Developmental issues of grandchildren who provide care to grandparents

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

Does providing informal care in young adulthood impact educational attainment and employment in the UK?

Most research on the effects of caring has focused on older spouses or working-age carers providing care for older people, but providing care in early adulthood may have longer-term consequences, given the importance of this life stage for educational and employment transitions. This study aims to investigate the impact of informal care in early adulthood on educational attainment and employment in the UK and to test whether these associations differ by gender or socio-economic circumstances. Data are from young adults (age 16-29 at first interview, n = 27,209) in the UK Household Longitudinal Study wave 1 (2009/11) to wave 10 (2018/2020). Carers are those who provide informal care either inside or outside the household. We also considered six additional aspects of caring, including weekly hours spent caring, number of people cared for, relationship to care recipient, place of care, age at which caring is first observed, and duration of care. Cox regression was used to analyse the association between caring and educational qualifications and employment transitions. We found that young adult carers were less likely to obtain a university degree and enter employment compared to young adults who did not provide care. In terms of care characteristics, weekly hours spent caring were negatively associated with the likelihood of obtaining a university degree qualification and being employed. Providing care after full-time education age negatively influenced employment entry, but having a university degree buffered the negative influence of providing care on entering employment. The influence on unemployment may be stronger for female carers than for male carers. Our results highlight the importance of supporting the needs of young adults who are providing informal care while making key life course transitions.

A Mixed-Method Examination of Emerging and Young Adult Cancer Caregivers' Experiences during the COVID-19 Pandemic

Advanced cancer caregivers in emerging and young adulthood (EYACs; ages 18-35) are an understudied yet vulnerable caregiving population. The COVID-19 pandemic created new challenges for advanced cancer caregivers but also created unique contexts from which caregivers sometimes benefited. To understand how the pandemic may have positively and negatively impacted their caregiving and bereavement experiences, we examined EYACs' experiences of caring for and losing a parent with advanced cancer during the pandemic in comparison to those of EYACs with a parent who died outside the context of the pandemic. Eligible EYACs completed an online survey and semi-structured interview. Quantitative analyses compared responses for pre-pandemic EYACS (n = 14) and pandemic EYACs (n = 26). A thematic analysis of the interview transcripts of pandemic EYACS (n = 14) was conducted. Pandemic EYACs experienced non-significant but higher communal coping, benefit finding, negative emotional experiences, and caregiver strain than pre-pandemic EYACs. Thematic analysis revealed that the pandemic negatively affected EYACs' caregiving efficacy, personal well-being, interpersonal dynamics, and bereavement; shifts to remote work and schooling were reported as benefits. The findings can inform the design of resources to support EYACs whose parents died during the pandemic and who are navigating the healthcare system today.

Factors Associated with the Quality-of-Life of Young Unpaid Carers: A Systematic Review of the Evidence from 2003 to 2019

The aim of this review was to identify factors influencing the quality of life (QoL) of young people providing care for family members with chronic illnesses, disabilities, and/or mental health and substance abuse problems (young unpaid carers; YC), as well as the social-care related QoL measures. Focused and broad search strategies were performed in four databases, identifying 3145 articles. Following screening, lateral searches, and quality appraisal, 54 studies were included for synthesis. An inductive approach was used to synthesise the findings, grouping factors associated with YC QoL into interrelated themes: "perceived normality of role and identifying as a carer", "social support from formal and unpaid networks", "caring demands and their impact", and "coping strategies". No social-care related QoL measures for YC were found. This systematic review provides groundwork for the development of such a tool and emphasises the need for further studies allowing the investigation of the interrelated factors affecting YC QoL.

Grandchildren as Caregivers: Adding a New Layer to the Sandwich Generation

Although 10% of family caregivers are grandchildren, only a few studies have examined the experience of grandchildren who provide care to grandparents. The current study examined the caregiving processes and outcomes of grandchild caregivers to grandparents. Participants were (N  =  5,778) adults identified as a caregiver, including 311 adult grandchildren. Analyses showed that although caregivers to grandparents did not differ significantly from other family caregivers in terms of depression, grandchildren did differ on a variety of demographic and caregiving context variables. A hierarchical binary logistic regression showed that providing personal care and helping with household tasks contribute to the equation, however, grandchild status did not uniquely contribute to the equation after other elements of the caregiving and personal contexts were entered. Post-hoc analyses identified additional predictors within the group of grandchild caregivers. The current study is an important starting point in understanding the experiences of grandchildren caregivers.

Extended Family Caregivers for Persons Living With Dementia

Despite changes in the structure of contemporary families, little is known about extended family members-siblings, grandchildren, nieces/nephews, stepkin-who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face.

Young Adult Carers in the UK-New Evidence from the UK Household Longitudinal Study

Despite growing interest in young adult carers, little is known about trends in prevalence of caregiving among young adults aged 16-29. Furthermore, few studies have so far investigated demographic, health, and socioeconomic inequalities in the duration of care among young carers as well as demographic differences in caregiving characteristics. Using data from 11 waves of the nationally representative UK Household Longitudinal Study (2009-2021), we first estimated the prevalence of caregiving among 16-29 years-old adults at each wave. Results show that about 9% of those aged 16-29 provided care, and that this prevalence remained stable throughout the 2010s. Then, selecting respondents who participated for three waves of more, we assessed demographic, socioeconomic, and health characteristics associated with duration of care using ordinal regression models. Almost 52% of carers cared at two or more waves. Compared to non-carers, those who cared had more disadvantaged socioeconomic backgrounds, were from ethnic minorities and reported poorer health, particularly if they cared at two or more waves. Finally, focusing on carers, we tested differences by sex, age, and urbanicity in care relationships, intensity, and duration. Overall, women and those aged 25-29 cared for longer hours, for more people, and for more years than men and younger carers respectively. Put together, these findings provide an up-to-date description of young carers in the 2010s in the UK.

Becoming a Caregiver: Experiences of Young Adults Moving into Family Caregiving Roles

While the vast majority of family caregivers struggle to find balance between different roles in their lives, young adult caregivers are faced with the atypical challenge of caring for family member while simultaneously accomplishing developmental tasks typical of this stage in life (e.g., establishing career, developing romantic relationships). This exploratory, qualitative study examined strategies used by young adults to adopt family caregiving roles. These strategies can be described as embracement, compromise, and integration. While each approach allowed for the young adult to facilitate their caregiving role, additional research is needed to understand how the strategy affects the emerging adult's development.

Italian Adolescent Young Caregivers of Grandparents: Difficulties Experienced and Support Needed in Intergenerational Caregiving-Qualitative Findings from a European Union Funded Project

The article aims to describe the experiences of 87 Italian adolescent young caregivers (AYCs) of grandparents (GrPs), with reference to the caregiving stress appraisal model (CSA) that provides a theoretical lens to explore the difficulties encountered and support needed in their caring role. Qualitative data were drawn from an online survey conducted within an EU Horizon 2020 funded project. An inductive thematic analysis was carried out, and the findings were critically interpreted within the conceptual framework of the CSA model. The analysis highlighted three categories of difficulties: material, communication and emotional/psychological. The most common material difficulty was the physical strain associated with moving “uncooperative” disabled older adults. The types of support needed concerned both emotional and material support. The study provides a deeper understanding of the under-studied experiences of AYCs of GrPs. Based on these findings, policies and support measures targeted at AYCs of GrPs should include early needs detection, emotional support and training on intergenerational caring in order to mitigate the stress drivers. Moreover, the study advances the conceptualisation of the CSA model by considering the above-mentioned aspects related to intergenerational caregiving.

"It makes me feel like good inside because I helped him do stuff" - Perceptions of psychological well-being in adolescents providing dementia care

According to a 2018 report by the Alzheimer's Association, an estimated 250,000 children help support a family member with dementia, but few studies exist that describe their experience as family carers. This qualitative descriptive study sought to understand the perceived psychological well-being of adolescents who assist with providing care to family members with dementia. Eleven adolescents ages 12 to 17 caring for older non-parental family members with dementia in northwest Ohio participated in one of three focus group discussions. An adult family member was surveyed about family background and level of assistance provided. The data from the two questionnaires were analyzed using descriptive statistics. Focus group transcripts were analyzed using thematic content analysis. Thematic analysis revealed six themes related to psychological well-being: 1) Feeling compassion for the family member; 2) Finding connection through fun, humor, and mutual affection; 3) Helping even though it is not always pleasant; 4) Feeling good inside about helping family "do stuff"; 5) Believing no one can do it like family; and 6) Reflecting that it is just something that they do. The findings of this study provide new insight into adolescents' experiences of dementia family care and how it affects their psychological well-being. An examination of the themes suggests that secondary caring roles were mostly positive in nature and may help adolescents forge closer family relationships, find opportunities for personal growth and development, and overcome challenges to grow more confident. These findings may also suggest ways to include adolescents in family care as a means of positive growth opportunities.

Intergenerational caring: a systematic literature review on young and young adult caregivers of older people

BACKGROUND

The theme of young family caregivers of older relatives is still partially uncovered, although the phenomenon is increasing worldwide. This Systematic Literature Review discusses methodological and content issues of ten articles covering this topic, in order to contribute to increase the knowledge and provide suggestions for designing effective support services for adolescent young caregivers. To this purpose, the findings of this review are framed within the caregiving stress appraisal model (renamed CSA model) elaborated by Yates' and collegues, in order to highlight differences between young caregivers and the older ones.

METHODS

Multiple databases including PubMed, Web of Science, Scopus, ProQuest - Psychology Database, CINAHL Complete - EBSCOHost were used to carry out a systematic review of the literature. Additional references were retrieved from experts contacted and research knowledge. The selected articles underwent both methodological appraisal and contents analysis: for every article an appraisal score was calculated and themes and sub-themes were identified.

RESULTS

Out of the ten included studies three were mixed methods, six qualitative and one quantitative. Nine reached a high quality methodological score and one medium. Four main themes emerged from the content analysis: aspects of the caregiving relationship; effects of caregiving; coping strategies; recommendations for services, policy and research.

CONCLUSIONS

Selected studies explored practical features of the relationship between young caregivers and older family members (tasks performed, motivations, coping strategies) and highlighted both positive and negative outcomes on young people's everyday life condition and future development. Nevertheless, these evidences were often limited to small samples that did not allow to make generalizations. More studies are needed including large samples in order to deepen the different aspects of caregiving and design tailored support services.

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.

Unexpected Caregiving in Later Life: Illuminating the Narratives of Resilience of Grandmothers and Relative Caregivers through Photovoice Methodology

This research study implements photovoice methodology with unexpected caregivers to illuminate the lived experiences of female grandparents and relative caregivers who are raising young children in the later stages of their life. As they enter older adulthood, grandmothers are increasingly finding themselves taking care of their children's children for various reasons, including, but not limited to, their adult child's incarceration, mental health issues, drug and alcohol addiction, or child abuse or neglect. Informed by various feminist theoretical lenses, we use photovoice methodology to highlight the narratives of resilience and explore the ways in which grandmothers re-conceptualize their roles and identity as an unexpected caregiver and the sources of strength and resilience that inform the ways in which they navigate the various circumstances in their lives.

The morality of lying to my grandparent with dementia

We used a morality of care perspective to examine how grandchildren cope with having to deceive or lie to their grandparent with dementia. Data from interviews with 13 young adults were analyzed using interpretative phenomenological analysis. We found that a moral orientation shift toward a person-centered morality of care occurs gradually. Grandchildren struggle with concepts of moral goodness, importance of close others, and questions about self as a moral agent. We uncovered three antecedents of this shift (severity of dementia symptoms, valuing of the grandparent's welfare, and valuing of the relationship) and three outcomes (transformation of moral self, changed relationship with the grandparent, and changed family relationships). Implications of a morality of care in intergenerational dementia relationships are discussed.

Weaving social reality around the grandparent/great-grandparent with dementia to maintain relational presence: A verbal and non-verbal dementia interactions model

We proposed a dementia interactions model based on analyses of five focus groups with grandchildren of grandparents with dementia. Interactions with their grandparent with dementia motivate grandchildren to maintain connection with a grandparent who is relationally present. To do so, they weave a social reality around the grandparent. To help the grandparent remain connected, grandchildren engage in scripts and routines and employ three intertwined psychological processes: perspective taking, vigilance, and knowledge about the grandparent's preferences, personality, state of mind, and context. Grandchildren use four relationship anchors to help the grandparent remain relationally present: family members, meaningful sensory objects and activities, physical space/context, and themselves. Implications for improving social interactions with close others with dementia are discussed.

Young Adults' Concerns and Coping Strategies Related to their Interactions with their Grandparents and Great-Grandparents with Dementia

Young adults' concerns and coping strategies related to their face-to-face interactions with their grandparents/great-grandparents with dementia were explored through the lens of a solidarity-conflict conceptual framework. Participants indicated concerns about their inability to maintain the relational connection, not knowing what to say or how to behave, their lack of perspective-taking skills and emotion-regulation strategies, interacting with an ever-changing other, as well as concerns about other co-participants in the interaction. Participants' coping strategies were driven by two interaction motives: maintaining solidarity (e.g., desire to maintain and improve the interaction with the grandparent by seeking the other's company, loving the other, and maintaining the other's personhood) and dealing with conflict (e.g., dealing with self-focused concerns about lack of skills and knowledge by engaging in substitute avenues for communication and down-regulating negative affect). Implications for improving interactions between young adults and their grandparents/great-grandparents with dementia are discussed.

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill

This article discusses, from the grandmother's perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52-90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.

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.

The Intergenerational Family Relationships of Grandparents and GLBQ Grandchildren

This paper describes the intergenerational family relationships of grandparents and GLBQ grandchildren. Reviewing empirical research on GLBQ family of origin relationships that include materials on grandparent-GLBQ grandchild relationships, this paper examines, 1) disclosure patterns with grandparents, 2) social expectations that exist about "coming out" to grandparents, 3) social expectations of GLBQ grandchildren when "coming out" to grandparents, 4) the mediating role of parents and other extended family in grandparent-GLBQ grandchild relationships, and 5) theorizing differences amongst grandparent-GLBQ grandchild relationships. This review indicates that grandparents have been overlooked in existing empirical research in research on GLBQ family relationships. Grandparents may be a unique source of support for younger GLBQ individuals and their parents. Future research may usefully incorporate grandparents, as well as other extended family members, to better understand the experience of "coming out" in families.

“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.