Family Systems and Aging

Angela G. Rothrock, PhDAssistant Professor, Division of Gerontology, Geriatrics and Palliative CareAssociate Director, UAB Geriatrics Education Center and UAB Reynolds Program

• What’s your family structure?

• Where do the members live?

• Have you provided care for a parent?

• Has a family member provided care to you?

Our Family Structure

• What defines “Family”• Family Systems Perspective• Intergenerational Relationships• Family Interaction Patterns• Family Assessment• Culture and the Family

– Living Arrangements– Caregiving

• Family Conferences

Presentation Overview

• Those who: – consider themselves economically and

emotionally related to each other by blood, marriage, or commitment

– are tied together through their common biological, legal, cultural, and emotional history and their implied future together

• Varies by size, composition, and closeness• Most important system that we belong to• Primary identification

What Defines Family?

• Nuclear– Married or committed pair

– Dependent children

– Independent household

– Bound to outside kin by voluntary ties of affection or duty

Three Traditional Family Types

• Extended/Modified Extended– All relatives connected by blood or marriage

Three Traditional Family Types

• Surrogate Family/Support System– Any individuals

– Join together to give support and assistance

– Sometime for a specific purpose

– Fictive Kinship - “She’s like a sister to me”

Three Traditional Family Types

• Considerable change in the 20th/21st centuries– Patterns of living arrangements– Divorce and remarriage– Decreases in fertility– More women working outside the home

• Older adults embedded in a complex web of ties

• “Beanpole” Families (Bengston, Rosenthal & Burton, 1990)

Changing Family Structures

• Family is an interdependent, emotional unit– Change or stress that affects one, affects all

– Interaction patterns are repeating and hard to reorganize

– Losses occur regarding • Control• Continuity• Defined roles• Significant relationships• Sense of purpose

Family Systems Perspective

• Joint responsibility for problems

• Unresolved issues will resurface

• Crucial that families adapt to changing circumstances– Ex. Physical or cognitive decline of a member

Family Systems Perspective

• First presented in 1957, Evelyn Duvall

• Based on census data, post WWII

• Widely utilized

• Largely driven by the age of the oldest child

• 8 stages reflecting– Size of the family– Age of members– Types of challenges faced

Family Life Cycle Theory

Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134.

• Families progress through eight stages:– Getting married– Childbearing – Preschool years– School-age years– Adolescent/Teenage years– Launching– Middle-aged parents– Aging family members

Family Life Cycle Theory

• Tasks must be completed before moving to the following stage

• Criticized for heavy reliance upon traditional/ idealized culture-specific assumptions regarding:– what constitutes a family– the experiences families will have– when these will occur

• Does not address intergenerational family issues

Family Life Cycle Theory

• Developmental task and needs of generations are no longer complementary

• Multiple iterations, now more focused on transitions of the family or its individuals– Emphasis on family dynamics– Successful transitioning may help to prevent

disease and emotional or stress-related disorders.

Family Life Cycle Theory

• 50% of older adults have daily contact with their children

• Intergenerational relationships between parents and adult children:– are frequently characterized by ambivalence

• 2 “sets of parents”• Feelings regarding “role reversals”• Competing priorities/goals

– Carstensen’s Socioemotional Selectivity Theory

Intergenerational Relationships

Socioemotional Selectivity Theory

• Social contact/Relationships are motivated by either:– Pursuit of knowledge– Desire to regulate emotion

Knowledge Acquisition

Emotion Regulation

Infancy Late Life

Carstensen, L.L (1987. 1991. 1992)

• Implications for health and well-being– Family habits (eating, exercising)– Encouragement– Stress/burden (increase or decrease)– Feelings of well-being– Contributions

Intergenerational Relationships

• Bengston’s Theory of Intergenerational Solidarity (Bengston & Roberts, 1991)

• Generations relate to each other in terms of:– Living arrangement (structural)– Shared values (normative)– Norms (consensual)– Contact (associational)– Closeness (affectual)– Instrumental Support (functional)

• Financial, caregiving, etc

Intergenerational Relationships

• Dependence to independence– Filial Maturity

• Adult children learn to accept and meet parents’ dependency

• Involves being depended on and being dependable• They are emotionally ready to relinquish earlier roles

• Obligation to volunteerism– Filial obligation, felt by children– Parents don’t want to be a burden

Continuum of Social Family Norms

• Compatible vs. Conflictual– Always in agreement or always arguing– Resurfacing of old conflicts

• Cohesive vs. Fragmented– Present as a unit or as individual members

5 Family Interaction Patterns(Blazer, 1998)

• Productive vs. Non-Productive– Mobilize to create changes needed or powerless

to act

• Fragile vs. Stable– Family stability or disruption in relationships

• Rigid vs. Flexible– Exchange and share roles and respond

readily to crisis

5 Family Interaction Patterns(Blazer, 1998)

• The Family APGAR (FAPGAR) (Smilkstein, 1978)

• Brief screening questionnaire– 5 closed-ended questions– Fitting for multiple family structures

Family Assessment

• A - Adaptation

• P - Partnership

• G - Growth

• A - Affection

• R - Resolve

FAPGAR5 Components of Family Function

• Reflect a patient’s view of the functional state of their family

• Focus on family unit as part of medical care/treatment

• Useful for multiple cultures

FAPGAR Results

• Familial cultural norms are specialized in three ways– Specific to particular role relationships– Systematically related to social class, race,

ethnicity, religion, or region– Vary across individual families (traditions)

• Research has focused on cultural differences in living arrangements and caregiving

Culture and the Family

• Affects the exchange of help and support

• Western countries and Japan (Sundstrom, 1993)

– Decline in the proportion of older people living with adult children since 1950

– In US, decreased from 33% to 15%– In Sweden, decreased from 27% to 5% (most

extreme change)

• Intimacy at a distance– Pattern of proximity but in separate households

Culture and Living Arrangements

• Korean families (Won & Lee, 1999)

– 75% of those age 60+ live with their children– More likely to live with sons– More likely to live with married children

• Developing Countries (Hashimoto, 1991)

– Brazil, Egpyt, India, South Korea, Singapore, Thailand, Zimbabwe

– Older adults maintain co-residence with children– Lowest in Egypt and Brazil

Culture and Living Arrangements

• ~80% of informal care of frail elders is provided by family caregivers

– Usually a single, primary caregiver

– 1/3 are adult children • Sandwich generation

Family Caregiving

• Gender and history of relationships are key to determining: (Matthews, 2002)

– Which child provides care

– How caregiving is shared among relatives• Sibling conflict

– How the older adult participates• Some cultures don’t involve the elder in decisions

Family Caregiving

• Distinct cultural differences

• PBS series – Life, Part 2– Ethnicity, Race and Aging episode– http://www.pbs.org/lifepart2/watch/season-2/ethni

city-race-aging

Culture and Family Caregiving

• Family Conferences– Involve healthcare professionals and family

members– Interdisciplinary team approach– Presentation of loved ones diagnoses, concerns– Improved quality of care– Considerations of various perspectives– Discussion of advanced care planning, resources– Engage multiple family caregivers– Sort out tasks and schedules

Family Conferences

Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992) ,The Family Conference in Geriatrics,Canadian Family Physician, p585-588

• Bengtson, V.; Rosenthal, C. J.; and Burton, L. (1990). "Families and Aging: Diversity and Heterogeneity." In Handbook of Aging and the Social Sciences, 3rd edition, ed. R. H. Binstock and K. George. New York: Academic Press.

• Bengtson, V. L., & Roberts, R. E. L. (1991). Intergenerational solidarity in aging families: An example of formal theory construction. Journal of Marriage and the Family, 53, 856-870.

• Blazer D (1998). Emotional problems in later life: Intervention strategies for professional caregivers. New York: Springer

• Carstensen, L.L. (1987). Age-related changes in social activity. In L.L. Carstensen & B.A. Edelstein (Eds.), Handbook of Clinical Gerontology (pp.222-237). New York: Pergamon Press.

• Carstensen, L.L. (1991). Selectivity theory: Social activity in life-span context. Annual Review of Gerontology and Geriatrics, 11, 195-217.

• Carstensen, L.L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity theory. Psychology and Aging, 7, 331-338.

• Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134.• Hashimoto, A. (1991). "Living Arrangements of the Aged in Seven Developing Countries: A Preliminary Analysis."

Journal of Cross-Cultural Gerontology 6:359–81.• Matthews S (2002). S isters and Brothers/Daughters and Sons: Meeting the Needs of Old Parents. Bloomington:

Unlimited Publishing; 2002.• Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992) ,The Family Conference in Geriatrics, Canadian

Family Physician, p585-588• Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. Journal of

Family Practice, 6(6), 1231-1239. • Sundstrom, G. (1993). "Care by Families: An Overview of Trends." In Caring for Frail Elderly People. Paris:

Organization of Economic Co-operation and Development.• Won, Y., and Lee, G. (1999). "Living Arrangements of Older Parents in Korea."

Journal of Comparative Family Studies 30:315–28.

References