A Care Paradox: The Relationship Between Older Adults' Caregiving Arrangements and Institutionalization and Mortality.

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004-2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population.

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Family Ties and Older Adult Well-Being: Incorporating Social Networks and Proximity.

OBJECTIVES: This paper examines the family ties of older adults in the United States and how they are associated with mental health and social activity. We compare older adults with 4 types of family ties: adults "close" to family in proximity and social network, "kinless" older adults without a partner or children, "distanced" adults who live far from close kin, and "disconnected" older adults who do not report kin in their social network or do not report a location for some kin. METHODS: Using pooled data from the National Health and Aging Trends Study 2015-2019 for older adults aged 70 and older (N = 24,818 person-waves), we examine how family ties are associated with mental health and social activity, and whether lacking family is tied to poor well-being because older adults' needs are not being met. RESULTS: Kinless older adults and disconnected older adults have poorer outcomes (lower mental health scores and less social activity), compared to those close to their family. These findings suggest that both the presence and quality of the connection, as measured here via both location and social network, are critical for understanding which older adults are "at risk." Older adults who were not geographically proximate to their close kin (i.e., distanced) were not disadvantaged relative to those close to their families. Unmet needs do not help explain these patterns. DISCUSSION: Our results highlight that family ties are important for older adults well-being, not just through their existence but also their quality and strength.

Work as Overload or Enhancement for Family Caregivers of Older Adults: Assessment of Experienced Well-Being Over the Day.

Objective: This study examines work and care patterns and their association with experienced well-being over the course of the day and tests a moderating effect of gender. Background: Many family and unpaid caregivers to older adults face dual responsibilities of work and caregiving. Yet little is known about how working caregivers sequence responsibilities through the day and their implications for well-being. Method: Sequence and cluster analysis is applied to nationally representative time diary data from working caregivers to older adults in the U.S. collected by the National Study of Caregiving (NSOC) (N=1,005). OLS regression is used to test the association with well-being and a moderating effect of gender. Results: Among working caregivers, five clusters emerged, referred to as: Day Off, Care Between Late Shifts, Balancing Act, Care After Work, and Care After Overwork. Among working caregivers, experienced well-being was significantly lower among those in the Care Between Late Shifts and Care After Work clusters relative to those in the Day Off cluster. Gender did not moderate these findings. Conclusion: The well-being of caregivers who split time between a limited number of hours of work and care is comparable to those who take a day off. However, among working caregivers balancing full-time work - whether day or night - with care presents a strain for both men and women. Implications: Policies that target full-time workers who are balancing care for an older adult may help increase well-being.

Cohabiting Adult Children's Transfers to Parents in the United States.

Objective: This brief report presents national estimates of transfers of time and money from cohabiting adult children (ages 18 to 65) to their parents (own and in-laws) to test whether cohabiting adults give differently from their counterparts. Background: Previous U.S. studies use data collected in the late 1980s and mid-1990s, when cohabitation was an emerging family form; they find mixed results. Rising rates of cohabitation and an aging population of parents who may rely on transfers from adult children necessitate updated estimates that can help develop the theory of institutionalization of cohabitation. Method: This study used the 2013 Panel Study of Income Dynamics (PSID) Rosters and Transfers Module, a sample of U.S. households (N=6,340), and logistic and negative binomial models to estimate the likelihood of giving any time or any money to parents by the respondent's union status, the amounts given, and parent type (own, in-laws). Results: Cohabitors were less likely to give time to their own parents than their never married counterparts, and gave fewer hours, but were more likely to give time and gave more hours than married adults. For financial transfers to own parents, cohabitors and married respondents gave similarly, but both were less likely to give any money than are single respondents. Cohabitators gave more hours to their in-laws than married respondents. Conclusion: Cohabitors behave somewhere in-between marital "greedy institution" norms and broader norms of solidarity with parents. More work should be done to understand how union status affects transfers to parents.

Shared Care Networks Assisting Older Adults: New Insights From the National Health and Aging Trends Study.

BACKGROUND AND OBJECTIVES: Caregiving research often assumes older adults receiving care have a primary caregiver who provides the bulk of care. Consequently, little is known about the extent to which care responsibilities are shared more evenly within a care network, the characteristics associated with sharing, or the consequences for meeting older adults' care needs. RESEARCH DESIGN AND METHODS: We analyze a sample of U.S. older adults receiving care from the 2011 National Health and Aging Trends Study (n = 2,398). Based on variables reflecting differences in care hours, activities, and care provided by the whole network, we create network typologies for those with two or more caregivers (n = 1,309) using K-means cluster analysis. We estimate multinomial and logistic regression models to identify factors associated with network type and the association between type and unmet needs. We conduct analyses overall and for older adults living with and without dementia. RESULTS: Analyses reveal four network types: Small, low-intensity shared care network (SCN); large, moderate-intensity SCN; small, low-intensity primary caregiver network (PCN); and moderate-sized, high-intensity PCN. Among all older adults receiving care, 51% have a sole caregiver, 20% have an SCN with no primary caregiver, and 29% have a PCN. Among older adults with dementia receiving intense care, unmet needs are lower among those with an SCN (vs. PCN). DISCUSSION AND IMPLICATIONS: Findings underscore that the primary caregiver construct, although common, does not apply to a substantial share of care networks. Moreover, having an SCN when needs are high may be beneficial to meeting older adult's needs.

The Social Cost of Providing Care to Older Adults With and Without Dementia.

OBJECTIVES: Social participation is known to enhance well-being. Caregiving responsibilities are more intense when caring for an older adult with than without dementia and may affect caregivers' ability for social participation. We estimate social participation restrictions among caregivers for older persons with versus without dementia, variation within racial/ethnic group, and the mediating effect of care hours. METHODS: We use the 2017 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC) to study family caregivers for older adults. We estimate the prevalence of social participation (e.g., visiting family/friends, religious activities, group/club activities, going out) that were important to the caregiver but missed due to caregiving. We use logistic models to test for differences in restrictions by the older adult's dementia status overall and within race/ethnic group, adjusting for caregiver and care receiver characteristics. RESULTS: One-third of family caregivers for older adults with dementia reported restrictions due to caregiving, double the prevalence among caregivers of an older adult without dementia (33.3% vs 16.0%; p < .001). This doubling gap persisted in adjusted models (odds ratio [OR] = 2.4; p < .01) but mainly for White, non-Hispanic caregivers (OR = 3.2; p < .001). Substantially greater caregiving hours for people with versus without dementia was found (104 vs 60 hr per month), which is responsible for about 21% of the total difference in restrictions (p < .05). DISCUSSION: More time spent among caregivers of persons with versus without dementia may be an important factor undermining social participation, but hours only partially explain the gap. Future interventions should consider how to facilitate social participation among caregivers.

Caregiving and Self-Esteem in Mid and Later Life: Is There Variation by Age, Parental Status, and Gender?

Caregiving may prove either beneficial or harmful for caregiver well-being, depending on the circumstances surrounding care provision. Using data from the two most recent waves of the National Survey of Midlife Development in the United States (MIDUS, 2004-2014; N = 1,100), we examine whether providing care for an adult at both time points (i.e., 8-10 years apart) is associated with changes to self-esteem over the ten-year period, in comparison with providing care at only one time point, or not at all. We also examine moderation by caregivers' age, parental status, and gender. Findings indicated (1) caregiving at both waves was associated with decreases in self-esteem among younger and midlife adults, but this effect weakened and even reversed with age; and (2) caregiving at both waves was associated with increased self-esteem among participants without children, but not among those with children. We discuss implications for identifying caregivers at greatest risk of diminished well-being.

Co-residence beliefs 1973-2018: Older adults feel differently than younger adults.

Objective: This brief study examines support for co-residence (i.e. aging parents living with their adult children), and how age predicts support for this belief considering the rapidly aging U.S. population. Background: Co-residence, a form of intergenerational transfer between family members, can help facilitate care for aging parents as well as help older adults age in the community. Support for this type of co-residence was on the rise in the 1970s and 1980s. Method: Support for co-residence of older adults living with their adult children is estimated using 36,843 responses from the U.S. General Social Survey from 1973 to 2018. Descriptive analyses, logistic regression, and decomposition analyzes are used to test explanatory factors in trends, focusing on differences for older (age 65 and older) vs. younger (under 65) respondents. Results: Older adults are less supportive than younger adults of co-residence even as support has generally increased across time. Decomposition results show that a little over half of the difference between younger and older adults is explained by cohort replacement, with two-fifths of the difference unexplained by social or demographic factors. Conclusion: Findings suggest that although cohort replacement has contributed to an attitude shift over time, important age differences in attitudes remain. Older adults are less supportive of co-residence than younger adults.

A day in the life of caregivers to older adults with and without dementia: Comparisons of care time and emotional health.

INTRODUCTION: How care-related time and emotional health over the day differ for those assisting older adults with and without dementia is unclear. METHODS: Using 2134 time diaries from the National Study of Caregiving, we compared emotional health and care time for caregivers of older adults with and without dementia. RESULTS: Caregivers to older adults with dementia experienced worse (higher scores) on a composite measure of negative emotional health (4.2 vs 3.3; P < .05) and provided more physical/medical care (33.7 vs 16.2 minutes; P < .05) and less transportation assistance (12.6 vs 24.8 minutes; P < .05) than other caregivers. In models, providing physical/medical care was associated with worse emotional health (ß = 0.15; P < .01) and socializing with the care recipient was associated with worse emotional health when the recipient had dementia (ß = 0.28; P < .01). DISCUSSION: Findings highlight the opportunity for targeted interventions to address the emotional consequences of different types of care time in the context of dementia.

Feeling the Squeeze.

People often provide caregiving to other family members across the life course. "Sandwiched" caregiving, or caring for a child and aging parent at the same time, is a common form of combining care duties. However, adults share more years of life with many different family members due to population level demographic shifts in life expectancy and family formation. This shift means that multigenerational care, or providing for two or more different generations of family members simultaneously, may better reflect the reality of caregiving for contemporary cohorts of adults. Although there is strong public backing for providing supports to caregivers, current policies are often limited.

Educational Attainment Differences in Attitudes toward Provisions of IADL Care for Older Adults in the U.S.

Educational attainment is increasingly associated with family inequality in the U.S., but there is little understanding about whether and how education stratifies attitudes toward eldercare. Using the General Social Survey 2012 Eldercare Module, I test the association between educational attainment and attitudes toward eldercare provisions of Instrumental Activities of Daily Living (IADL) including different combinations of help and payment for help. IADLs are the most common care received by older adults and needs are projected to grow, so understanding attitudes toward this type of care is timely and relevant. Results show that adults with a bachelor's degree or graduate/professional degree, compared to adults with less than a high school degree, are more likely to support complete family IADL eldercare, where families provide the care and any payment necessary for care, compared to complete outside IADL eldercare, where outside institutions provide both care and payment. Educational attainment is an important axis of stratification in the U.S. and may explain potentially bifurcated policy solutions desired among different groups.

Greater Inclusion of Asian Americans in Aging Research on Family Caregiving for Better Understanding of Racial Health Inequities.

With the substantial demographic changes in racial composition in the United States since 1965, research on racial health inequities must build upon the Black-White binary to assess the complex ways "race" affects health and aging. Considering variation in the prevalence and meanings of aging across racialized groups requires concerted efforts to expand and disaggregate samples. Aligned with the goals of the intersectionality framework, we argue that greater inclusion of Asian Americans is critical to advance both theoretical and methodological considerations that enable us to investigate the lived experiences of Asian Americans. Using caregiving as an example, we discuss how systemic, cultural, and interpersonal marginalization from racism and other oppressive systems intertwine with "race" to produce the race effects. Greater inclusion of Asian Americans helps further provide the opportunity to conceptualize culture as dynamic and interacting with structure to produce different racial patterns. Meaningful inclusion of Asian Americans in research requires more systemic effort to collect accurate, reliable, and quality data for Asian Americans that can be disaggregated by other important axes of stratification.

Care Received and Unmet Care Needs Among Older Parents in Biological and Step Families.

OBJECTIVES: Increased likelihood of having step children among more recent cohorts of older adults, alongside lower levels of assistance from step children, has led to concerns about greater unmet needs for older parents in step families. However, few studies have directly examined family structure and unmet needs. We examined the associations between having step children (vs. only biological children) and receiving care from adult children, and unmet needs for assistance. METHODS: Using the 2015 National Health and Aging Trends Study, we investigated among older parents with care needs whether levels of care received from adult children and unmet needs differed between those with biological versus step families. We also explored whether a partner or paid care compensated for observed differences. RESULTS: Older parents in need of care were more than twice as likely to receive care from their adult children if they had biological instead of step families. Unmet needs among older parents did not differ by family structure, nor did levels of partner or paid care. DISCUSSION: Results illustrate that concerns about the implications of the rising prevalence of step families for care parents receive from their children may be warranted. However, there is a lack of evidence of greater unmet need for care for older parents in step families, as risks of unmet needs are high for older parents regardless of family type.

Family embeddedness and older adult mortality in the United States.

Do different operationalizations of family structure offer different understandings of the links between family structure and older adult mortality? Using the American Health and Retirement Study (N = 29,665), we examine mortality risks by three measures of family structure: whether respondents have different family statuses (e.g. married vs. unmarried), volume of family members available (e.g. having one vs. two living immediate family members), and family embeddedness (e.g. having neither spouse nor child vs. having spouse but no child). We focus on three kin types: partner/spouse, children, and siblings. We find that differences in empirical estimates across measures of family structure are not dramatic, but that family embeddedness can show some additional heterogeneity in mortality patterns over family status variables or the volume of ties. This paper tests different ways of operationalizing family structure to study mortality outcomes and advances our understanding of how family functions as a key social determinant of health.

Intergenerational Relationships, Family Caregiving Policy, and COVID-19 in the United States.

Families and intergenerational relationships are important sources of risk for COVID-19 infection, especially for older adults who are at high risk of complications from the disease. If one family member is exposed to the virus they could serve as a source of transmission or, if they fall ill, the resources they provide to others could be severed. These risks may be especially heightened for family members who work outside the home and provide care, or for those family members who care for multiple generations. Policies have the potential to help families bear the burden of these decisions. This essay argues that policies that address health, employment, and other social issues have implications for families, and that policies aimed at families and caregivers can affect the health, employment, and the general well-being of the nation.

Linked Lives and Childhood Experience of Family Death on Educational Attainment.

Sociological theory and research suggest that experiencing family members' deaths during childhood and adolescence is an important event subject to significant disparities. Previous research links immediate family members' deaths to poor life outcomes, but it considers a limited set of family members and has not tested the association of family member death with educational attainment. This study estimates the rates and educational impacts of experiencing the deaths of immediate (siblings, parents) and extended family members (aunts and uncles, cousins, and grandparents) during childhood and adolescence for Black and White Americans. We find that family death is associated with educational attainment, but the associations differ by family member type and gender, and child's race. Experiences of family death are unequally distributed by race and demonstrate complex associations with educational attainment. This research broadens life course and family systems theory by incorporating childhood family experiences of death on adult educational attainment and stratification.

Beyond Household Walls: The Spatial Structure of American Extended Kinship Networks.

How far do Americans live from their close and extended kin? The answer is likely to structure the types of social, instrumental, and financial support that they are able to provide to one another. Based on the Panel Study of Income Dynamics, kin pairs vary widely in odds of household co-residence, co-residence in the same administrative units, and inter-tract distances if they do not live in the same census tract. Multivariate regression tests show that family structure, educational attainment, and age are closely associated with kin proximity. Fixed effects models demonstrate that fam ily formation shapes spatial relations between kin.

Mothers' Time and Relationship with Their Adolescent Children: The Intersecting Influence of Family Structure and Maternal Labor Force Participation.

We investigate whether the anticipated risks of increasing maternal work hours for mother-adolescent relationships differ across family structures: Do intensive mothering norms exacerbate these risks particularly for mothers in two-parent biological families or does their partners' greater involvement significantly mitigate these risks? We predict mothers' accessible time, engaged time, and the quality of their relationship with their adolescent children using the National Study of Adolescent to Adult Health. Although the association between mothers' labor force participation and mothers' accessible time is significantly weaker in stepfather families relative to two-parent biological families, family structure does not moderate the associations between mothers' labor force participation and mother's engaged time or the quality of her relationship with her adolescent. We conclude that mothers face strong normative pressure to privilege their relationship with their child even in the face of long work hours and weaker family support.

Single-parent households and mortality among children and youth.

Although many studies have examined associations between family structure and child outcomes, few have considered how the increase in single-parent households since the 1960s may have affected child mortality rates. We examined state-level changes in the percentage of children living with single parents between 1968 and 2010 and state-level trends in mortality among children and youth (age 19 or younger) in the United States. Regression models with state and year fixed effects revealed that increases in single parenthood were associated with small increments in accidental deaths and homicides.