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Elise K. Eifert, PhD(c), CHES Assistant Professor, Florida Atlantic University November 11, 2014. Emerging Trends in Family Caregiving Using the Life Course Perspective. Introduction. Our country is aging!
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Elise K. Eifert, PhD(c), CHES Assistant Professor, Florida Atlantic University November 11, 2014 Emerging Trends in Family Caregiving Using the Life Course Perspective
Introduction • Our country is aging! • Increase in chronic disease or disability and people who need intermittent or long-term care • Providing this care is typically done by family • Trends related to family caregiving will emerge
Demographics • By 2030, there will be about 72.1 million older persons, more than twice their number in 2000→19% of population • Mostly because of baby boomers • 85+ is fastest growing segment of older adults • Often need the most personal care and support
Chronic Disease & Family Caregiving • “Health care hasn’t slowed the aging process so much as it has slowed the dying process…“ – Dr. Ezekiel Emanuel (2014) • Family provides an estimated 90% of long-term care • Compare to paid, professional caregivers • 48.9 million caregiver or 1 in 5 households in 2009 • Expected to increase by 85% from 2000 to 2050
Baby Boomers • Individuals born between 1946 and 1964 • 76 million babies! • 65.2 million (2012) • All be 65 in 2029 • Influenced by distinct circumstances that affected how they think and behave as well as what they value • How will they respond to caregiving situations?
Generational Markers • TV • Vietnam & Korean wars • Scandals such as Watergate • Availability of oral contraceptive & legal abortion • Protests such as the women’s and civil rights movements • College educated and held white collar jobs • Lower rates of marriage, higher rates of divorces, and gave birth to fewer children • More discretionary income but less savings
Younger vs Older Older (1945-1954) Younger (1955-1964) Abnormally high expectations Seek balance between work & family Making a difference within himself Graduated college during conservative Reagan years Males have less military service • Individualistic • Focused on work • Making a difference in society • Graduated college during “free love” years • Males experienced conscription (until 1973)
Life Course Perspective • Interplay between man and history offers context for understanding common occurrences • “…looks at how chronological age, relationships, common life transitions, and social change shape people’s lives form birth to death” (Hutchinson, 2007)
Life Course Perspective • Cohort or Generation • Group of persons who were born at the same historical time • Transitions • Changes in roles and statuses • Trajectory • Long-term patterns involving multiple transitions • Life Event • Abrupt occurrence that involves change • Turning Point • Life event that alters the life course trajectory
Methods • Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (Moher et al., 2009)
Additional records resulting from online search (n = 12,351) Records identified through database searching (n = 2,034) Identification Records after duplicates removed (n = 1,320) Screening Records excluded (n =250) Records screened (n = 437) Literature fully assessed for eligibility (n = 187) Literature excluded, with reasons (n = 125) Eligibility Studies included in synthesis (n = 62) Included
Results • Increasing use of digital technology for information gathering and support • Increasing diversity • Strained finances and loss of entitlements • More complex care and care management • Demand for public policies related to caregiving • Balancing work, family, and caregiving
Increasing use of digital technology for information gathering and support • Availability of PC, tablets, cell & smart phones, MP3 players, GPS, game consoles, digital cameras, web cameras, “apps”, etc.(Pew Research, 2010) • Caregivers recognize the benefits of technology (FCA, 2012; United Healthcare & NCA 2011) • Boomers are heavy internet users (Cline & Hayes, 2001; Neilson 2012;
Increasing use of digital technology for information gathering and support continued… • Social network sites for support (Hamm et al,2013) • Caregiver “Apps” (Hasman 2011; US VA 2011) • Online communities and support groups (Colvin et al 2003; Aging Care 2013; Glueckauf et al, 2003) • Telemedicine (WHO 2010; Ludwig et al 2012)
Increasing use of digital technology for information gathering and support continued… • From a Life Course Perspective… • Boomers are situated in a specific time and place and experienced the emergence of the Internet as an everyday technology • Timing of Internet’s arrival in life trajectory affect experiences (older vs younger) • Use of technology may be dependent on life stage and events
Increasing diversity • Traditional caregiver profile is changing • Race & Ethnicity • ↓ white, ↑ other racial or ethnic minorities (Vincent & Velkoff 2010; Administration on Aging 2012; NAC & AARP 2009) • Caregiving experiences differ among racial & ethnic groups (Scharlach et al 2008; Pinquart & Sorenson 2003; National Academy on an Aging Society 2000; Dilworth-Anderson et al 2002; Toseland et al 2003)
Increasing diversity continued… • Gender (NAC & AARP 2009) • Caregiving has traditionally been a female role (Alzheimer’s Association 2012) • Males respond to & handle caregiving differently (Pinquart & Sorenson 2006) • Sexual Orientation (Grant & National Gay & Lesbian Task Force 2010) • More likely to be single, childless, and estranged from biological family (MAP & SAGE 2010) • Face stigma, discrimination, & legal issues surrounding caregiving (Metlife 2010)
Increasing diversity continued… • From a Life Course Perspective… • Human agency • Cumulative advantage-disadvantage (CAD)
Strained finances and loss of entitlements • Older adults are economically vulnerable (National Council on Aging 2012) • Females & Minorities • Costs of getting older are rising while resources are decreasing (Meschede, Sullivan, & Shapiro 2011)
Strained finances and loss of entitlements continued… • Boomers less likely to have pensions and benefit plans (Meschede et al 2011) • First generation to have government programs (“entitlements”) from birth until death (Roszak 2009) • Dependency Ratio (Age Works 2004; SSA 2013) • 16% of elderly fall under Federal Poverty Line→ higher risk if experience health crisis (O’Brien et al 2010; Short & Census Bureau 2011)
Strained finances and loss of entitlements continued… • Caregiving is a threat to financial stability and retirement security (Wakabyashi & Bonato 2006) • ~42% spend $5000 a year in out of pocket expenses (Feinberg et al 2011) • 70% make work accommodations [reduce hours, forfeit promotions, less contributions to 401(k)] (NAC & AARP 2005) • Some leave workforce all together (Metlife 2011)
Strained finances and loss of entitlements continued… • From a Life Course Perspective… • Assets and wealth accumulate over a lifetime • Life events like a major illness or transitions like caregiving can be catastrophic to financial stability • Younger baby boomers may have less entitlement benefits than older baby boomers
More complex care and care management • Chronic disease management requires a comprehensive and integrated approach to care (Hwang et al 2011; Goldberg & Solloway 2011) • Complex healthcare system with little communication between different sectors (Wagner 2013)
More complex care and care management continued… • Caregivers perform medical/nursing tasks with little to no training (medication management, injections, wound care, physical therapy, etc) (Reinhard, Levine & Samis 2012) • ↑ in caregiver burden (Given et al 2001; Papastavrou et al 2007)
More complex care and care management continued… • From a Life Course Perspective… • Few individuals look beyond themselves or close family members for help • Human lives are interdependent and the family is the primary focus • Caregiving is becoming a normative life event
Demand for public policies related to caregiving • Lack of (funded) federal policy that supports family caregivers (Riggs 2008) • Older adults have high voter turnout (Binstock 2000; Martinson & Minkler 2006) • Need for a more policy that supports caregiver (Feinberg, Wolkwitz, & Goldstein 2006; FCA 2009)
Demand for public policies related to caregiving continued… • From a Life Course Perspective…. • Boomer history of political activism • Belief that government has an obligation to support them considering the sacrifices they are making
Balancing work, family, and caregiving • Will be caregivers while being employed and have dependent children • Delaying retirement age (Kromer & Howard 2013) • Caregiving negatively effects work performance (Wagner & Niles 2005; NAC & AARP 2005)
Balancing work, family, and caregiving continued… • Caregiving cost employers (Metlife& NAC 2010) • Boomers as “sandwich” generation (Grundy & Henretta 2006; Parker & Patten 2013; Riley & Bowen 2005)
Balancing work, family, and caregiving continued… • From a Life Course Perspective…. • Boomers had different opportunities for education, work, and family which altered their trajectories towards simultaneous, demanding roles
Discussion • Knowledge of baby boomer caregivers is limited and fragmented • First literature review to examine the generational impact of baby boomers on family caregiving using the life course perspective
Implications • Boomer caregivers will have more options and choices because of technology • Increased understanding of caregiving experiences, care-related values and beliefs, and care practices • Boomers will be at risk for poverty and outliving resources especially if they are caregivers or face a health crisis
Implications • Caregiving will be a more complicated and precarious experience than ever before which could cause an increase in caregiver stress & burden • Increase in state and federal policies that support family caregivers • More awareness of employed caregiver needs
Conclusion • Highlight emerging trends related to family caregiving • Address the needs of baby boomer family caregivers
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