Family Caregiving for Older Adults: Not Just an “Aging” Issue
By Amy Horowitz

Providing care to an older relative with mental and/or physical impairments is one of the most central areas of inquiry in social gerontology, and one that has particular relevance to social work practice and policy. More than any other profession, social workers work with families, regardless of their particular field of practice (with families defined here in its broadest sense to include significant others, partners, and close friends). It is hard to find a family that has not been touched by an illness of an older family member, nor experienced the multidimensional consequences of providing care, such as negotiating health and social service systems and making difficult decisions about long-term care options and end-of-life treatments. This is one substantive area where most practitioners and researchers who work in family caregiving have lived the experience as well.

Recent estimates indicate there are 44.4 million adult caregivers in the United States, of whom 28 million are caring for someone age 65 or older (NAC/AARP, 2004). The economic value of this unpaid care is approximately $350 billion (AARP, 2008). But this care is not without cost to family members. Caring for an older relative can often disrupt a family’s equilibrium, and social workers must be able to recognize and address the issues that confront such families. Discomfort at providing intimate personal care, lack of time for oneself and other family members, dealing with familial conflict regarding care decisions, and the pain at not being recognized by a cognitively impaired relative are all common problems experienced by family caregivers. Three decades of research have consistently documented the often profound consequences of caregiving, particularly for spouses/partners and adult children. Providing care affects the caregivers’ emotional well-being, with high rates of reported burden, depression, and distress among caregivers, as well as stress related physical illnesses, (Vitaliano, Zhang, & Scalan, 2003; Pinquart & Sorsensen, 2003) and even mortality (Schulz & Beach, 1999).

But it is also important to remember that not all families experience only stress as a consequence of caring for an elder family member. We are learning more about the resilience of families and the positive aspects of providing care (e.g., personal growth), which points to the relevance of the strength perspective of social work practice. Social workers have also been in the forefront of developing psychosocial and psycho-educational interventions for family caregivers, which have been found to be relatively effective in reducing caregiver depression and distress (Gallagher-Thompson & Coon, 2007; Gallagher-Thompson, Haley, Guy, Arguelles, Zeiss, et al., 2003).

I was recently privileged to attend the conference on the State of the Science: Nurses and Social Workers, Supporting Family Caregivers, organized by the Council on Social Work Education (through the CSWE Gero-Ed Center), the Family Caregiver Alliance, AARP, the American Journal of Nursing, and Rutgers University. One of the major goals of the conference was to identify the competencies that nurses and social workers need to support family caregivers. This focus recognizes that social workers need to work as a team, both with other professionals and with the family client. Many of the competencies identified represent basic social worker skills of assessment, communication, and knowledge of policies, systems, and resources, that now need to be applied to a rapidly growing population of caregivers who will increasingly call on the assistance of social workers to help them continue to do what families do best: to care.

Dr. Amy Horowitz is the Director of Research at the Jewish Home & Hospital Lifecare System and the Anna A. Greenwall Professor of Geriatrics and Gerontology at the Mt. Sinai School of Medicine. She has written numerous articles on family care focusing on autonomy and congruence issues, as well as articles on disability and mental health. She is currently a member of the National Advisory Committee and the Director of Research Development for the Hartford Foundation Social Work Faculty Scholar Program.

(For more information on CSWE’s partnership in this multi-disciplinary caregiving initiative, please see the article in this issue of Aging Times.)

References

AARP (2008). Valuing the Invaluable: A New Look at State Estimates of the Economic Value of Family Caregiving. Retrieved on February 10, 2008 from: http://www.aarp.org/research/housing-mobility/caregiving/dd158_caregiving.html.

Gallagher-Thompson, D., & Coon, D.W. (2007). Evidence=-based psychological treatments for distressin family caregivers of older adults. Psychology and Aging, 22, 37-51.

Gallagher-Thompson, D., Haley, W., Guy, D. Rupert, Arguelles, T. Zeiss, L. M. et al. (2003). Tailoring psychological interventions for ethnically diverse dementia caregivers. Clinical Psychology: Science and Practice, 10, 423-438.

National Alliance for Caregiving and the American Association of Retired Persons (NAC/AARP) (2004). Caregiving in the U.S. Retrieved on February 10, 2007 from: http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2043.

Pinquart, M., & Sorsensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18, 250-67.

Schulz, R. & Beach, S. (1999). Caregiving as a risk factor for mortality. The caregiver health effects study. JAMA, 282, 2215-19.

Vitaliano, P.P., Zhang, J., & Scalan, J.M. (2003) is caregiving hazardous to one’s physical health? A meta-analysis. Psychological Bulletin, 129, 946-72.