing more robust measurement approaches. The sample of 134 family caregivers indicated that Internet exchanges, in-person sessions, and newsletters were all acceptable when receiving information about delirium. The findings imply that any of these delivery modes are appropriate when designing future interventions for family caregivers of persons with delirium who experience hospitalization.
A systematic review by Hong and Coogle (2016) further expand our perspectives on caregiving. In an excellent example of adopting a theoretical framework to critically review a body of literature, Hong and Coogle apply Calasanti’s gendered view of work (e.g., husbands who are caregivers adopt a more task-oriented/masculine approach to care provision while wives adopt a more emotionally-focused/feminine perspective) to deductively review current literature on dementia family caregiving. The authors concluded that Calasanti’s theory is an effective lens with which to interpret dementia family caregiving and its implications, and such a framework could help to inform interventions that adopt a more gendered-based view of care provision.
A brief report in this issue that held particular interest for me was by Morrison, Winter, and Gitlin (2016) that examined the costs and successes of various recruitment strategies for a nonpharmacological randomized controlled evaluation. I have confronted many challenges to recruiting dementia caregivers in my own work, as I must often rely on community-based recruitment approaches (rather than clinic enrollment) to identify participants. Interestingly, direct mailing to family caregivers resulted in the most enrollees and was the least costly (US$63 per caregiver–care recipient dyad), while community outreach was the most expensive (US$350 per dyad). I have often relied on multiple community outreach efforts and advertisements for my own studies, but the findings of Morrison et al. may lead me to consider direct mailing (although whether investigators can identify partners willing to distribute these mailings often poses a significant hurdle).
Given families’ prominence in the provision of long-term care in the United States, family caregiving has remained a topic of transdisciplinary interest. The scholarship in this month’s issue of the Journal of Applied Gerontology examines family caregiving expectations and their implications for elder abuse, gendered-based views of care provision, delirium and family caregiving, and effective recruitment strategies for intervention protocols. These topics are all of immediate concern for those of us engaged in research on family caregiving, service provision, or both. It is exactly this kind of novel, applied research that will help us to “transform the landscape” of family caregiving.