geriatrics
Family Caregiving for Older Adults
Introduction
Family caregivers play a key role in delaying and possibly preventing institutionalization of chronically ill older patients. Although neighbors and friends may help, about 89% of help in the home (physical, emotional, social, economic) is provided by family caregivers (1). When the patient is mildly or moderately impaired, a spouse or adult children often provide care, but when the patient is severely disabled, a spouse is more likely to be the caregiver, often along with others in or outside the family. In 2020, > 40 million caregivers in the United States provided unpaid care to a family member or another person age ≥ 50 ( References ). About 38% of people ≥ 80 years and 76% of people ≥ 90 years require routine help with self-care and household tasks. The amount and type of care provided by family members depend on economic resources, family structure, quality of relationships, and other demands on the family members’ time and energy. Family caregiving ranges from minimal assistance (eg, periodically checking in) to elaborate full-time care. On average, family caregivers for older adults spend about 22 hours per week giving care, and about 19% of these caregivers spend > 41 hours per week ( References ). Caregivers of older adults > 55 report that > 66% of their care recipients have long-term physical conditions, and > 24% have d memory problems with an increase of nearly double by age 85 ( References ). Caregiving for older adults with neurocognitive disorders is known to be particularly intense and burdensome and to have harmful effects on caregivers. Although society tends to view family members as having a responsibility to care for one another, the limits of filial and spousal obligations vary among cultures, families, and individual family members. The willingness of family members to provide care may be bolstered by supportive services (eg, technical assistance in learning new skills, counseling services, family mental health services) and supplemental services (eg, personal care [assistance with grooming, feeding, and dressing], home health care, adult day care, meal programs). Supplemental services may be provided on a regular schedule or as Respite Care for a few hours or days. Some older adults with significant care needs do not have any available, willing, or capable family members or friends to provide care and are living with unmet needs and sometimes social isolation. Changes in demographics and social values have reduced the number of family members available to care for impaired older relatives because of the following: Increased life span: As a result, the population of the very old has been increasing. Thus, their children, who are potential caregivers, are likely to be old also. Delayed procreation: Combined with increased longevity, this delay has created a sandwich generation of caregivers who care simultaneously for their children and their parents. Smaller family size: Reduced numbers of offspring throughout the past several decades have resulted in a more even distribution of the population across age groups compared with prior centuries, resulting in a much lower dependency ratio (currently about 28 older dependents for every 100 working-age adults compared with about 17 older dependents per 100 workers in 1960 [ References ]). 65 live within 20 minutes of one family caregiver ( References ). An increasing number of women in the workforce: Previously, women have provided the majority of care for older parents due to gender role expectations, but the demands of careers have diminished their availability to do so. Improved management of chronic conditions: The number of dependent and very sick older people is increasing. These factors predict an increasing demand for home health care services provided by someone other than family members, friends, and neighbors. 