Abstract
Family caregivers are integral to older patients’ quality of life, arranging medical care, managing symptoms, and providing instrumental and emotional support (Lund et al., 2014). However, this time-consuming, emotionally and physically intensive labor can have substantial negative effects on caregivers’ mental, physical, and financial wellbeing (Dee et al., 2023; Kim et al., 2015), and there is minimal support for caregivers (Riffin et al., 2021). Adult-children caring for a parent confront particularly challenging situations including juggling their own employment, geographic distance to their parent, and relational dynamics of transitioning from child to caregiver. Although adult-children account for nearly half of caregivers (National Alliance of Caregiving & American Association of Retired Persons, 2020), they are grossly understudied as a population, limiting relevant opportunities for support.
Dr. Bethany Morgan Brett’s book, The Child-Parent Caregiving Relationship in Later Life: Psychosocial Experiences, helps address this knowledge gap. Drawing primarily on interviews with White, late midlife adults in England whose parent entered long-term care (LTC), Morgan Brett weaves together theories of psychoanalysis, sociology, psychology, and anthropology to provide nuanced insight into the lived experiences of adult-child caregivers and their parents as they navigate the parent’s decline and transition to LTC, their changing relationship with one another, and their identities.
I found the first chapters the most valuable. The introduction reflects Brett Morgan’s sociological lens, highlighting the numerous demographic, political, and economic trends that exacerbate the systemic challenges facing caregivers. The population is expanding, and we are living longer, but the years of life without disability or a serious illness are not keeping up. This means greater numbers are reaching older ages, but in poorer health, and thus need support. The resulting increased healthcare demand is made on a barely recovering national healthcare system with increased cuts to its resources. Furthermore, rising economic inequality traps lower income families in a vicious cycle; they cannot afford to outsource care further limiting their wage earnings and increasing their risk of poverty.
In Chapter 1, Brett Morgan wrestles with generational shifts, midlife as a life phase, and parents’ impact on this phase. As a psychoanalyst, she focuses less on defining midlife and rather what it brings, which are fears of mortality elicited and shaped by losses experienced through caregiving for parents and watching their decline. For Brett Morgan, a parent’s decline is central to the existential and aging anxieties of midlife because it marks adult-children’s impending shift to the oldest generation and position in the mortality queue: “healthy parents represented a psychological buffer between them [caregivers] and death” (p. 17).
Chapter 2 stuffs in several important themes. The first pages briefly cover the expansive and ambiguous boundaries of care work, that this work is essential, and women are disproportionately responsible for and negatively impacted by care work. Thus—and because of females’ overrepresentation—care work is poorly rewarded by society and the market. This not only plays out in family life since women are more often caregivers than men, but also in paid work since women, for both push and pull reasons, dominate care-related professions and industries. Consequently, many a caregiver juggles caring for a parent with her paid care work. However, employers of care workers ironically rarely provide the flexibility and wages needed to support a dependent family member. Women’s overrepresentation in paid and unpaid caregiving is especially consequential for adult-child caregivers since adult-child caregivers are more likely to work than spousal caregivers (Fenton et al., 2022) and daughters are more likely than sons to provide care (and more care if they have a brother) (Grigoryeva, 2017). The chapter then focuses on the transition to caregiver and how it can impact relationships among siblings and between the parent and adult-child. Particularly unique to the experiences of adult-child caregivers, Brett Morgan examines how caregiving can reignite old conflicts among siblings and how adult-children struggle emotionally as they construe caregiving for their parent as a role reversal and identity change whereby they view themselves as now in charge of their parent.
Chapters 3–5 explore the difficult decision and transition to LTC, which typically begins with a fall, cognitive decline, or loneliness. Here Morgan Brett shares parents’ voices from her interviews and their ambiguous feelings about the move. In these chapters, Morgan Brett offers advice on how to make the move gentler for both parent and adult-child through engagement and empowerment. Chapter 4 highlights the loss of self for both parent and adult-child as personal items with links to the parent’s identity must be winnowed down for the move, which also often means selling the caregiver’s childhood home. Brett Morgan advocates that older people should be, but often are not, involved in the decisions about which possessions to keep, particularly clothing, to help maintain their identities and sense of control. Chapter 5 focuses on the altered parent-child relationship after the move to LTC. Staff and volunteers become parents’ primary support for daily life, causing many adult-children extensive guilt. Morgan Brett finds that this guilt fosters a vicious cycle whereby adult-children either visited less to avoid guilty feelings or became hyper critical of their parent’s facility and micromanaged their parent’s care to offset guilt. Similarly, many parents, while they built important friendships with residents, staff, and volunteers, often resented their children for the move and for not visiting enough. Morgan Brett urges that facilities could ameliorate parents’ resentment and adult-children’s guilt by ensuring that visits feel valuable via opportunities for adult-children to engage meaningfully with their parents (e.g., helping with personal care, off-site excursions, and participating in activities with other residents).
Chapter 6 focuses on the loss of a parent in later life. Our longest relationship is often with our parents, and so, as echoed throughout the book, a parent’s death has ripple effects for many aspects of one’s identity through the joint loss of the child role and the simultaneous shift to the oldest generation. The author also examines loss, primarily through the lens of anticipatory grief, particularly for those with parents with dementia. These caregivers feel their parents have died psychologically first, and often have contradictory feelings, including taboo ones like relief, about their parent’s impending death.
This book offers an engaging nuanced view into the emotional complexities of midlife caregiving for an aging parent. With its interdisciplinary theoretical framing, the book would be valuable to academics and graduate students in gerontology, social work, and human development, adult-child caregivers considering LTC, and LTC staff to support residents and their adult-children. It is important to note, however, that the book focuses on a relatively narrow population of late midlife adults and their older parents, specifically White, English persons who chose LTC and had the resources to do so (only 2.5% of 65-year-olds and older in England and Whales live in care homes (Office for National Statistics, 2023)). I therefore wish Morgan Brett had done more to highlight how her findings might differ from other populations. For instance, Morgan Brett does not question respondents’ perception of caring for one’s parent as an upsetting role reversal and argues that many parents feel uncomfortable moving into their child’s home due to loss of privacy and fears of being a burden. These distresses are more common, however, among certain groups (i.e., generally affluent, non-Hispanic Whites in certain regions of North America and Western Europe). Whereas, for many, particularly those raised in cultures that emphasize familial piety, caring for one’s parent is central to the child role, rather than a reversal, and it can be considered shameful if parents enter LTC (Apesoa-Varano et al., 2015; Dilworth-Anderson et al., 2005). Thus, diverse voices are not important simply for representation’s sake, but because they provide invaluable insight into what caregiving experiences can be, suggesting that different perspectives of caregiving could alter the emotional burdens and relational consequences of caregiving and receiving care highlighted in this book (Dilworth-Anderson et al., 2004; Liu et al., 2021).
The book still offers important insight by adding to the bare knowledge about adult-child caregivers, while providing a nuanced lens into the emotional lives of the population that it does sample. Findings that can be generalized beyond the targeted population are also valuable. The book demonstrates that, even amongst the more advantaged (e.g., White persons with access to LTC), caring for an elderly parent is physically and emotionally taxing and complex with deep levels of anticipatory grief and uncertainty about care decisions. Morgan Brett also provides a psychoanalytical approach, rarely used in caregiving research, which could be leveraged for other dyads outside the parent and adult-child. Her focus on adult-children’s shift from middle to oldest generation and its accompanying fear of mortality and decline along with parents’ changes in independence and residence and the resulting fluctuations in their relationship with their adult-child. This approach reifies the importance of paying attention to transitions in identity and relationships along the caregiving and aging trajectory and their reciprocal impact on each other and our emotions and decisions.