Caring for a demented relative at home: Effects on parent–adolescent relationships and family dynamics

Lived experiences of maintaining self-identity among persons living with young-onset dementia: A qualitative meta-synthesis

BACKGROUND

The self-identity of persons with young-onset dementia (YOD) is affected by the disease progression. However, the lived experience of maintaining self-identity along the disease trajectory is understudied. This meta-synthesis integrated qualitative data on the challenges, coping strategies, and needs of persons living with YOD and how their experiences affected their self-identity over time.

METHODS

Four English (PubMed, Scopus, CINAHL, PsycINFO) and two Chinese (CNKI and Wanfang) electronic databases were searched for published literature peer-reviewed from the time of database inception to 2022. We used thematic analysis to extract and synthesize data from the literature concerning the long-term lived experiences of persons living with YOD.

RESULTS

A total of five peer-reviewed publications were eligible for inclusion in this meta-synthesis study. We identified four themes: (1) declining cognitive function and a prolonged diagnostic process threaten the self-identity of persons living with YOD, (2) struggling to accept the diagnosis of YOD and maintain self-identity, (3) maintaining self-identity and the normalcy of life through social support and person-centered care, and (4) living with YOD through self-development and self-identity reshaping at a later stage of the disease.

CONCLUSIONS

Persons living with YOD experience challenges maintaining their self-identity throughout the disease trajectory. These challenges are affected by their cognitive function, experiences of personal and social stigma associated with the disease, perceived social support, and person-centered care. Study findings have implications for developing tailored supportive programs for persons living with YOD at various stages of the disease trajectory.

Grandchildren of grandparents with Alzheimer's disease: Exploratory study of the impact of the disease on their relationships

The aim of this study was to describe the perception of changes that Alzheimer's disease in grandparents has made to the relationship with their grandchildren of between 6 and 13. Qualitative methodology was used. Semi-structured interviews were carried out with 25 grandchildren living in Catalonia, Spain. Participants reported a change in roles from being the care receiver to being the caregiver, changes in the activities that they did together and a positive impact on the grandparent's emotional wellbeing. In the physical sphere, sleeping problems were reported in grandchildren that cohabited with their grandparents. The feelings they described include fear of not being recognized by their grandparents and sadness, as well as satisfaction resulting from their affection and participating in caring. These findings suggest the need to provide information and resources for grandchildren and their families to enable them to deal with the disease.

The impact of dementia family caregiving on adolescent well-being: A scoping review

With rates of dementia on the rise and upward trends in multigenerational households, the number of families providing care to persons with dementia is likely to increase. Although caregiver stress in adults has been well-documented, less is known about the impact of dementia family caregiving on adolescents. We conducted a scoping review to assess research on the impact of dementia family caregiving on adolescents. Eight articles representing five studies were identified. Findings suggest that while adolescents developed strategies to cope with the challenges of dementia caregiving, the long-term impact of caregiving on overall well-being has not been well described. Further, research has shown inconsistent findings with studies reporting both improved and strained adolescent relationships. The paucity of research on the impact of dementia family caregiving on the well-being of adolescents is a serious omission given that adolescents are at high-risk for emerging health problems.

Childhood perspectives of parental young onset dementia: A qualitative data synthesis

Background

While it is less common, young onset dementia manifests at a significantly younger age (< 65). Many people with young onset dementia are parents; however, little is known about impact of the condition on children and young adults. A qualitative thematic analysis was conducted to synthesise the literature on the perspectives of children and young adults with a parent living with young onset dementia.

Methods

Electronic databases were searched in order to identify all peer-reviewed literature in relation to the perspectives of children and young adults with a parent living with young onset dementia. A thematic analysis was conducted on the relevant literature.

Results

The electronic database search resulted in 15 full texts articles. Four main themes with related subthemes emerged from the thematic analysis. The four main themes were: changing family dynamics; psychological and physical strain; stigma and coping strategies.

Conclusion

The current synthesis outlines the perspectives of children and young adults with a parent living with young onset dementia. There is a significant lack of research in this area which adds to the stereotypical view of dementia as an older person’s disease. This can lead to children and young adults being impacted by lack of awareness and stigma resulting in significant psychosocial problems. As the number of people living with dementia (including young onset) is set to increase, future research with children and young adults with a parent with young onset dementia is important in order to better support this cohort.

Young people's moral attitudes and motivations towards direct-to-consumer genetic testing for inherited risk of Alzheimer disease

Purpose

Since the U.S. Food and Drug Administration approved sales of genetic tests for late-onset Alzheimer's disease (LOAD) risk, a heated debate has arisen over whether these tests should indeed be offered online and direct-to-consumer (DTC). As this debate progresses, it is important to understand the ethical perspectives and motivations of young people, who are a key target group for DTC services.

Methods

Thirty-one grandchildren of people with LOAD, aged 16–26, were interviewed about their moral attitudes and motivations with regards to DTC genetic testing for LOAD.

Results

Even though most participants claimed that people should have the right to access these services, they also expressed concerns about potential distress in response to learning about risk, particularly for minors. About a third were interested in testing, primarily to gain self-knowledge regarding one's health; however, face-to-face services were vastly preferred over the online option.

Conclusion

While DTC genetic companies often market their services as a “fun consumer product”, DTC testing for LOAD was largely understood as a serious health screening procedure and a vulnerable moment in the lives of young people in Alzheimer's families. This points to the importance of appropriate standards of information and support to young people pre- and post-testing.

The experiences of grandchildren who provide care for a grandparent with dementia: A systematic review

Much of the research exploring the experiences of family caregivers of people with dementia has focussed on spouses and adult children. It is hypothesised that other family members at different life stages and with different family roles may experience and perceive the caregiving role differently. The objective of the current review was to explore the experiences of grandchildren who provide care to a grandparent with dementia. A systematic search of four databases identified 12 studies which met the inclusion criteria. An assessment of quality was completed for each of the included studies. Grandchildren described dementia-related changes, changes to their role and relationship with their grandparent, multiple impacts of caregiving, influences of other family relationships on caregiving and positive aspects of caregiving. Many of the included studies met most of the quality criteria for the respective methodological design; however, there was some variation in quality and sample across included studies. The review indicates that assessments and interventions to incorporate grandchildren and the wider family system may help to support family carers to continue to provide care for grandparents with dementia. The research and clinical implications and limitations of the review are also considered.

Positive and Negative Impacts of Caring among Adolescents Caring for Grandparents. Results from an Online Survey in Six European Countries and Implications for Future Research, Policy and Practice

Although up to 8% of European youngsters carry out high-intensity care for a family member, adolescent young carers (AYCs), especially those caring for their grandparents (GrPs), remain an under-researched group. This study aimed at addressing the current knowledge gap by carrying out an online survey in Italy, the Netherlands, Slovenia, Sweden, Switzerland, and the United Kingdom. The analysis included a final sample of 817 AYCs aged 15-17 years old. AYCs of grandparents (GrPs) were compared to AYCs of other care recipients (OCRs), in order to identify any difference in positive and negative caregiving outcomes and exposure factors between the two groups. Linear or logistic regression models were built, and multivariate analyses were repeated, including a fixed effect on the country variable. AYCs of GrPs experienced more positive caregiving outcomes than AYCs of OCRs across all six countries. Being female or non-binary, and having a migration background, were associated with more negative outcomes, regardless of the relationship with the care recipient. Further research on intergenerational caregiving outcomes is recommended for shaping measures and policies, which preserve the intergenerational emotional bonds, whilst protecting AYCs from inappropriate responsibilities, undermining their mental health and well-being.

‘I try my best … I try to relieve the burden of my mum’: a narrative analysis of the everyday care-giving experiences for five intergenerational Singapore-Chinese families where one member has dementia

Singapore is experiencing a rapid growth in its ageing population with most of the islands’ inhabitants living in high-rise apartments due to the scarcity of land. The Chinese community living in Singapore comprises the largest ethnic group and they are more likely to live together under one roof in an intergenerational family grouping. Currently, there are gaps in understanding intergenerational Singapore-Chinese families and their approach to caring at home for a family member with dementia. The aim of this longitudinal qualitative study was to understand better this everyday care-giving experience. Using semi-structured biographical interviews and digital photographs to elicit family stories, five intergenerational Singapore-Chinese families were visited at home for a period of between six and 15 months. Each recruited intergenerational family was treated as a ‘case’. Narrative analysis of the data was applied within and between cases and resulted in the emergence of three themes that represented various dynamics in the data. The three themes were identified as: (1) family values, which is about the cultural context in which everyday care takes place, the religious beliefs and practices of the intergenerational Singapore-Chinese families, and the practice of filial piety; (2) family support, which is about everyday access to family and service networks, including the contribution of the live-in maid in caring for the family member with dementia; and (3) family bonds, which is about the maintenance of intergenerational family relations in the Chinese family kinship system.

Caring for a Spouse with Alzheimer's Disease: Stressors and Strengths

This study focused on the experiences of eight female participants who were responsible for the daily care of their husbands, all of whom were diagnosed with Alzheimer's disease. An essentially qualitative research approach, triangulated with certain quantitative measures, was used to identify both stressors and strengths reported by these caregivers. Results from mental health questionnaires showed that the comprehensive social, economic and health-related stressors experienced by caregivers put them at risk of developing serious mental health problems. However, qualitative data obtained from support group discussions, individual interviews and personal diaries highlighted the particular strengths that these caregivers showed and made use of during the caregiving process. These identified sources of resilience might in future contribute towards the development of a programme aimed at keeping this, and similar groups known to be prone to the development of stress-related illnesses, psychologically strong.

Caregiving networks-using a network approach to identify missed opportunities

OBJECTIVES

This study demonstrates the added value to caregiving research by using a multi-informant social network approach within the context of Alzheimer's disease and related dementia.

METHOD

Sixty-six informants from 24 families enumerated caregiving network members in 2012. Comparisons were made between networks based on a single informant versus multiple informants in terms of network composition and caregiving roles, core-periphery structure, and identification of "missed opportunities" in recruitment.

RESULTS

On average, each informant beyond the index enumerated 6.2 new members, resulting in about 10 new members per family network when the multiple-informant approach is used. Compared with index informants' networks, multi-informant networks showed an 85% increase in identification of direct care providers (1.71 compared with 3.42) and a 48% increase in identification of those involved in care decision making (3.33 compared with 4.92). Informants from the same network generally showed agreement in reported participation in caregiving activities. However, the reports of non-participation in these roles were less consistent among the informants. Resulting structure indicated a core caregiving network (M = 6.12 members), with semi-peripheral and peripheral members (M = 5.19 and M = 14.83 members, respectively).

DISCUSSION

Results suggest that an iterative, targeted sampling approach with at least three informants allows for a more comprehensive assessment of caregiving processes. Applying this approach in future research will greatly enhance our knowledge and better inform future interventions to facilitate family adaptation.

Motivating adult children to provide support to a family caregiver

This study compared altruistically and egoistically framed messages for encouraging adult children to support a parent providing care for an elderly relative. Undergraduate students imagined their mother filling a caregiving role while reading a message about family caregiving and the physical and psychological stresses it involves. The message encouraged participants to support the caregiver either for altruistic (other-oriented) or egoistic (self-oriented) reasons. Thereafter, participants completed self-assessment surveys of attachment style and willingness to provide support. Securely attached (less self-oriented) participants were not differentially influenced by the two messages. However, insecurely attached (more self-oriented) participants were more willing to help if they received the egoistic message than if they received the altruistic message. Thus, knowledge of a family member's attachment style can be useful for selecting an appropriate method for encouraging caregiver support. Whereas the type of message used does not matter for securely attached individuals, an egoistically framed message may be more influential than an altruistically framed message among insecurely attached individuals. It is important that clinicians work with families to establish appropriate levels of individual commitment to caregiving responsibilities or supportive behaviours such that involvement is beneficial to the health of the caregiver, the care recipient and supporters.

Prevalence and Predictors of Change in Adult-Child Primary Caregivers

Family caregiving research is increasingly contextual and dynamic, but few studies have examined prevalence and predictors of change in primary caregivers, those with the most frequent contact with healthcare professionals. We identified prevalence and predictors of 2-year change in primary adult-child caregivers. Data pooled from the 1992–2000 waves of the Health and Retirement Study (HRS) represent 1,068 parent-level care occasions and 3,616 child-level occasions. There is considerable 2-year stability in primary adult-child caregivers. Parents are more prone to experience a change in adult-child primary caregivers if they live by themselves and if they have more sons and daughters. As far as the adult children are concerned, daughters and children living closer to parents are more likely to remain primary caregivers. Results suggest that change in primary caregivers is more strongly associated with available alternatives and gender norms than burden and competing obligations.

Changes in adult children's participation in parent care

Care-giving research has focused on primary care-givers and relied on cross-sectional data. This approach neglects the dynamic and systemic character of care-giver networks. Our analyses address changes in care-givers and care networks over a two-year period using pooled data from the US Health and Retirement Study, 1992–2000. Based on a matrix of specific adult-child care-givers across two consecutive time-points, we assess changes in any adult-child care-giver and examine the predictors of change. A change in care-giver occurred in about two-fifths of care-giving networks. Ability to provide care based on geographical proximity, availability of alternative care-givers, and gender play primary roles in the stability of care networks. Results underline the need to shift care-giving research toward a dynamic and systemic perspective.

[Grandchildren in family care giving for people with dementia: experiences and evaluations--results from a life-world-oriented study]

Dementia often has a serious impact on family life in household care giving situations. The qualitative study in applied gerontology presented here focuses on the subjective experiences of grandchildren and the intergenerational relationships of the family members. It includes 15 in-depth retrospective interviews with young adults (11 female, 4 male). The theoretical background is a sociological life-world-oriented approach by Alfred Schütz. The grandchildren reported a wide range of experiences with positive and enriching incidents prevailing, e.g., individual and familial competence in care giving, increased contact between family members, i.e., so-called"family cohesion", improvements in the grandchildren's social responsibility, and their acquired knowledge of the needs of older people and of persons with dementia. Individual stress was experienced because of so-called "challenging behavior" by the grandparents (e.g., aggressive behavior) or family circumstances when the demands were too great.A third category includes those experiences which seem to be "taken for granted" and are regarded as insignificant by the grandchildren. Because this category encompasses many of the grandchildren's own care giving activities, the widespread assumption that dementia must always cause younger carers stress is not true in general. The data suggest that living in a family that has difficulties in coping with the situation might be more demanding than dealing with the behavior and psychological symptoms of dementia. The grandchildren should be given access to age-appropriate information about the disease and the ways to communicate effectively with their grandparent needing care.

Young children in early-onset Alzheimer's disease families: research gaps and emerging service needs

Early-onset Alzheimer's disease (EOAD), defined as affecting those under age 65, afflicts between 200,000 and 500,000 people in the US. EOAD tends to be a fast-progressing and aggressive form of AD. There is a beginning body of research exploring EOAD patients' experience and needs, as well as that of their primary family caregivers, often spouses. However, there has been very little written about the experience and needs of EOAD patients' children, who because of the early onset, and increasing postponement of childbearing, may be latency-aged or in their early teens. This paper reviews existing and related literature in this area, and illustrates the psychosocial impact on children using the case of a 50 year-old father diagnosed with AD and his 16 year-old daughter and 11 year-old son. The need for increased research and program development to address these children's needs is discussed.

Grandparenting in the 21st century: issues of diversity in grandparent-grandchild relationships

Although previous literature has demonstrated the importance of age, ethnicity, and socioeconomic status in understanding grandparent-grandchild relationships, additional factors contribute to a more complete and nuanced understanding of multigenerational relationships. Thorough understanding of the role of diversity requires examination of the discrete impacts of grandparents' gender, sexual orientation, and physical and/or cognitive limitations on the relationship. This article focuses on these 3 important, yet overlooked, issues of diversity, with a focus on strength-based and empowerment-oriented strategies and their implications for practice, policy, and future research.

“My Grandparent Has Dementia”

The study examined the grandparent–grandchild relationship when the grandparent has dementia. Grandchildren living in Barcelona, Spain, participated in the study ( n = 145). These participants completed a questionnaire that included questions on: (a) the frequency of 15 emotions they may have experienced in this relationship, (b) their current relationship with a grandparent who has dementia (frequency of contact, emotional closeness, and satisfaction with the relationship), and (c) perception of changes in the relationship. Results showed that the dementia process has a negative impact on the relationship between grandparent and grandchildren. However, in some cases, there was also potential for positive changes, which are mainly related to the ability to keep emotional contact and express positive emotions. Findings suggested the need to take into account grandchildren when planning training programs for families caring for relatives with dementia, such as providing information about the disease and improving their coping strategies.

Learning from the Disease: Lessons Drawn from Adolescents Having a Grandparent Suffering Dementia

The objective of this study was to explore what adolescent grandchildren have learned from having a grandparent who suffers dementia and what coping strategies they might recommend for other adolescents in similar situations. We also present information on background factors influencing lessons learned and coping strategies. Adolescent grandchildren living in Barcelona, Spain participated in the study ( N = 138). Qualitative analysis was conducted on responses to 2 open-ended questions regarding lessons learned from having a grandparent with dementia and advice to other grandchildren facing similar situations. Five learning and 4 coping strategies emerged from the analysis. Adolescents reported about the value of life, the complexity of the life-span, and changes in personal characteristics such as patience and responsibility as a result of the experience. Advice to other adolescents primarily focused on accepting the dementia as well as acquiring behavioral coping strategies. Binary logistic regression analysis revealed that type of care grandparent receives—day center versus nursing home—and age of the adolescent influenced lessons learned and coping strategies. Implications for the developmental tasks of the grandchild during adolescence are discussed.

Developmental issues of grandchildren who provide care to grandparents

This qualitative research examined the perceptions, beliefs, attitudes, and experiences of grandchildren caregivers who ranged in age from 7 to 29 years. Thirty-four caregiving grandchildren participated in face to-face semistructured interviews lasting approximately 35 to 90 minutes. Interviews were audiotaped and transcribed verbatim. Analysis of the data revealed that caregiving grandchildren: a) experienced a wide range of emotions as providers of care to their grandparents; and b) developed specific coping strategies to deal with the stress of providing care. The intensity, type, and range of emotions experienced and the coping strategies used were a reflection of the developmental issues of the grandchildren. Although grandchildren caregivers experienced similar responsibilities, their developmental level and the context in which care was provided played a role on how they were best able to cope with caregiving responsibilities. Practitioners must consider grandchildren caregivers when developing programs and services for family caregivers.

The division of parent care between spouses

Research on the division of family work has focused on household work and child-care to the exclusion of other domains, whereas studies on care-giving for older people typically ignore spouses' support to care-givers. In this paper we apply an approach that is typical of research on spouses' division of family work in caring for parents, in that the theoretical model focuses on the ‘cultural mandates’ that guide spouses' division of care, namely gender ideologies about appropriate roles, kinship obligations, and taboos against cross-gender personal care. Other predictors of the spousal division of care drawn from economic and health-care utilisation models are also examined. The analyses use pooled data on 1,449 care occasions from the first five waves of the US Health and Retirement Study. It was found that most couples to some extent share parent care, and that the involvement of husbands depended on a complex interplay of cultural mandates and contexts. Husbands participated most in personal care for parents if the care was mandated by kinship obligations (they cared more for their own than their wife's parents), and by cross-gender care taboos (they cared more for fathers than mothers). Other cultural contexts (such as race), a spouse's other commitments, health-related ability, resources (including support from the parents' other children), and care-burden also played a role. The findings demonstrate that decisions to care for parents emerge from complex negotiations among spouses and their children and siblings or, in other words, that parental care is a family endeavour.

Changes in adult child caregiver networks

PURPOSE

Caregiving research has typically relied on cross-sectional data that focus on the primary caregiver. This approach neglects the dynamic and systemic character of caregiver networks. Our analyses addressed changes in adult child care networks over a 2-year period.

DESIGN AND METHODS

The study relied on pooled data from Waves 1 through 5 of the Health and Retirement Study. Based on a matrix of specific adult child caregivers across two consecutive time points, we assessed changes in any adult child caregiver as well as in the primary adult child caregiver.

RESULTS

More than half of all adult-child care networks, including more than one fourth of primary adult child caregivers, changed between waves. Gender composition of the caregiver network and availability of other adult child caregivers were particularly important for network change, but socioeconomic context, caregiver abilities and resources, and caregiver burden played a role as well.

IMPLICATIONS

The results underline the need to shift caregiving research toward a dynamic life course and family systems perspective. They also raise concerns about the viability of informal care networks for future smaller birth cohorts and suggest that health care providers need to recognize and address coordination and potential conflicts among care network members.

What is it to be a daughter? Identities under pressure in dementia care

This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person's well-being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of the moral issues in the care for people with dementia is centred on responsibilities; how do people conceive and determine their responsibilities towards one another? To investigate this issue we use the theoretical perspective of Margaret Walker. She states that ideas about identity play a crucial role in patterns of normative expectations with regard to the distribution of responsibilities in daily practices of care. The results of this study show how the identity of a family-member is put under pressure and changes during her loved one's illness that leads to difficulties and misunderstandings concerning the issue of responsibility These results offer an insight into the complexities of actual practices of responsibility and highlight the importance for those caring for people with dementia of attending carefully to how they see themselves and how they see other people involved (Who am I? Who do I want to be for the other?). Answers to such questions show what people expect from themselves and from one another, and how they at any rate, are distributing responsibilities in a given situation. Professional caregivers should take into account that family members might have different ideas about who they are and consequently about what their responsibilities are.