Health and Grandparent–Grandchild Well-Being

Abstract

Objective: Comparatively little longitudinal data exist focusing on grandparent caregiving, to say nothing of health’s impact over time on grandparent and grandchild well-being. Accordingly, the present study explored relationships among grandparent caregiver physical health, well-being, and adjustment, as well as with grandchild well-being across a 1-year period. Method: Participants were 79 grandparents who had full-time responsibility for their grandchildren. Measures of grandparent physical health, well-being, and grandchild well-being were completed across two assessments, 1 year apart. Results: Cross-lagged analyses exploring potential causality over time suggested that with one exception, the relationships between health and well-being appeared to be bidirectional. Discussion: In general, these longitudinal data indicate that better perceived health may provide an adaptive advantage for both grandparent caregivers and their grandchildren, yet also underscore to the potentially causal role that proactivity in the face of adversity plays in the maintenance and improvement of grandparent caregiver health over time.

Keywords

grandfamilies physical health well-being longitudinal

According to the 2011 Community Survey by the U.S. Census Bureau, 2.7 million grandparents reported that they were the primary caregivers of one or more grandchild under the age of 18, wherein 5.5 million children under the age of 18 were reported to live with a grandparent householder (U.S. Census Bureau, American Community Survey, 2011). Given the magnitude of the impact on both grandparents and grandchildren of this caregiving relationship, it is important to explore possible influences on grandparents’ ability to provide quality care to their grandchildren. In this light, the physical health of custodial grandparents is a key concern in impacting their adjustment (Hayslip & Kaminski, 2005; Park & Greenberg, 2007), and concerns about their poorer health are shared by both grandparents and the grandchildren they are raising, where declines in health may impair a grandparent’s ability to manage the physical and emotional demands of raising a grandchild (Baker & Silverstein, 2008; Hipple & Hipple, 2008).

Custodial Grandparenting: An Overview

Understanding the potential impact of health on well-being among custodial grandparents requires an appreciation for the context in which such caregiving comes about. Unfortunately, grandparent caregiving is usually linked to the divorce, drug use, incarceration, job loss, or death of the adult child, as well as when the parents abandon or abuse their child. These circumstances stigmatize and isolate grandparents from needed social and emotional support as well as make it difficult to be treated equitably by social service providers (see Hayslip & Kaminski, 2005). Indeed, ambivalence and contradiction define grandparent caregivers’ experiences, contributing to the distress many experience (Erbert & Aleman, 2008).

Raising a grandchild has the potential to disrupt one’s life plans (Jendrek, 1993). This disruption is underscored by the common difficulties reported by custodial grandparents: poor physical or emotional health, less satisfaction with grandparenting, less meaningful grandparenting, impaired or strained relationships with spouses and their grandchildren, and isolation from other grandchildren and friends because of their parental responsibilities (Hayslip & Kaminski, 2005; Park & Greenberg, 2007). Such persons often feel overloaded and confused about their roles as parents and grandparents, and frequently care for (male) children who have behavioral or school difficulties, for which grandparents are less likely to seek help (Hayslip & Shore, 2000; Hayslip, Shore, Henderson, & Lambert, 1998). Importantly, the impact on grandmothers’ distress on grandchildren’s adjustment is mediated by dysfunctional parenting (Smith, Palmieri, Hancock, & Richardson, 2008), and perhaps exacerbated by the grandparent caregiver’s dysfunctional parental attitudes (Kaminski, Hayslip, Wilson, & Casto, 2008). In light of the loneliness, invisibility, and isolation many feel (Wohl, Lahner, & Jooste, 2003), social support is key to their well-being (Generations United, 2002; Gerard, Landry-Meyer, & Roe, 2006). Empowering grandparents so that they can advocate for themselves and their grandchildren and regain control over their everyday lives is equally important (Cox, 2000).

Children who are raised by their grandparents suffer as well; relative to children in intact homes, more live in poverty (U.S. Census Bureau, 2000). Many such children have difficulty registering for school (Silverstein & Vehvilainen, 2000), and are more likely than those living with their parents to not have health insurance (Kirby & Kaneda, 2002). Such difficulties are greatest for grandchildren cared for “informally,” wherein grandparents lack a formal legal basis (e.g., adoption, legal custody, guardianship) for doing so (Generations United, 2002). Many custodial grandparents come to resent their adult children for creating the situation leading to the care of the grandchild, and yet, they may feel guilty over having failed as parents in raising such a child (Shore & Hayslip, 1994). If the relationship with the adult child is ambivalent or the relationship between the grandparent and grandchild/adult child is poorly defined, the demands on the grandparent caregiver are more debilitating (Henderson, Hayslip, Sanders, & Louden, 2009).

Grandparent Caregiving and Health

Poorer health has been linked to a variety of outcomes among grandparent caregivers: less positive affective functioning, less role satisfaction, and less productive and satisfying relationships with the grandchild being cared for (Hayslip, Shore, & Emick, 2006). Furthermore, Roberto, Dolbin-MacNab, and Finney (2008) found that not only greater duration of (grand) parental caregiving was associated with lowered use of preventive health measures, but also among those caregiving grandmothers, risky health behaviors (i.e., obesity/lack of exercise, smoking, alcohol use) were common. Significantly, such behaviors covaried with the duration of caregiving, greater financial stress, and higher parental stress (Roberto et al., 2008).

Complementing the increased health risk associated with caregiving, such grandmothers, despite an awareness of their own health problems, may prioritize their grandparental caregiving role responsibilities and, as a consequence, neglect their own health (Minkler & Fuller-Thomson, 1999). Indeed, grandparent caregivers often neglect their own health in deference to the health and well-being of their grandchildren, and custodial grandmothers are less likely to engage in behaviors that are preventive regarding illness than are their noncustodial counterparts (Baker & Silverstein, 2008).

In addition to the potential impact of poorer health on grandparent caregivers’ mental health and ability to provide care for their grandchildren, declines in a grandparent’s health over time also may heighten both the grandparent’s and grandchild’s fears about the long-term future of their relationship and the stability of caregiving, especially given concerns about dementia or death (Hayslip & Page, 2012). This is of concern not only because of the greater chronic health problems that likely accompany aging (Ferrini & Ferrini, 2008) but also due the fact that custodial grandparents are more likely than noncustodial grandparents to experience health difficulties (see Dolbin-MacNab, Roberto, & Finney, 2013; Hayslip et al., 2006). For example, Musil and Ahmad (2002) found that custodial grandparents tended to report worse self-assessed health and more diagnosed health problems, and that this perception of poorer health covaried with length of caregiving. Custodial grandmothers, who make up the majority of custodial grandparents, report not only poorer health, but also more physical limitations than noncustodial grandparents (Caputo, 2001), which may inhibit their ability to meet the physical demands of raising children (Hipple & Hipple, 2008). While some of these health problems may be attributable to conditions that predate the grandparent assuming parental responsibilities, it may also be that assuming these responsibilities may exacerbate existing health conditions, where health-related quality of life among custodial grandparents has been found to be negatively associated with the number of grandchildren in one’s care and with an increased likelihood of depression (Neely-Barnes, Graff, & Washington, 2010). In addition to depression being linked with lower health-related quality of life (Neely-Barnes et al., 2010), grandmothers have been shown to have higher levels of depression and anxiety compared with normative samples of persons matched by age (Musil, 1998).

In spite of the largely negative picture painted by the literature, it must be emphasized that custodial grandparents often have little time to prepare for parenting, assume it under socially stigmatizing, negative family circumstances, and frequently have had little direct and/or ongoing responsibility for raising a child for many years. Importantly, grandparent caregivers have been characterized as “resilient” in the face of the many challenges they face (Hayslip et al., 2013), wherein resilience (as well as its parental equivalent, parental efficacy) mediates the relationship between role demands/role stressors and grandparent adjustment. In addition, parental efficacy mediated the relationship between grandchild behavioral/emotional difficulties and parental stress (Hayslip et al., 2013). It is clear that grandparent caregivers’ task is indeed a generative one and that they carry out this obligation with love and a passionate commitment to their grandchildren.

The little longitudinal work on the impact of grandparent caregiving on health presents a mixed picture regarding the health consequences of raising a grandchild. Hughes, Waite, LaPierre, and Luo (2007) found no evidence for a negative influence of raising a grandchild on health, and Li-Jung et al. (2013) found grandparent caregivers to report better health over time, relative to non-caregiving grandparents. However, Musil et al. (2011) found declines in physical health over time among grandmother caregivers. Musil et al. also found that poorer health was associated with grandmother caregivers switching to higher levels of caregiving over time. Chen and Liu (2012) found that skipped-generation grandparent caregivers did not experience health difficulties over time, especially if they enjoyed a greater income. Conversely, coresiding grandparent caregivers whose child care roles were more intense experienced greater health declines; this was especially true for grandmothers. Chen and Liu also found that a lighter caregiver load served to protect persons from health difficulties; this pattern was also observed for rural grandparent caregivers and grandfathers assuming high intensity care. Grundy et al. (2012) found that grandfathers who provided at least 4 hr of care per week had greater life satisfaction 2 years later, and that those who provided material help had better physical−mental health later.

Despite such work, no longitudinal data exist explicitly speaking to the potential long-term influence of changes in a grandparent’s health over time on indicators of a grandparent’s adjustment to a new parenting role and to changes in her lifestyle (see Jendrek, 1993). These health difficulties may interfere with a grandparent’s well-being and/or ability to parent a difficult child (Emick & Hayslip, 1999; Hayslip et al., 1998) and conversely, a lack of well-being (e.g., depression) or caring for a grandchild with health conditions may lead to further adverse consequences to the grandparents own health (Dowdell, 1995). The fact that health difficulties not only impair a grandparent’s ability to parent her grandchild, but also secondarily further worsen a grandparent’s health via the stress of raising a troubled grandchild is important considering that many grandparents report that their grandchildren have emotional (21.0%) and behavioral (17.6%) problems (Neely-Barnes et al., 2010). Furthermore, Musil (1998) found that 38% of grandmothers reported clinically significant levels of parental stress as well as higher overall levels of difficulty in parent/child interactions.

The Present Study

The present study explored the correlates of health and health changes over time regarding both grandparent caregiver well-being and adjustment as well as grandchild well-being, significant in that comparatively little longitudinal data exist focusing on grandparent caregiving to say nothing of health’s impact over time on grandparent and grandchild well-being. In this respect, it is important to consider that while health difficulties may exacerbate the stress a grandparent may experience in parenting a child (see Emick & Hayslip, 1999; Hayslip et al., 1998), it may also be, conversely, that the demands of caring for a grandchild may lead to further adverse health consequences for caregiving grandparents (Dowdell, 1995).

In the context of the potential bidirectional relationship of health and well-being among grandparent caregivers, the present 1-year longitudinal study examines issues of causality with regard to these key constructs. Specifically, the current study examined relations among grandparent health, grandchild well-being, and several features of grandparent well-being (e.g., grandparent resilience, parental stress), as well as an initial assessment of directionality via cross-lagged panel analyses of these constructs over a 1 year period.

Method

Participants

Seventy-nine custodial grandparents (M_age = 58.90, SD = 7.79, range = 43-73, 67 women) who had full-time responsibility for their grandchildren (years of care M = 6.11, SD = 4.87) were followed-up over a year as a part of a larger study exploring grandparent caregiver resilience (Hayslip et al., 2013). Grandparents qualified for the study if they were currently caring for a grandchild on a full-time basis.

The racial/ethnic composition of the longitudinal sample was as follows: 87.3% Caucasian/White, 7.6% African American, 5.1% Hispanic. Employment status included 19.7% working part-time, 37.3% full-time, and 42.7% retired. Nineteen percent of grandparents were divorced, 65.8% married, 10.1% widowed, and 5.1% single. Annual household income ranged from less than US$10,000 to more than US$60,000: 10.4% reported annual incomes up to US$20,000, 24.7% US$20,000 to US$40,000, 28.6% US$40,000 to US$60,000, and 36.4% reported earning more than US$60,000 annually. Grandparents reported caring for up to four grandchildren under the age of 18 years who currently lived with them (M = 1.39, SD = .70; M_age = 9.81, SD = 4.43).

Grandparents in the parent sample (n = 239) from which the current longitudinal sample was drawn were predominantly skipped-generation in nature; a minority was coparenting. Grandparent caregivers learned about and volunteered for the study via having been provided with information about its nature (to examine grandparent caregiver resilience) accessed through, for example, the American Association of Retired Persons, Grandparents.com, and Generations United, as well as many state agencies across the nation serving grandparents raising their grandchildren.

The parent sample (Hayslip et al., 2013) consisted of 42 male participants and 196 female grandparent caregivers (1 participant omitted gender). Of the sample, 79% comprised of White grandparent caregivers, with African American grandparents making up 13.8% of the total sample. Grandparent caregivers’ ages ranged from 38 to 90 years in age, with the mean age being 58.06 (SD = 8.17). The number of grandchildren being cared for by a grandparent caregiver ranged from 1 to as many as 13, with the average number of grandchildren being cared for being 1.61 (SD = 1.19). The mean age of the grandchild in care was 9.44 (SD = 4.65); their ages ranged from less than a year to 24 years of age. The average length of time that a grandparent had been caring for his or her grandchild was 6.44 years (SD = 4.68), and the length of time in care ranged from less than a year to 24 years.

In the parent sample, 270 survey packets were mailed to grandparent caregivers who indicated an interest in the project, described in terms of studying resilience among such persons. In all, 239 grandparents returned a completed survey, yielding a response rate of 88.1%. A letter of invitation, an informed consent form, a demographic information sheet, and the survey packet were mailed to each participant. Participants signed and returned by mail the consent form separate from the demographic information sheet and the survey packet. In all cases, strict criteria were defined to ensure the reliability of all survey data; all surveys were sealed and signed by participants and each was contacted and responses verified by telephone.

The current longitudinal analyses included those grandparent caregivers with complete data collected at an initial assessment as well as a 1-year follow-up (n = 79). Grandparent caregivers who participated in the longitudinal study were older than those who did not (M = 59.37, SD = 7.75 vs. M = 57.18, SD = 8.38); t(231) = −1.98, p < .05, d = .27. Persons who participated in the longitudinal study also had more grandchildren living at home than those who did not (M = 1.70, SD = 1.39 vs. M = 1.41. SD = .71); t(231) = −2.14, p < .04, d = .26.

Measures

Grandparent physical health

Items drawn from the Short Form–36 (SF-36) General Health Survey (Ware, 1993) were used to assess physical health. The widely used SF-36 consistently evidences good psychometric properties (Ware, 1993).

First, participants respond to a single, face-valid self-assessment of self-rated physical heath at present (range: 0 = poor, 5 = excellent), and a single item addressing past-year self-rated health trajectory (i.e., “Compared to one year ago, how would you rate your health in general now?” 1 = much worse to 5 = much better). Next, participants respond to 16 items addressing health-related functioning, creating a health-related limitations score. Using a 3-point scale (1 = yes, a lot; 3 = no, not at all), participants indicate to what degree their health interfered with nine daily physical activities in a typical week (e.g., carrying groceries, climbing stairs). Participants then responded either yes (1) or no (2) to whether they experienced any problems in their work or other daily activities over the past 4 weeks due to physical health (four items) or emotional problems (three items). Finally, participants completed the nine items addressing pep/vigor over the past month. Items include “Did you have a lot of energy” and are responded to using a 6-point scale (1 = none of the time to 6 = all of the time).

Correlations among these measures suggested that they were distinct but interrelated (see Table 1). Accordingly, the four total scores (i.e., self-rated physical health, health trajectory, health-related limitations, and pep/vigor) were combined to create a multidimensional, overall health score. For the current study, overall health was highly internally consistent (Time 1 α = .91, Time 2 α = .91).

Table 1.

Correlations Among Health Indicators at Time 1 (n = 79).

	1	2	3	4
1. Self-rated	—
2. Trajectory	.29**	—
3. Limitations	.56**	.31**	—
4. Pep/vigor	.50**	.42**	.62**	—
5. Overall (total)	.63**	.47**	.86**	.93**

p < .01.

Grandchild well-being

The Strengths and Difficulties Questionnaire (SDQ; R. Goodman, 2001; Palmieri & Smith, 2007) is a self-report measure that consists of 25 items answered along a 3-point Likert-type scale (1 = not true and 3 = certainly true). The SDQ was used to assess psychological adjustment of children and adolescents. The 25 items are organized into five subscales that look at prosocial behavior, emotional symptoms, conduct problems, hyperactivity inattention, and peer relationship problems. Satisfactory internal consistency reliability has been demonstrated for all scales except peer relationship problems (current study Time 1 α = .74, Time 2 α = .83), and retest stability was found to have a lower bound estimate of .62 at 4 to 6 months (R. Goodman, 2001; Palmieri & Smith, 2007). Overall SDQ scores (summed across the 25 items) were used here, with higher scores indicating more dysfunction.

Grandparent Well-Being

Resilience

The Resilience Scale (RS; Neill & Dias, 2001) is a 15-item self-report survey modified from Wagnild and Young’s (1993) Resilience Measure used to measure themes of personal resilience. All items are worded positively (e.g., “My belief in myself gets me through hard times”; “I keep interested in things”) and responses are on a 4-point Likert-type scale (1 = not at all true to 4 = completely true). This widely used measure evidences good psychometric properties (Ahern, Kiehl, Sole, & Byers, 2006; current study Time 1 α = .87, Time 2 α = .90); higher total scores represented higher levels of resilience.

Parental role strain

Custodial grandparent’s parental role strain was assessed via a 17-item measure derived from the Structure of Coping Scale (Pearlin & Schooler, 1978) and used to identify potential strains in grandparent’s roles as parents, as well as to identify emotional stress experienced by grandparents connected to this role. Each item is scored on a 4-point Likert-type scale (1 = never to 4 = very often). Example items include the correction of “misbehavior in the house,” “poor school work,” and frequency with which “advice and guidance are ignored.” Higher scores indicated the grandparent experienced more stress and strain associated with the caregiving role (current study Time 1 α = .88, Time 2 α = .88).

Hardiness—Personal Views Survey (PVS)

Hardiness was assessed via the PVS (Funk, 1992; Kobasa, 1985), a 50-item scale assessing hardiness that is comprised of three subscales: Control (feeling that all events are a consequence of one’s own actions), Commitment (active attempts to infuse meaning into one’s life), and Challenge (where changes in life are defined as exciting and stimulating, rather than stressful experiences). Each item is scored in a Likert-type manner, where 1 = not at all true to 4 = completely true (current study Time 1 α = .84, Time 2 α = .88). Higher scores indicated higher levels of hardiness.

Grandparenting satisfaction

Satisfaction with grandparenting was assessed via items drawn from Thomas (1990). This measure included 15 items (e.g., “One of the best things about this period of my life is my grandchild”) to which grandparents respond using a 5-point scale (1 = strongly disagree, 5 = strongly agree). Higher scores indicate greater satisfaction (current study Time 1 α = .79, Time 2 α = .79).

Caregiving appraisal

Positive aspects of the caregiving experience were assessed via a nine-item scale (Pearlin, Mullan, Semple, & Skaff, 1990). Each item began with the phrase “Providing help to my grandchild has . . . ” (e.g., “made me feel appreciated”; “made me feel strong and confident”) and was rated on a 5-point scale (1 = disagree a lot, 5 = agree a lot). Responses are summed such that higher scores indicate a more positive appraisal of the caregiving experience (current study Time 1 α = .86, Time 2 α = .84).

Life Disruption Scale

The extent of life disruption experienced was measured by items proposed by Jendrek (1993) in research relative to grandparents raising grandchildren. The scale consists of 20 items addressing the extent to which caring for a grandchild has affected the caregiver over the past year. The items were rated on a 5-point Likert-type scale ranging from 1 = not at all to 5 = a great deal. Examples of items in this scale include “doing things for fun or recreation,” “worrying about things,” and “having contact with friends.” In the current study, total scores were reverse coded such that higher scores indicated less life disruption (current study Time 1 α = .92, Time 2 α = .95).

Parenting Stress Index/Short Form (PSI/SF)

The PSI/SF (Abidin, 1990) is a 36-item self-report measure consisting of three subscales: Parental Distress (e.g., “I feel trapped by my responsibilities as a parent”), Parent−Child Dysfunctional Interactions (e.g., “Sometimes my grandchild does things that bother me just to be mean”), and Child Difficulty (e.g., “My grandchild’s sleeping or eating schedule was much harder to establish than I expected”). Items were responded to on a 5-point Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree. Custodial grandparents completed the PSI/SF as it related to their acquired roles as the grandchild’s functional parent. The PSI/SF demonstrates high internal consistency (current study Time 1 α = .91, Time 2 α = .91), high test−retest stability (r = .84), adequate construct, discriminant and predictive validity, acceptable concurrent validity with clinical and self-report criteria, and acceptable cross-cultural validity (Abidin, 1990). PSI/SF Total scores were used here, with higher scores indicating greater stress.

Grandparents’ perceptions of relationships with grandchildren

Grandparents’ perceptions of their relationships with grandchildren were measured by the Positive Affect Index (10 items) and Negative Affect Index (10 items; Thomas, 1990). The Positive Affect Index asked grandparents to describe the extent of their mutual understanding with, trust in, respect for, and affection for their grandchildren (current study Time 1 α = .86, Time 2 α = .88), whereas the Negative Affect Index measured the extent of the grandparents’ negative feelings toward irritating behaviors of the grandchild (current study Time 1 α = .72, Time 2 α = .74). An additional question asked the participants to rate the quality of the grandchild relationship (5-point Likert-type scale, with 1 = none and 5 = a great deal). Higher scores indexed less positive and greater negative affect, respectively.

Overall psychological well-being

Self-assessed psychological well-being was indexed via a 15-item scale that was designed to measure respondents’ feelings about their lives (Liang, 1985). The scale integrated items from the Bradburn Affect Balance Scale (Bradburn, 1969) and the Life Satisfaction Index A (Neugarten, Havighurst, & Tobin, 1961). Using a 5-point response scale (1 = strongly disagree to 5 = strongly agree), the Liang measure allows for the assessment of positive and negative affect (transitory affective components), happiness (long-term affective component), and congruence (long-term cognitive component). Responses are summed, with higher scores indicating greater well-being (current study Time 1 α = .89, Time 2 α = .90).

Results

Table 2 presents the descriptive data across both times of assessment for the measures utilized here. Data were first analyzed utilizing correlational techniques exploring relations between overall health and the above variables at Time 1 and at Time 2. As seen in Table 3, better overall health was associated (p < .05) with greater personal resilience and well-being, as well as less parental strain, grandchild difficulties, life disruption, and parental stress at Time 1. With the exception of well-being, these relationships held at Time 2. Furthermore, better overall health at Time 2 also was associated with reduced negative affect, increased positive affect, greater hardiness and greater grandparenting satisfaction. Changes in overall health across the assessment period also were examined via the creation of an overall health change score (i.e., Time 2 overall health minus Time 1 overall health), such that lower (negative) scores indicated worsening health. Changes in overall health were associated with greater hardiness at Time 2 such that worsening health across the 1-year period was related to lower hardiness scores at follow-up.

Table 2.

Means (Standard Deviations) and Correlations Across Assessments (n = 79).

Variable	Time 1 M (SD)	Time 2 M (SD)	T1 − T2 correlation
Self-rated health	3.30 (0.85)	3.25 (0.95)	.64**
Trajectory	3.01 (0.91)	3.05 (0.91)	.30**
Limitations	33.81 (5.48)	33.27 (6.91)	.72**
Pep/vigor	37.65 (7.78)	34.17 (7.21)	.54**
Overall health	77.78 (12.94)	73.75 (12.88)	.65**
GC difficulties	19.36 (6.26)	16.15 (7.85)	.68**
Resilience	34.17 (6.31)	33.79 (6.96)	.55**
Parental strain	34.11 (8.68)	33.70 (8.62)	.79**
Hardiness	158.25 (18.40)	155.45 (24.12)	.63**
GP satisfaction	57.02 (8.13)	55.63 (8.42)	.80**
CG appraisal	33.84 (6.58)	34.45 (7.04)	.71**
Life disruption	55.37 (15.78)	57.40 (18.46)	.72**
Parental stress	83.73 (22.45)	80.88 (24.25)	.67**
Positive affect	19.70 (5.92)	19.30 (6.17)	.74**
Negative affect	24.10 (5.75)	21.70 (5.62)	.72**
Well-being	51.67 (10.78)	51.05 (11.06)	.66**
Factor 1 (range)^a	−1.56 to 3.04	−1.55 to 3.13	.90**
Factor 2 (range)^b	−2.31 to 2.05	−2.24 to 2.04	.69**
Factor 3 (range)^c	−2.93 to 2.15	−3.09 to 1.59	.69**

Note. GC = grandchild; GP = grandparenting; CG = caregiving.

Personal and parental distress.

Personal well-being.

Role satisfaction.

p < .01.

Table 3.

Zero-Order Correlations Among Overall Health and Individual Factors at Each Assessment (n = 79).

Variable	1	2	3	4	5	6	7	8	9	10	11	12	13
1. Total Health	—	−.41**	−.36**	.36**	−.23*	.32**	.29**	.14	.54**	−.45**	−.23*	−.25*	.55**
2. Δ Health^a	−.41**	—	.06	.05	.06	.27*	.19	.07	.09	−.01	−.00	−.11	.01
3. GC difficulties	−.36**	.08	—	−.18	.61**	−.02	−.26*	−.00	−.43**	.48**	.55**	.53**	−.26**
4. Resilience	.38**	−.01	−.19	—	−.19	.26*	.16	.23*	.33**	−.35**	−.28*	−.08	.47**
5. P strain	−.22*	.13	.65**	−.03	—	−.17	−.47**	−.17	−.34**	.54**	.67**	.46**	−.36**
6. Hardiness	.08	.12	−.13	.27*	−.08	—	.36**	−.09	.31**	−.27*	−.10	−.25*	.36**
7. GP satisfaction	.15	.07	−.34**	.17	−.39**	.28*	—	.51**	.34**	−.43**	−.50**	−.29**	.30**
8. CG appraisal	.16	−.15	−.06	.01	−.18	−.03	.54**	—	.21	−.30**	−.33**	−.10	.28**
9. Life disruption	.51**	−.04	−.43**	.35**	−.20	.29**	.42**	.28*	—	−.64**	−.35**	−.34**	.44**
10. P stress	−.48**	.06	.59**	−.40**	.56**	−.22*	−.57**	−.33**	−.68**	—	.57**	.35**	−.45**
11. PA^b	−.21	.04	.65**	−.25*	.74**	−.23*	−.50**	−.17	−.34**	.63**	—	.62**	−.29**
12. NA	−.17	−.15	.45**	−.23*	.44**	−.22*	−.14	.06	−.19	.29**	.44**	—	−.16
13. Well-being	.60**	−.24*	−.33**	.44**	−.29**	.26*	.40**	.39**	.50**	−.53**	−.37**	−.14	—

Note. Data for Time 1 are below the diagonal; data for Time 2 are above the diagonal. GC = grandchild; P = parental; GP = grandparent; CG = caregiving; PA = positive affect; NA = negative affect.

Change in overall health (Time 2 health minus Time 1 health).

Higher values indicate less PA.

p < .05. **p < .01.

Prior to the formal analysis of the temporal relationship between overall well-being and health, scales potentially indexing grandparent well-being were factor analyzed utilizing Principal Components extraction with oblique rotation to a terminal solution (see Tabachnick & Fidell, 2001). This solution yielded three factors accounting for 66.25% of the common variance among measures, and this three-factor model was confirmed via a scree plot. Factor 1, labeled here as personal and parental distress (eigenvalue = 4.12, 41.21% of the common variance, factor loadings in parentheses), was principally defined by parental strain (.851), less grandparenting satisfaction (−.484), parental stress (.621), less positive affect (.786), and greater negative affect (.811). Factor 1 was secondarily defined by greater life disruption (−.363). Factor 2, labeled personal well-being (eigenvalue = 1.41, 14.12% of the common variance) was principally defined by resilience (.766), hardiness (.709), less life disruption (.487), less parental stress (−.534), and greater psychological well-being (.737). Finally, Factor 3, labeled role satisfaction (eigenvalue = 1.09, 10.91% of the common variance) was principally defined by grandparenting satisfaction (.647) and positive caregiving appraisal (.910), and secondarily defined by psychological well-being (.353). The above three-factor structure remained consistent at Time 2, wherein the same three factors were extracted, being principally defined by the same variables. Factor scores at each assessment were saved and utilized in the analyses reported below.

A series of cross-lagged panel analyses (Kenny, 1975; Kenny & Harackiewicz, 1979; Locascio, 1982) were conducted to examine associations among overall health, grandparent well-being, and grandchild difficulties over time. As can be seen in Table 4, correlations between health and personal/parental distress (Factor 1) did not differ (i.e., both rs = −.24) and those between role satisfaction (Factor 3) and both health and grandchild difficulties were nonsignificant; thus, these relations were not analyzed further.

Table 4.

Zero-Order Correlations Among Well-Being, Overall Health and Grandchild Difficulties Over Time (n = 79).

	Time 2 Overall Health	Time 2 GC Difficulties		Time 1 Overall Health	Time 1 GC Difficulties
T1 GC Difficulties	−.29**	.68**	T2	−.42**	1
T1 Resilience	.37**	−.10	T2	.31**	−.10
T1 P Strain	−.11	.56**	T2	−.29**	.58**
T1 Hardiness	.18	−.13	T2	.09	−.08
T1 GP Satisfaction	.22*	−.26*	T2	.13	−.19
T1 CG Appraisal	.03	−.06	T2	.08	.01
T1 Life Disruption	.48**	−.29**	T2	.46**	−.43**
T1 P Stress	−.43**	.47**	T2	−.43**	.56**
T1 PA^a	−.17	.44**	T2	−.22*	.51**
T1 NA	−.30*	.43**	T2	−.15	.49**
T1 Well-Being	.39**	−.32**	T2	.53**	−.22*
T1 Factor 1^b	−.24*	.56**	T1	−.19	.70**
T1 Factor 2^c	.46**	−.17	T1	.50**	−.22*
T1 Factor 3^d	.02	−.04	T1	.14	−.06
T2 Factor 1	−.22	.65**	T2	−.24*	.72**
T2 Factor 2	.60**	−.25*	T2	.51**	−.23*
T2 Factor 3	−.07	.05	T2	−.03	.09

Note. GC = grandchild; P = parental; GP = grandparent; CG = caregiving; PA = positive affect; NA = negative affect; T1 = Time 1; T2 = Time 2.

Higher values indicate less PA.

Personal and parental distress.

Personal well-being.

Role satisfaction.

p < .05 **p < .01.

Cross-lagged analyses indicated that the association between Time 1 overall health and Time 2 personal well-being (Factor 2; r = .46) did not significantly differ from the association between Time 1 personal well-being and Time 2 overall health (r = .51; Z = −0.51). This pattern held across selected follow-up analyses of variables evidencing the greatest discrepancy in the correlation with health over time. For example, the association between Time 1 overall health and Time 2 negative affect (r = −.15, p > .05) did not differ significantly from the association between Time 1 negative affect and Time 2 health (r = −.30, p < .05; Z = 1.35). Together, these data emphasize the bidirectional nature of these linkages over time. Specifically, physical health evidenced concurrent and predictive associations with both personal/parental distress and personal well-being across the 1-year assessment period as did, importantly, the well-being factors in relation to physical health at follow-up.

The association between Time 1 overall health and Time 2 grandchild difficulties (r = −.42) did not significantly differ from the association between Time 1 grandchild difficulties and Time 2 overall health (r = −.29; Z = 1.20). However, the relation between Time 1 grandchild difficulties and personal/parental distress at Time 2 (r = .72) was significantly greater than the relation between Time 1 personal/parental distress and Time 2 grandchild difficulties (r = .56; Z = 2.19; please see Figure 1).

Figure 1.

Model linking grandchild difficulties and grandparent personal/parental distress across the 1-year assessment period.

Follow-up analyses of component variables evidencing the greatest discrepancy in the correlation with grandchild difficulties over time were nonsignificant. For example, the correlation between grandchild difficulties at Time 1 and life disruption at Time 2 (r = −.43) did not significantly differ from the relation between Time 1 life disruption and Time 2 grandchild difficulties (r = −.29; Z = 1.34). Finally, analyses indicated that the association between Time 1 grandchild difficulties and Time 2 personal well-being (r = −.23) did not significantly differ from the association between Time 1 personal well-being and Time 2 grandchild difficulties (r = −.17; Z = −0.53).

Discussion

These data are largely consistent with recent theory and related empirical work (e.g., Berg, Smith, Henry, & Pearce, 2007) emphasizing the dynamic, recursive nature of linkages among physical and psychological health and psychosocial individual difference and contextual factors. The one exception to this pattern evidenced in the current data was the finding that greater grandchild difficulties (e.g., behavioral problems, problematic peer relations) prospectively predicted elevated personal/parental distress to a significantly greater degree than the converse (i.e., distress predicting grandchild difficulties). It is important to note that the current study examined parental distress as experienced by the grandparent (e.g., feeling trapped, worried, less affection toward the grandchild) and did not examine related parenting style or specific behaviors (e.g., disciplinary tactics) that may more proximally, and perhaps prospectively, predict grandchild difficulties (Darling & Steinberg, 1993; Wood, McLeod, Sigman, Hwang, & Chu, 2003).

This being said, our findings do suggest that the behavioral and psychosocial difficulties experienced by one’s grandchild do apparently predict parental/personal distress over time to a greater extent than parental/personal distress predicts grandchild difficulties (see Figure 1). This finding is consistent with the impact of the lack of recent experience in raising children reported by many grandparent caregivers (see Hayslip & Kaminski; 2005; Hayslip & Shore, 2000; Park & Greenberg, 2007), to say nothing of the impact on well-being of raising a problematic grandchild (Hayslip et al., 1998). However, it is to an extent inconsistent with the finding that the impact of grandmothers’ distress on grandchildren’s adjustment is mediated by dysfunctional parenting (G. Smith et al., 2008), as well as the fact that personal distress is exacerbated by the grandparent caregiver’s dysfunctional parental attitudes (Kaminski et al., 2008). However, this conclusion is tempered somewhat by the relationship (r = .56) between personal/parental distress at Time 1 and grandchild difficulties at Time 2 (see Figure 1), which suggests that programs speaking to alleviating personal distress and/or ineffectual parenting skills are also warranted (see Campbell & Miles, 2008; G. Smith & Richardson, 2008).

That grandchild difficulty predicted personal/parental distress here suggests that clinical and/or health interventions to deal with the many difficulties (e.g., developmental disabilities, asthma, birth defects, attention deficit hyperactivity disorder [ADHD], depression, drug use, bipolar disorder, autism) that many grandchildren experience be given primacy (see Hayslip & Kaminski, 2006; Kaminski & Murrell, 2008; Musil, Warner, McNamara, Rokoff, & Turek, 2008). Future work of a longitudinal and/or interventive nature integrating these features of the grandparent−grandchild relationship will be important.

Given that either health may predict well-being or well-being might predict health over time among grandparent caregivers, the relevance of a variety of interventions that are either health-related or well-being-related becomes paramount. Such interventions (e.g., formal and informal social support) might either directly impact one’s health and health-related behaviors (McCallion, Ferretti, & Kim, 2013) via minimizing adverse reactions to stress in lessening allostatic load (e.g., blood pressure, cortisol, cholesterol), thereby improving health (see Almeida, Piazza, Stawski, & Klein, 2011; Moren-Cross & Lin, 2006; Whitfield, Thorpe, & Szanton, 2011), or they may indirectly improve health by providing information about needed health care and social services (Carr, Gray, & Hayslip, 2012).

Likewise, participating in a support group (e.g., Cohen & Pyle, 2000), enrolling in a formally designed program to improve psychosocial functioning and the quality of relationships with the grandchild one is caring for (Hayslip, 2003), or finding ways to facilitate access to both formal and informal support from others to ease the stress of caregiving and improve psychological adjustment (i.e., lessening depression; by making timely and effective referrals to formal health care professionals and via feedback from others in one’s network, changing persons’ health beliefs and values; Dolbin-MacNab et al., 2013) could also be effective in improving health and/or enhancing the well-being and adjustment of grandparent caregivers. In this respect, a lessening of depression may be accompanied by less isolation from others, less reluctance to ask for help from others, greater personal resilience (see Hayslip & Smith, 2013), lessened parental stress (G. Smith & Dolbin-MacNab, 2013), and improved relationships and communication with a grandchild (A. Smith, Dannison, & James, 2013), all of which might result in (or be derived from) greater use of preventive health care or improved self-care practices (Fruhauf & Bundy-Fazioli, 2013; Kolomer, Himmelheber, & Murray, 2013; McCallion et al., 2013; Muliira & Musil, 2010; Roberto et al., 2008). Efforts to personally empower grandparent caregivers may enable them to become more proactive about their health as well as enable them to make more effective decisions about their lives could also contribute to greater well-being and better health (James & Ferrante, 2013; Whitley, Kelley, & Campos, 2013).

Limitations of the Present Study

Despite the significance of the longitudinal assessment used in the current study, several additional limitations must be noted. First, the sample was small, and thus may reflect a selective participation bias associated with better psychological and/or physical health. Future work examining larger, more heterogeneous samples (e.g., larger proportions of African American and Hispanic families) is warranted, both in terms of generalizability and power to utilize more advanced modeling techniques (e.g., structural equation models). Furthermore, it is important to note that all data were reported by the grandparent; more objective assessments of physical health (e.g., via physicians) as well as multi-informant designs addressing grandparent and grandchild well-being (e.g., via additional family members, the grandchild) will reduce concerns related to the single-informant design used here. Finally, the current study included only two time points across a single year among families differing across several important features (i.e., years of care, grandchild age, number of grandchildren). Future work accounting for these features (e.g., begin assessment at the outset of the caregiving role), conducted over a greater length of time, will aid in building sophisticated models of the complex interplay among grandparent health, well-being, and grandchild well-being over time.

These limitations notwithstanding, these longitudinal findings indicate that better perceived health provides an adaptive advantage for both grandparent caregivers and also for their grandchildren. They parallel those associated with the mental health of each generation (C. Goodman & Hayslip, 2008; Hayslip, King, & Jooste, 2008), wherein benefits to both are accrued via grandparents actively attending to their health in both a preventive and remedial way. Furthermore, the current data also attest to the potentially causal role that proactivity in the face of adversity (i.e., resilience) plays in the maintenance and indeed the improvement of grandparent caregiver health over time. These findings argue strongly for the importance of grandparents not only actively monitoring their own health but also taking purposeful steps to seek out information regarding health and its impact on their own well-being and that of their grandchildren.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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