Grandparenting, health, and well-being: a systematic literature review

Keeping Us Young? Grandchild Caregiving and Older Adults' Cognitive Functioning

Objective

This study investigates longitudinal associations between providing care to grandchildren and cognitive functioning. It also examines heterogeneity in these relationships.

Background

Grandchild caregiving may support older adults' cognitive functioning by providing social engagement and emotional meaning. However, studies caution that time- intensive or custodial grandchild caregiving can take a toll on grandparents. The cognitive health implications of grandchild caregiving may thus depend on contexts including time spent providing care and living arrangements. They may also vary across sociodemographic groups and have greater effects on older adults who are more vulnerable to cognitive decline.

Method

Data came from the 1998-2016 waves of the Health and Retirement Study (HRS) and represented over 11,000 U.S. adults age 50+. Using linear growth curve and dynamic panel models, the analysis explored relationships between level of grandchild care and cognitive functioning over time and across sociodemographic, family, work and health characteristics.

Results

Those providing 100-199, 200-499 or 500+ hours of care to grandchildren had better cognitive functioning than non-caregivers regardless of whether they lived with grandchildren. Positive links between grandchild caregiving and cognition were stronger for lower income, non-working, and unpartnered adults and grew with age and functional limitations.

Conclusion

These findings suggest that providing care to minor grandchildren may help support cognitive functioning as adults age. They also support the hypothesis that more vulnerable or isolated groups of older adults may benefit the most from grandchild caregiving.

The Perceived Quality of Life of Older People in Spain Who Care for Grandchildren and Related Variables: A Mixed Methods Study

Grandparental care of grandchildren is a prevalent social phenomenon. This study explores the perceptions of health-related quality of life of grandparents caring for their grandchildren. A mixed methods design was developed. In the first phase, participants were interviewed using a baseline questionnaire. The second phase consisted of focus groups with 19 of the 100 participants in the quantitative phase. The scores obtained from the quantitative analysis are in line with the qualitative data; they reflect that grandparent carers who are more involved in the care of their grandchildren have more symptoms of depression and stress and have poorer perceptions of physical health-related quality of life. What may at first appear to be a positive aspect, keeping grandparent carers active, can become negative when it comes to shared care and when the grandparents' willingness to provide care is abused.

A within-subject examination of grandparents' physical activity and sedentary behavior levels in the presence or absence of grandchild care provision

BACKGROUND

This study aimed to examine within-subject differences in levels of physical activity (PA) and sedentary behavior (SB) among Flemish grandparents aged 50 years and older during a day of providing versus not providing grandchild care. Additionally, grandparents' PA and SB levels of the specific caregiving moment within the included care day were also compared with those of the corresponding specific time frame on the matching non-care day.

METHODS

Data were obtained and pooled from three assessment time points of the Healthy Grandparenting Project. Objectively measured PA and SB levels were assessed through ActiGraphs wGT3x(+) worn during waking hours for seven consecutive days and expressed relative to the total wear time of the selected days or moments (i.e., percentage of time per day or per moment). Generalized linear mixed models were used to evaluate the within-subject differences in grandparents' light intensity PA (LIPA), moderate-to-vigorous intensity PA (MVPA) and SB levels between a care and non-care day as well as between the care and non-care moment of those respective days.

RESULTS

A total of 92 grandparents (64.6 ± 4.8 years, 67.4% women) were included in the analyses. During the care day and care moment, grandparents showed higher relative levels of LIPA (∆=4.0% and ∆=7.9%, respectively) and lower relative levels of SB (∆=3.7% and ∆=6.7%, respectively) as compared to their respective non-care day and non-care moment (all p < 0.001). While there was no significant difference in relative MVPA levels between a day of providing versus not providing grandchild care (∆=0.3%, p = 0.500), the grandparents showed significantly lower relative levels of MVPA during the specific care moment against the non-care moment (∆=1.3%, p = 0.029).

CONCLUSIONS

The higher percentage of time of LIPA and lower percentage of time spent on SB during a care day and care moment compared to a non-care day and non-care moment, highlight the positive impact of grandchild care provision on grandparents' activity levels, potentially improving other health-related outcomes. Furthermore, grandparents seem to compensate for their lower MVPA levels during the actual care moment since no differences in MVPA levels were found at day level when compared to a day without grandchild care.

TRIAL REGISTRATION

clinicaltrials.gov, Identifier: NTC04307589. Registered March 2020.

The Effect of Informal Caregiving on Depression: An Asymmetric Panel Fixed-Effects Analysis of In-Home and Out-Of-Home Caregivers Across Europe

Previous research has shown that providing intensive informal care can have a negative effect on an individual's mental health. However, few studies have been able to draw a precise comparison between the experiences of in-home and out-of-home caregivers. This study used data from 16 countries collected from 2011-2019 as part of the Survey of Health, Ageing and Retirement in Europe (SHARE) to conduct asymmetric panel fixed-effects models that examined within-person variation in depression scores after a respondent started providing daily or almost daily personal care either inside or outside of their home. The results substantiated previous findings that in-home caregivers experience more pronounced increases to their reported depressive symptoms after starting to provide daily personal care than do out-of-home caregivers. In addition, in-home caregivers in countries with greater governmental responsibility for long-term care provision (The Northern and Central Clusters) reported fewer increases to their depressive symptoms after starting to provide care than caregivers in countries where long-term care responsibility predominantly rests on families (The Southern and Eastern Cluster). Further, Northern Cluster countries most successfully shrank the pool of out-of-home care providers. Together, these findings underscore the context-specific nature of caregiver wellbeing.

A Randomized Clinical Trial of Online Social Intelligence Training With Custodial Grandmothers

BACKGROUND AND OBJECTIVES

In this study, we investigated the efficacy of a self-administered, online Social Intelligence Training (SIT) program aimed at enhancing psychological and relational well-being among a nationwide U.S. sample of custodial grandmothers.

RESEARCH DESIGN AND METHODS

A two-arm randomized clinical trial (RCT) was conducted, where 349 grandmothers raising grandchildren aged 11-18 years were assigned to either SIT or an attention control condition (ACC). Participants self-completed online surveys at baseline and immediately postintervention, in addition to follow-ups at 3-, 6-, and 9-month postintervention. First-order latent difference score models were used to compare SIT to ACC, across all times of measurement, along key indicators of psychological and relational well-being on an intent-to-treat basis.

RESULTS

Although SIT was largely superior to ACC at yielding positive results, it appears that it attenuated longitudinal declines that occurred among ACC participants. SIT also exerted stronger effects on relational than psychological outcomes, with perceived relations with grandchildren being the most positively affected.

DISCUSSION AND IMPLICATIONS

Given that the historical time of this RCT unpredictably corresponded with the coronavirus disease 2019 pandemic, we suspect that SIT helped offset declines in psychological and relational well-being that are widely documented to have resulted from the pandemic. Our overall positive findings support future use of the inexpensive and easily delivered SIT program under normal environmental conditions, with the vulnerable and geographically disperse population of custodial grandmothers.

CLINICAL TRIALS REGISTRATION NUMBER

NCT03239977.

Research Review: Grandparental care and child mental health - a systematic review and meta-analysis

BACKGROUND

The number of children residing in grandfamilies is growing worldwide, leading to more research attention on grandparental care over the past decades. Grandparental care can influence child well-being in various forms and the effects vary across contexts. In this systematic review and meta-analysis, we synthesize the evidence on the relation between grandparental care and children's mental health status.

METHODS

We identified 5,745 records from seven databases, among which 38 articles were included for review. Random effects meta-analyses were used to synthesize evidence from eligible studies. We also examined the variability across study and participant characteristics, including study design, recruitment method, child age, child gender, study region, family type, comparison group, and outcome rater.

RESULTS

The meta-analysis consisted of 344,860 children from the included studies, whose average age was 10.29, and of which 51.39% were female. Compared with their counterparts, children being cared for by their grandparents had worse mental health status, including more internalizing problems (d = -0.20, 95% CI [-0.31, -0.09], p = .001), externalizing problems (d = -0.11, 95% CI [-0.21, -0.01], p = .03), overall mental problems (d = -0.37, 95% CI [-0.70, -0.04], p = .03), and poorer socioemotional well-being (d = -0.26, 95% CI [-0.49, -0.03], p = .03). The effects varied by study design and child gender.

CONCLUSIONS

The findings highlight that grandparental care is negatively associated with child mental health outcomes with trivial-to-small effect sizes. More supportive programs and interventions should be delivered to grandfamilies, especially in disadvantaged communities.

Caring for others without neglecting oneself? Grandparent caregivers, gender, and perceived health-related quality of life

In this study, we explored the impact of caregiving on quality of life and health perceptions and outlined the profile of grandparent caregivers in Andalusia (Spain) in terms of a range of sociodemographic variables related to the care of their grandchildren. A sample of 171 participants (21.6% men) completed the Health-Related Quality of Life (HRQoL) questionnaire and another ad hoc one providing sociodemographic and caregiving data. We studied the relationships between these variables and HRQoL using ANOVA, chi-square and Multiple Linear Regression. We found a mainly female profile for the care of grandchildren and interesting relationships for the physical and mental components of HRQoL. Some relationships were marked by gender: caregiving for pleasure was more often the motive for men while by imposition was more common among women. We discuss the impact of caregiving on health according to the Self-Determination Theory and suggest practical implications derived from the main findings.

Feasibility and Acceptability of an ABCD Program for Child Development Among Skipped Families in Rural Thailand: A Pilot Study

Introduction

The study aimed to develop and examine the aesthetic, bedtime story, connecting with nature, and drawing (ABCD), community based, program for grandparents to help them promote their grandchildren's development.

Methods

The action research was conducted in two phases. In the first phase, semi-structured interviews and focus group discussions were utilized to gather information from healthcare providers, teachers, and community leaders to develop the ABCD program. This was followed by a critical evaluation of the program's activities, materials, and contents. The second phase was to examine the program's effectiveness. A one-group pretest-posttest design was used to study the effectiveness of the program among 20 dyads of grandparents and grandchildren.

Results

All grandparents attended and completed the program. The grandparents' knowledge increased significantly (p = 0.024), and satisfaction with the program was high (X = 9, SD = 0.93) while children's development was not statistically different (p = 0.317).

Conclusion

The ABCD program was found to be feasible and acceptable to grandparents of skipped families to promote their grandchildren's development. The importance of healthcare providers, teachers, and community leaders in providing ABCD programs must also be recognized.

Projections of human kinship for all countries

Demographers have long attempted to project future changes in the size and composition of populations, but have ignored what these processes will mean for the size, composition, and age distribution of family networks. Kinship structures matter because family solidarity-a crucial source of informal care for millions of people around the world-is conditional on kin being alive. Here, we present innovative projections of biological kin for the 1950 to 2100 period and discuss what they imply for the availability of informal care. Overall, we project that the number of living kin for individuals will decline dramatically worldwide. While a 65-yo woman in 1950 could expect to have 41 living kin, a 65-yo woman in 2095 is projected to have just 25 [18.8 to 34.7] relatives (lower and upper 80% projection intervals). This represents a 38% [15 to 54] global decline. The composition of family networks is also expected to change, with the numbers of living grandparents and great-grandparents markedly increasing, and the numbers of cousins, nieces and nephews, and grandchildren declining. Family networks will age considerably, as we project a widening age gap between individuals and their kin due to lower and later fertility and longer lifespans. In Italy, for example, the average age of a grandmother of a 35-yo woman is expected to increase from 77.9 y in 1950 to 87.7 y [87.1 to 88.5] in 2095. The projected changes in kin supply will put pressure on the already stretched institutional systems of social support, as more individuals age with smaller and older family networks.

Grandparenting and life satisfaction among Chinese elderlies: a study of possible mechanisms

OBJECTIVE

This study examines the impact of caregiving on older people's life satisfaction, focusing on the role of caring for grandchildren. The study considers individual characteristics (aging attitudes) and situational factors (intergenerational support) and aims to identify the mediating roles of aging attitudes and intergenerational support in the relationship between caregiving and life satisfaction.

METHOD

The study analyzed data from the 2014 China Longitudinal Aging Social Survey (CLASS), focusing on 5363 grandparents who reported providing care for their grandchildren in the 12 months before the survey. Life satisfaction was subjectively measured. The data was analyzed using multiple linear regression, propensity score matching, and mediation analysis.

RESULT

The study found that grandparents who cared for their grandchildren have higher levels of life satisfaction. Self-aging attitudes, general aging attitudes, intergenerational economic support, intergenerational instrumental support, and intergenerational emotional support fully mediated the relationship between grandchild care and life satisfaction.

CONCLUSION

This study demonstrates that caring for grandchildren is a vital activity for older people that helps them develop positive aging attitudes and strengthens intergenerational support, thereby improving their quality of life. Hence, the government, society, families, and communities should provide more social support to older adults caring for grandchildren. This would not only benefit the health of the older people themselves but also promote intergenerational harmony and family development.

The prevalence of grandparental childcare in Europe: a research update

We investigate (a) how the proportion of European grandparents providing childcare changed over a period of 15 years, (b) how these proportions differ by gender and education, and (c) how countries not covered in earlier analyses fit into previously identified regional patterns of grandparental childcare in Europe. Using data from Waves 1, 2, and 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE), our descriptive analysis provides estimates of the prevalence and intensity of grandparental childcare in 26 European countries as well as of the changes therein over time and across socio-demographically defined groups. Overall, the prevalence and intensity of grandparental childcare in Europe has remained fairly stable over time, with minor increases. Proportions of grandparents providing any childcare strongly vary, however, across countries (from 24 to 60%). Grandmothers are generally more likely to provide childcare than grandfathers, while differences based on educational levels are less clear-cut. Central and southeastern Europe, representing the bulk of the 'new' countries in the analysis, exhibit patterns of grandparental childcare closely resembling those observed in Mediterranean countries. Our analysis revealed an overall stability over time rather than change in grandparents' provision of childcare in Europe, with substantial variations across welfare state regimes and within countries when accounting for grandparents' gender and educational levels. Including countries that had previously been excluded from other studies challenges the 'narrative' that has emerged around a negative macrolevel association between the provision of extensive and intensive grandparental childcare.

Age-Dependent Differences in Frequent Mental Distress (FMD) of US Older Adults Living in Multigenerational Families versus Living Alone

Frequent mental distress (FMD) is prevalent among older Americans, but less is known about disparities in FMD of older adults living in multigenerational families versus living alone. We pooled cross-sectional data (unweighted, n = 126,144) from the Behavioral Risk Factor Surveillance System (BRFSS) between 2016 and 2020 and compared FMD (≥14 poor mental health days in the past 30 days = 1; 0 otherwise) of older adults (≥65 years) living in multigenerational families versus living alone in 36 states. After controlling for covariates, findings indicate 23% lower odds of FMD among older adults living in multigenerational households compared to counterparts living alone (adjusted odds ratio (AOR): 0.77; 95% confidence interval (CI): 0.60, 0.99). Findings also show that the reduction in the odds of FMD with each 5 year increase in age was larger among older adults living in multigenerational families by 18% (AOR: 0.56; 95% CI: 0.46, 0.70) compared to older adults living alone (AOR: 0.74; 95% CI: 0.71, 0.77), and this difference was significant at the 5% significance level. Multigenerational living may have a protective association with FMD among older adults. Further research is needed to identify multigenerational family and non-kin factors that translate into mental health advantages for older adults.

Grandchild care and life satisfaction of older adults: Empirical evidence from China

Background

In China, grandchild care plays an important social role later in life. The effects of grandchild care on physical health and depression in older adults have been illustrated. However, there is a gap in research on grandchild care and life satisfaction of older adults specifically based on the Chinese experience.

Method

Based on 7,079 individuals' data from 2018 China Longitudinal Aging Social Survey (CLASS), this study explored the impact of grandchild care on older adults' life satisfaction by using Ordinary Least Squares (OLS), Propensity Score Matching (PSM), and instrumental variables (IV) models.

Results

The empirical results indicated that (1) life satisfaction was significantly higher for older adults who undertook grandchild care compared to those who did not; (2) non-coresiding grandparents showed higher life satisfaction than those non-carers, and this effect was not found in custodial grandparents or three-generation household grandparents; (3) higher life satisfaction of grandchild caregivers was achieved through reduced loneliness, enhanced self-efficacy, and increased emotional support from children, with the latter being the greatest contribution; and (4) the improving effect of grandchild care on life satisfaction was found mainly in the group of older adults who were male and in rural households.

Conclusion

There was a significant difference in life satisfaction between older Chinese adults who provided grandchild care and those who did not. Efforts in terms of old age policy protection and family relationships should be made to enhance the subjective well-being of older adults.

Unpaid productive activities and loneliness in later life: Results from the Indonesian Family Life Survey (2000-2014)

INTRODUCTION

Contributing to society constitutes an essential part of healthy ageing. To date, however, it remains unclear how valuable contributions such as caregiving and volunteering, also described as unpaid productive activities, are related to older adults' loneliness. The present longitudinal study addresses this question in a lower-middle-income country, in Indonesia.

METHODS

Using data from two waves of the nationally representative Indonesian Family Life Survey (2000-2014), logistic regression models were applied with caregiving (to non-resident children, siblings, and parents) and volunteering (1-99 h, >100 h per year) as predictors and loneliness as outcome. Participants who were <50 years old and felt lonely at baseline were excluded. Results are reported as odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Of the 3,572 participants (52.8% women; Mean age: 60 years), 538 (15.1%) developed loneliness. In the unadjusted model, volunteering 1-99 h per year and caregiving to parents were each associated with a lower likelihood of feeling lonely later in life. For moderate volunteering (1-99 h), participating in the volunteer decision-making process was beneficial for loneliness. After adjusting for covariates, only the association between caregiving to parents and loneliness remained significant (OR=0.48, 95%CI: 0.27-0.81, p = 0.01). Specifically, providing care to parents who did not need help with daily activities was associated with lower loneliness.

CONCLUSION

This longitudinal study addresses important research gaps in the literature on global healthy ageing, as it relates to the protective role of older adults' unpaid productive activities on loneliness in Indonesia.

Caregiving, volunteering, and loneliness in middle-aged and older adults: a systematic review

OBJECTIVES

Older adults contribute vast amounts of care to society, yet it remains unclear how unpaid productive activities relate to loneliness. The objective of this systematic review is to synthesise the evidence for associations between midlife and older people's unpaid productive activities (i.e., spousal and grandparental caregiving, volunteering) and loneliness.

METHODS

Peer-reviewed observational articles that investigated the association between loneliness and caregiving or volunteering in later life (>50 years) were searched on electronic databases (Ovid MEDLINE, Embase, PsychInfo and Global Health) from inception until July 2021. Studies were analysed using narrative synthesis and assessed for methodological quality applying the Newcastle Ottawa Scale.

RESULTS

A total of 28 articles from 21 countries with 191,652 participants were included (52.5% women). Results were separately discussed for the type of unpaid productive activity, namely, general caregiving (N = 10), spousal caregiving (N = 7), grandparental caregiving (N = 7), and volunteering (N = 6). Risk of bias assessments revealed a moderate to high quality of included studies. Loneliness was positively associated with spousal caregiving but negatively associated with caregiving to grandchildren and volunteering.

CONCLUSIONS

Grandparental caregiving and volunteering may be promising avenues for reducing loneliness in older age. Future studies will need to distinguish between different types of caregiving and volunteering and explore more complex longitudinal designs with diverse samples to investigate causal relationships with loneliness.

Changes in Grandparental Childcare During the Pandemic and Mental Health: Evidence From England

OBJECTIVES

Policies aiming at reducing rates of hospitalization and death from coronavirus disease 2019 (COVID-19) encouraged older people to reduce physical interactions. In England, until July 2021, provision of care for grandchildren was allowed only under very limited circumstances. Evidence also suggests that reduced face-to-face interactions took a toll on mental health during the pandemic. This study aims to investigate associations between changes in grandchild care provision during the first 8/9 months of the pandemic and grandparents' mental health.

METHODS

Using prepandemic data from Wave 9 (2018/2019) and the second COVID-19 substudy (November/December 2020) of the English Longitudinal Study of Ageing, we first describe changes in grandchild care provision during the pandemic to then investigate, using regression models, associations between changes in grandchild care provision and mental health (depression, quality of life, life satisfaction), while controlling for prepandemic levels of the outcome variables.

RESULTS

About 10% of grandparents stopped looking after grandchildren altogether during the first 9 months of the pandemic, with 22% reporting an overall decrease in the amount of grandchild care provided. Compared to grandparents who mostly maintained unchanged their grandchild care provision, those who stopped altogether and those who mostly reduced the amount of grandchild care provided were more likely to report poorer mental health, even accounting for prepandemic health.

DISCUSSION

While measures to limit physical contact and shield older people were necessary to reduce the spread of COVID-19, policymakers should acknowledge potential adverse consequences for mental health among grandparents who experienced changes in their roles as grandchild caregivers.

The transition to grandparenthood: No consistent evidence for change in the Big Five personality traits and life satisfaction

Intergenerational relations have received close attention in the context of population aging and increased childcare provision by grandparents. However, few studies have investigated the psychological consequences of becoming a grandparent. In a preregistered test of grandparenthood as a developmental task in middle and older adulthood, we used representative panel data from the Netherlands ( N = 563) and the United States ( N = 2210) to analyze first-time grandparents’ personality and life satisfaction development. We tested gender, employment, and grandchild care as moderators. To address confounding, we employed propensity score matching using two procedures: matching grandparents with parents and nonparents to achieve balance in different sets of carefully selected covariates. Multilevel models demonstrated mean-level stability of the Big Five personality traits and life satisfaction over the transition to grandparenthood, and no consistent moderation effects—contrary to the social investment principle. The few small effects of grandparenthood on personality development did not replicate across samples. We found no evidence of larger inter-individual differences in change in grandparents compared to the controls or of lower rank-order stability. Our findings add to recent critical re-examinations of the social investment principle and are discussed in light of characteristics that might moderate grandparents’ personality development.

Juggling Grandchild Care and Labor Force Participation: The Effect on Psychological Wellbeing of Older Women

Although it is well-known that care responsibilities are strongly gendered also in later life, the consequences for older women of juggling work and care responsibilities are understudied. This study contributes to fill this gap by focusing on the wellbeing implications for older European women of combining work and grandchild care. The role strain and role enhancement theories guide our theoretical predictions. While the former predicts a lower wellbeing due to the double burden of grandchild care and paid work, the latter posits an increase in wellbeing through the accumulation of social identities or roles. By using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigate whether grandmothers who do and those who do not work experience different levels of quality of life, depressive symptoms and life satisfaction. Our statistical model consists in a fixed-effect regression that adjusts for the lagged outcome. Results show that, among grandmothers engaged in paid work, grandchild care is not significantly associated with any of the three outcomes considered. Instead, non-working grandmothers seem to benefit from provision of grandchild care, in terms of higher quality of life and lower number of depressive symptoms. As thus, the provision of grandchild care tends to be beneficial for grandmothers' wellbeing only if they do not combine this activity with paid work. Juggling paid work and childcare to grandchildren may result in an excessive burden which eliminates the potential benefits of grandchild care on older women's wellbeing.