1. ISSUES AND CONCEPTS
IN AGING
Caring For the Frail Elderly
Chapter 12

2. A PROFILE OF CAREGIVING
 Approximately ____ million
people needed some assistance with daily
living
 Only ___ percent of people aged 65 to 69
need help with activities of daily living.
 While ___ percent of those older than 85
needed help
 _______ are most likely to provide care to
aging parents. followed by a __________
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3. FAMILY CARE
A PROFILE OF CAREGIVING
 Activities of daily living (ADLs): questionnaire is
designed to measure the capability of elderly living
on their own.
 Instrumental activities of daily living (IADLs):
keeping track of money, doing light
housework, taking medicine, running errands.
 Long-term care: a range of services designed to help
people with chronic conditions compensate for
limitations in their ability to function independently.
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4. GENDER DIFFERENCES
IN CAREGIVING
 Primary caregivers: usually women;
 Why?
 tends to be the daughter who has fewer competing
obligations.
 Usually one who is not working or is unmarried – many
daughters take on the caregiving role regardless of their
other responsibilities.
 Gender differences in the caregiving experience may
reflect that daughters perform more intimate tasks
for their elderly parents than sons do and that they
spend many more hours providing care.
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5. WORK AND
CAREGIVING
 __/__ of caregivers are no longer
working, __/__ are employed full-time or part-time.
 Since 1970, there has been a substantial increase in paid
employment among women.
 Why would Caregivers experience greater job stress and
more work/family conflicts than non-caregivers?
 Employer concerns over caregiving
 Employers often recognize that caregiving affects the job
performance of caregivers.
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6. THE CAREGIVER
BURDEN
 The Cost of Being a Caregiver
 Many caregivers are additionally stressed by financial
worry associated with paying for home care
services, health care, nursing home care.
 Caregiver burden: management of the tasks.
 Coping Skills
 Caregiver stress: the strain felt by the caregiver.
 The degree of stress felt by a caregiver depends partly on the
coping skills she or he may have developed to deal with other
life events, and partly on the kind of social support available.
© 2011 McGraw-Hill Higher Education. All rights reserved.

7. HOW CAREGIVING AFFECTS FAMILY
RELATIONSHIPS
 First research on caregiving focused on primary
caregiver in isolation from other family members.
 New research suggests that caregiving not only affects
the emotional well-being of the caregiver but
reverberates across other family relationships.
 Caregiving can also be a positive influence on the family
relationship by bringing kin together to accomplish a
shared goal.
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8. THE EFFECT ON PARENT-CHILD
RELATIONSHIPS
 Relationship between the caregiver and an elderly parent
can take many forms.
 Mutuality: both mother and daughter describing a
rewarding relationship characterized by joint activities and
minimal conflicts.
 Ambivalent: mothers and daughters had relationships
where there were rewards and costs; relationships were
sometimes tense.
 Conflicted: few rewards and frequent costs. (“She’s
generous and compassionate to others, but not to me”.)
 Stress can increase role reversal. The parent becomes the
dependent one.
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9. EFFECT ON SIBLING RELATIONSHIPS
 Caregiving can generate tension between primary
caregivers and their siblings.
 Why?
 One study found that greatest source of stress for women
caring for parent with Alzheimer’s was siblings.
 Different types of sibling conflict create different
responses on the part of caregivers.
 Disagreements over how to care for a parent may lead to
depression.
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10. CARFGIVING EFFECTS ON MARITAL
RELATIONSHIPS
 The Bad  The Good
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11. EFFECT ON MARITAL RELATIONSHIPS
 Caregiving can reduce the time husbands and wives have
for each other.
 Women may be too worn out from performing
caregiving duties to spend quality time with their
husbands and may worry about whether caregiving
demands are harming their marriage.
 The most stressful caregiving situation occurs with
Alzheimer’s disease.
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12. EFFECT ON
GRANDCHILDREN
 The Bad:
 Problems that arise: stress between grandparent
and grandchild, disruption of teen’s social life,
resentment of their mother’s caregiver burden.
 Children may have to compete with their
grandparents for their parent’s attention.
 Despite such potential strains, several studies
have found that family caregiving may also have
positive consequences for grandchildren.
© 2011 McGraw-Hill Higher Education. All rights reserved.

13. EFFECT ON
GRANDCHILDREN (CONT)
 The Good:
 Most grandchildren felt the caregiving situation
had a positive influence on family relationships.
 Another positive effect: it made the young people
more empathetic toward other adults and their
grandparents.
 The adolescents repeatedly described feeling
closer to their mothers, who were nearly always
primary caregivers.
© 2011 McGraw-Hill Higher Education. All rights reserved.

14. HOME AND COMMUNITY-BASED SERVICES
 Home and community-based services: most common
are:
 Case management is provided by a social worker who
assists frail elderly people and their families in obtaining
the medical, social, and personal services needed.
© 2011 McGraw-Hill Higher Education. All rights reserved.

15. INSTITUTIONAL CARE
 Nursing homes: the long-term care
option of last resort.
 Why is it the last resort?
 More than ___ percent of Americans who turned
65 in 1990 will spend some time in a nursing
home.
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16. THE NURSING HOME INDUSTRY
 People who reach age 65 have 40% chance of entering a
nursing home at some point during their lives.
 Problems:
 Although many nursing homes provide adequate and, in
some cases, exceptional care, poor-quality care is a
continuing problem.
 Among the problems documented were untrained
staff, poor health care, unsanitary conditions, poor
food, and unenforced safety regulations.
© 2011 McGraw-Hill Higher Education. All rights reserved.

17. STAFF TURNOVER IN LONG-TERM CARE
 High turnover leads to _____ care, placing the
most vulnerable population group at risk of
__________, falls, and inadequate _______.
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18. PROBLEMS IN ADJUSTING TO A NURSING
HOME
 People who live independently in a community find the
transition to institutional life difficult.
 People sometimes wept recalling a cherished piece of
furniture or a comforting daily routine.
 Older Hispanics or other immigrants who enter nursing
homes face unique obstacles in adjusting to
institutionalization, including language and cultural
differences.
© 2011 McGraw-Hill Higher Education. All rights reserved.

19. PATIENT ABUSE IN
NURSING HOMES
 Patient abuse very/not very common;
may be ______ or ________
 High turnover and high absenteeism among
staff creates situations that provoke abuse.
 Aides may use _________s to control
patients, pinch or slap them.
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20. PATIENT ABUSE IN NURSING
HOMES (CONT)
 More often abuse is more subtle and
psychological.
 Federal government and states have established
vigilant rules in an attempt to protect patients.
 Greatest protection against abuse in nursing homes
is presence of an “Ombudsman program”.
 Serve as watchdogs, monitor the quality of care
in nursing homes by investigating complaints
by families and residents against facilities.
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21. FAMILIES OF THE INSTITUTIONALIZED
ELDERLY
 Caregiver stress often does not end after an aging parent
or spouse is admitted to a nursing home.
 Constant conflict with the staff adds to the stress, as
caregivers who formerly attended to every need of their
loved ones now find they are at the mercy of strangers.
 Highest levels of stress and depression occur among
caregivers of patients with severe behavioral problems
and memory loss.
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22. NEXT WEEK
 Review for the final exam
 Student Learning Outcomes Quiz review
 Student Presentations
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