Family Systems and Aging

1. Family Systems and Aging Angela G. Rothrock, PhD Assistant Professor, Division of Gerontology, Geriatrics and Palliative Care Associate Director, UAB Geriatrics Education Center and UAB Reynolds Program

2. Our Family Structure • What’s your family structure? • Where do the members live? • Have you provided care for a parent? • Has a family member provided care to you?

3. Presentation Overview • What defines “Family” • Family Systems Perspective • Intergenerational Relationships • Family Interaction Patterns • Family Assessment • Culture and the Family • Living Arrangements • Caregiving • Family Conferences

4. What Defines Family? • Those who: • consider themselves economically and emotionally related to each other by blood, marriage, or commitment • are tied together through their common biological, legal, cultural, and emotional history and their implied future together • Varies by size, composition, and closeness • Most important system that we belong to • Primary identification

5. Three Traditional Family Types • Nuclear • Married or committed pair • Dependent children • Independent household • Bound to outside kin by voluntary ties of affection or duty

6. Three Traditional Family Types • Extended/Modified Extended • All relatives connected by blood or marriage

7. Three Traditional Family Types • Surrogate Family/Support System • Any individuals • Join together to give support and assistance • Sometime for a specific purpose • Fictive Kinship - “She’s like a sister to me”

8. Changing Family Structures • Considerable change in the 20th/21st centuries • Patterns of living arrangements • Divorce and remarriage • Decreases in fertility • More women working outside the home • Older adults embedded in a complex web of ties • “Beanpole” Families (Bengston, Rosenthal & Burton, 1990)

9. Family Systems Perspective • Family is an interdependent, emotional unit • Change or stress that affects one, affects all • Interaction patterns are repeating and hard to reorganize • Losses occur regarding • Control • Continuity • Defined roles • Significant relationships • Sense of purpose

10. Family Systems Perspective • Joint responsibility for problems • Unresolved issues will resurface • Crucial that families adapt to changing circumstances • Ex. Physical or cognitive decline of a member

11. Family Life Cycle Theory • First presented in 1957, Evelyn Duvall • Based on census data, post WWII • Widely utilized • Largely driven by the age of the oldest child • 8 stages reflecting • Size of the family • Age of members • Types of challenges faced Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134.

12. Family Life Cycle Theory • Families progress through eight stages: • Getting married • Childbearing • Preschool years • School-age years • Adolescent/Teenage years • Launching • Middle-aged parents • Aging family members

13. Family Life Cycle Theory • Tasks must be completed before moving to the following stage • Criticized for heavy reliance upon traditional/ idealized culture-specific assumptions regarding: • what constitutes a family • the experiences families will have • when these will occur • Does not address intergenerational family issues

14. Family Life Cycle Theory • Developmental task and needs of generations are no longer complementary • Multiple iterations, now more focused on transitions of the family or its individuals • Emphasis on family dynamics • Successful transitioning may help to prevent disease and emotional or stress-related disorders.

15. Intergenerational Relationships • 50% of older adults have daily contact with their children • Intergenerational relationships between parents and adult children: • are frequently characterized by ambivalence • 2 “sets of parents” • Feelings regarding “role reversals” • Competing priorities/goals • Carstensen’sSocioemotional Selectivity Theory

16. Knowledge Acquisition Emotion Regulation Infancy Late Life Socioemotional Selectivity Theory • Social contact/Relationships are motivated by either: • Pursuit of knowledge • Desire to regulate emotion Carstensen, L.L (1987. 1991. 1992)

17. Intergenerational Relationships • Implications for health and well-being • Family habits (eating, exercising) • Encouragement • Stress/burden (increase or decrease) • Feelings of well-being • Contributions

18. Intergenerational Relationships • Bengston’s Theory of Intergenerational Solidarity (Bengston & Roberts, 1991) • Generations relate to each other in terms of: • Living arrangement (structural) • Shared values (normative) • Norms (consensual) • Contact (associational) • Closeness (affectual) • Instrumental Support (functional) • Financial, caregiving, etc

19. Continuum of Social Family Norms • Dependence to independence • Filial Maturity • Adult children learn to accept and meet parents’ dependency • Involves being depended on and being dependable • They are emotionally ready to relinquish earlier roles • Obligation to volunteerism • Filial obligation, felt by children • Parents don’t want to be a burden

20. 5 Family Interaction Patterns(Blazer, 1998) • Compatible vs. Conflictual • Always in agreement or always arguing • Resurfacing of old conflicts • Cohesive vs. Fragmented • Present as a unit or as individual members

21. 5 Family Interaction Patterns(Blazer, 1998) • Productive vs. Non-Productive • Mobilize to create changes needed or powerless to act • Fragile vs. Stable • Family stability or disruption in relationships • Rigid vs. Flexible • Exchange and share roles and respond readily to crisis

22. Family Assessment • The Family APGAR (FAPGAR) (Smilkstein, 1978) • Brief screening questionnaire • 5 closed-ended questions • Fitting for multiple family structures

23. FAPGAR5 Components of Family Function • A - Adaptation • P - Partnership • G - Growth • A - Affection • R - Resolve

24. FAPGAR Results • Reflect a patient’s view of the functional state of their family • Focus on family unit as part of medical care/treatment • Useful for multiple cultures

25. Culture and the Family • Familial cultural norms are specialized in three ways • Specific to particular role relationships • Systematically related to social class, race, ethnicity, religion, or region • Vary across individual families (traditions) • Research has focused on cultural differences in living arrangements and caregiving

26. Culture and Living Arrangements • Affects the exchange of help and support • Western countries and Japan (Sundstrom, 1993) • Decline in the proportion of older people living with adult children since 1950 • In US, decreased from 33% to 15% • In Sweden, decreased from 27% to 5% (most extreme change) • Intimacy at a distance • Pattern of proximity but in separate households

27. Culture and Living Arrangements • Korean families (Won & Lee, 1999) • 75% of those age 60+ live with their children • More likely to live with sons • More likely to live with married children • Developing Countries (Hashimoto, 1991) • Brazil, Egpyt, India, South Korea, Singapore, Thailand, Zimbabwe • Older adults maintain co-residence with children • Lowest in Egypt and Brazil

28. Family Caregiving • ~80% of informal care of frail elders is provided by family caregivers • Usually a single, primary caregiver • 1/3 are adult children • Sandwich generation

29. Family Caregiving • Gender and history of relationships are key to determining: (Matthews, 2002) • Which child provides care • How caregiving is shared among relatives • Sibling conflict • How the older adult participates • Some cultures don’t involve the elder in decisions

30. Culture and Family Caregiving • Distinct cultural differences • PBS series – Life, Part 2 • Ethnicity, Race and Aging episode • http://www.pbs.org/lifepart2/watch/season-2/ethnicity-race-aging

31. Family Conferences • Family Conferences • Involve healthcare professionals and family members • Interdisciplinary team approach • Presentation of loved ones diagnoses, concerns • Improved quality of care • Considerations of various perspectives • Discussion of advanced care planning, resources • Engage multiple family caregivers • Sort out tasks and schedules Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992) ,The Family Conference in Geriatrics,CanadianFamily Physician, p585-588

32. References • Bengtson, V.; Rosenthal, C. J.; and Burton, L. (1990). "Families and Aging: Diversity and Heterogeneity." In Handbook of Aging and the Social Sciences, 3rd edition, ed. R. H. Binstock and K. George. New York: Academic Press. • Bengtson, V. L., & Roberts, R. E. L. (1991). Intergenerational solidarity in aging families: An example of formal theory construction. Journal of Marriage and the Family, 53, 856-870. • Blazer D (1998). Emotional problems in later life: Intervention strategies for professional caregivers. New York: Springer • Carstensen, L.L. (1987). Age-related changes in social activity. In L.L. Carstensen & B.A. Edelstein (Eds.), Handbook of Clinical Gerontology (pp.222-237). New York: Pergamon Press. • Carstensen, L.L. (1991). Selectivity theory: Social activity in life-span context. Annual Review of Gerontology and Geriatrics, 11, 195-217. • Carstensen, L.L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity theory. Psychology and Aging, 7, 331-338. • Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134. • Hashimoto, A. (1991). "Living Arrangements of the Aged in Seven Developing Countries: A Preliminary Analysis." Journal of Cross-Cultural Gerontology 6:359–81. • Matthews S (2002). S isters and Brothers/Daughters and Sons: Meeting the Needs of Old Parents. Bloomington: Unlimited Publishing; 2002. • Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992) ,The Family Conference in Geriatrics, Canadian Family Physician, p585-588 • Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. Journal of Family Practice, 6(6), 1231-1239. • Sundstrom, G. (1993). "Care by Families: An Overview of Trends." In Caring for Frail Elderly People. Paris: Organization of Economic Co-operation and Development. • Won, Y., and Lee, G. (1999). "Living Arrangements of Older Parents in Korea." Journal of Comparative Family Studies 30:315–28.