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Abstract
In contrast to just a few years ago, more research on the psychological and social gerontology of racial and ethnic minority groups is being included within the general investigation of ethnicity and cultural factors in aging and human development. The existence of large national data sets and more powerful analytical techniques is increasing the quality and quantity of aging research on these groups in many areas of psychological interest. National longitudinal data collection efforts are improving the available data on the aging experience of minority Americans. Although better data are always needed, the improvement in a relatively few short years has been impressive. Similarly, the approach to research on the ethnic minority elderly has also seen a greater recognition of the heterogeneity among and within these groups. Research is now more focused on the role of culture, socioeconomic status, and gender as important markers of potential process differences within and among aging groups of color, especially Black Americans. Recent ethnogerontology research is reversing historical trends, and generalizable high-quality findings are emerging concerning health, socioeconomic status, work and retirement, social support, well-being, and especially family patterns of caregiving and care receiving. This research paper reviews some implications of this work for the applied psychology of aging, with a special focus on issues related to perceptions of control, family caregiving, and care receiving among racial and ethnic minority populations.
Outline
- Introduction
- The Changing Nature of Aging in America
- A Life Course Framework for Aging in Racial and Ethnic Groups
- Resource Dependency: Work, Asset Accumulation, and Retirement
- Importance of Formal and Informal Care
- Receiving Care
- Importance of Perceived Control to Physical and Mental Health Outcomes
- Receiving Care, Sense of Control, and Psychological Well-Being
- Racial and Ethnic Minority Elderly as a Resource
- Conclusions
1. Introduction
Research on racial and ethnic minority populations has propelled significant interest in the development of life course models and frameworks that assume an important role of race and ethnicity, culture, acculturation, and national origin in how various groups in the United States traverse the individual life course and age. The growth of racial and ethnic groups in the United States, and the relative deprivation of these groups in material, social, and health resources, demands greater attention if we are concerned about characterizing them appropriately and providing effective and adequate services as they age.
The growing internationalization of research on aging demands that we move beyond singular cultural perspectives. Fortunately, the United States is culturally heterogeneous, and comparative research on racial and ethnic groups yields excellent models relevant to understanding basic processes in aging in larger cross-national contexts. Important processes, such as stress and coping, may be more sharply defined in environmentally pressured groups (e.g., Blacks, Latinos, Native Americans). Racial and ethnic group boundaries may provide a personal and group coalescing of culture/environment and biological differences. For example, recent research supports degrees of assimilation and acculturation as important variables for understanding basic processes in mental health and mental disorder outcomes.
2. The Changing Nature Of Aging In America
America has always been a nation of immigrants. Several factors will change the face of America in the future. The population will age dramatically. The racial and ethnic composition of the country will change significantly. Earlier waves of migration came from Europe, China, and Africa, whereas new waves are coming from Central and Latin America, the Middle East, and Southeastern Asia. Although the country is aging rapidly, the rate of aging is faster among the racial and ethnic minority ‘‘new’’ immigrant groups, especially Latinos, Asians, and (to a lesser extent) African Americans and other Black immigrant groups.
This changing racial and ethnic minority population will represent culturally unique groups of aging individuals. As culture has affected their lifetime experiences, it will also influence the nature of their aging experiences. Elements of the biopsychosocial model of aging are fundamentally affected by the cultural experiences of aging individuals, both cumulatively and contemporaneously. Immigrant groups in the United States have unique histories. For example, Cuban immigrants fled Castro and arrived in the United States feeling forcibly expelled from their homeland. They came to the United States, which was largely anti-Castro and sympathetic to their plight. Middle Easterners escaped dictators, war, and oppression, but (at least currently) they are aging in a considerably less sympathetic, if not hostile, United States. Asians (e.g., Koreans) also fled a homeland torn by war and remain embedded in communities with specific cultural values that guide their expectations about aging. The life span experiences of these individuals may include immigrating as children and spending 60 years in the United States, learning another language, living in urban versus rural communities, and being among a minority versus majority culture. Some immigrants left a higher standard of living, whereas others came to the United States to seek a higher standard of living. But particularly relevant to the aging experience is the fact that all immigrants have been influenced by their biological and physical characteristics, their family and friendship relationships, and the communities within which they live (i.e., their biopsychosocial development). Although this research paper focuses on minority racial and ethnic minority groups in the United States, these biopsychosocial influences are no less important for the majority group. In this case, recognizing the significant influences on racial and ethnic minority groups only serves to highlight the role of these factors for aging among all individuals.
3. A Life Course Framework For Aging In Racial And Ethnic Groups
As changing demographics require increased focus on older ages, lessons learned from the life span model of development are particularly germane. A life span framework is needed to explore how environmental stressors influence and interact with group and personal resources to both impede and facilitate the quality of life of successive cohorts of racial and ethnic minorities over the group life course and in the nature of their individual human development and aging experiences. Research on socioecological predictors of health in African American and Caucasian residents of a large midwestern city exemplifies the need for the life course approach. Findings have demonstrated relationships between socioecological factors (e.g., high crime rates, family dysfunction, high noise levels, social isolation) and negative health factors (e.g., hypertension) among minority residents. These factors can affect all members of the minority families and community, thereby possibly initiating poorer health among both younger and older individuals. It is the premise of a life course perspective that current and aging cohorts of ethnic minorities have been exposed to the conditions that will profoundly influence their social, psychological, and health statuses as they reach older ages during the years and decades to come.
Recent work on the incomplete ontogeny of human development and the recognition of the influence of culture in human development represents an important extension of the original work. In this latest consideration of life span developmental theory, the concepts of selection, optimization, and compensation are illustrative of the adaptive strategies that people use to maximize their competency. With the challenges of age, one has an increased need to select, optimize, and compensate to achieve designated goals. At the same time, it is noteworthy that culture is infused in every element of this process. What one selects, how one chooses to optimize, and what one considers appropriate forms of compensation all are culturally influenced if not culturally determined. As one ages, this influence accumulates and appears to have ever-increasing effects on the experiences of aging. The greater emphasis on culture in this life course modeling is very important in understanding the experiences of racial and ethnic minority groups. In fact, some have suggested that although culture becomes increasingly important with age, its actual influence on development decreases with age. Thus, biological and physical development are said to dominate during childhood when culture has minimal impact. Within most Western cultures, this appears to be true. But of course, one might imagine a culture where one group is disfavored (e.g., girls) and, thus, is provided only very limited access (e.g., to nutritional resources), thereby limiting the biological or physical development that might otherwise dominate. Similarly, among older people, what one values and how one copes with biological or physical losses might also be influenced by culture.
The current authors believe that it is necessary to incorporate both the life span model and the role of culture, especially a view of culture nuanced by racial and ethnic differences, into life course biopsychosocial models, especially as they apply to aging.
4. Resource Dependency: Work, Asset Accumulation, and Retirement
4.1. Socioeconomic Status
Many minority elderly individuals continue to lag behind Whites in social and economic status. For example, indicators of income, education, and health status document the deprived position of Blacks relative to Whites. Some argued that this was a cohort effect, but the lingering poor relative position of Blacks refutes this; new cohorts of the Black elderly are not faring significantly better than priors ones. For example, there is a continuing disadvantage of middle-aged and younger Blacks (and increasingly Hispanic groups), relative to Whites, in housing, income, occupation, health, and education. Recent reports on the circumstances of Blacks across the entire life course continue to show the presence of relatively poorer circumstances, especially wealth, suggesting that new cohorts of elderly Blacks will continue to experience relative disadvantage in comparison with other groups.
On the other hand, even though approximately one third of the Black elderly continue to live below the poverty level, today’s Black elderly are better fed, better housed, and in better health than were those during earlier eras. Most of this improvement is attributable to government assistance programs, which is still the prime support of many black Americans and increasingly among other older age groups as well. Unfortunately, because of histories of poor occupational opportunities, lack of wealth, and private retirement funds, a large proportion of Blacks are heavily dependent on these government programs. It is still unclear whether future cohorts of older Blacks will enjoy what may be the relative luxury of today’s elderly. Recent diminution of federal programs, a change in the economy favoring job creation in ‘‘high-tech’’ and specialized educational intensive sectors of the economy (e.g., computers, communications), and simultaneous growth in low-paying service positions (e.g., fast-food restaurants) provide little room for today’s Black adult and middleaged cohorts, many of whom lacked basic educational opportunities during their formative years. It is now predictable that future cohorts of older Blacks may not be as well off as their White counterparts, and it is still unlikely that they will be as well off as today’s cohort of Black elders, many of whom worked in union-intensive industries.
4.2. Health Morbidity and Mortality
At nearly every point from birth to death, African Americans and other minority groups (e.g., Native Americans) have poorer morbidity and mortality rates than do Whites. It is also well documented that there is increased longevity among Blacks (and some suggest that this is also true among Hispanics) who live to approximately 84 years of age. Many have suggested a possible selection bias favoring the long-term survival of particularly robust and hardy individuals (e.g., immigration) or differential rates of aging within Black, Asian, Hispanic, Native American, and White populations. Others have claimed that this crossover is only an artifact of faulty reporting and exaggerated age claims. The effect has been firmly established, although there is still no widely accepted explanation. The racial mortality crossover appears to be a real phenomenon—one that may involve some type of ‘‘survival of the fittest.’’
Recent research on the ‘‘oldest old’’ continues to document the heterogeneity of the social and psychological health of very old Blacks. This type of data provides strong support for a thesis that views the mortality crossover as involving the survival of hardier old Blacks and not a methodological artifact. Similarly, other work reveals some evidence for greater functional health among older elderly Blacks in comparison with Whites, although the effect seems highly dependent on educational status.
Recent research points to differences between ethnic minority groups and Whites in the nature of self-reported health. Early in the past decade, it was found that the largest differences were in the validity of the subjective interpretations of health state. These findings challenge traditional thinking and research regarding possible race differences in health. At this point, whether there are differences in the structure of health, the processes of health, or the influence of service use on experienced health problems remain open questions. What is clear is that changing health policies may have increasing negative effects on the ability of Black and many other minority elderly to receive adequate health care in the new century.
4.3. Psychological Well-Being
Research on psychological well-being has shown an increasing sophistication over the past few years. Structural factors, such as income and education, tend to show small but positive relationships to wellbeing. Some recent work suggests that psychological well-being may be strongly tied to family and health satisfaction. Some recent evidence also suggests that younger ethnic minority cohorts may be less satisfied than older cohorts at comparable periods during the life span. This is in sharp contrast to Whites, who have shown the opposite pattern. This lowered satisfaction and happiness in younger Blacks may be related to rising expectations and structural constraints that are likely to persist into older age.
4.4. Work and Retirement
Little empirical research had been devoted to the study of work and retirement among ethnic and minority elderly individuals. Some earlier work had speculated that the entire retirement process, viewed within a life span context, may be very different for Blacks and other disadvantaged ethnic minorities. For example, Blacks and other groups, such as Native Americans and some Latino groups, often have long histories of dead end jobs with poor benefits and bleak expectations, thereby lowering any advantages of retirement. Thus, inadequate income, poor housing, and uncertain futures may confront these older groups at retirement age. Faced with limited retirement resources, many older ethnic minorities may continue to work past customary retirement ages out of desperation. Some research indicates that these individuals are physically, psychologically, and socially worse off than their retired counterparts. As suggested earlier, even the relatively poor but stable government retirement support (if these individuals are fortunate enough to qualify for such support) may, in contrast, be better than sporadic and poor jobs in the regular labor market. Thus, retirement may provide a small but secure government income, leading to increased psychological and social well-being.
4.5. Family and Social Support
Historically, research on minority family and social support networks has been based predominantly on anecdotal data. Two myths have dominated this area. The first is a view of older minorities being cared for by loving and extended family members and fictive kin. The other is a view of impoverished, lonely, older minority elderly individuals being abandoned by a disorganized and incompetent family system. National and other large social surveys indicate a reality somewhere in between, documenting the existence of extended family forms but also demonstrating that much of the assistance is reciprocal; that is, ethnic minority elderly individuals often provide help to younger family members and neighbors. Recent research supports the importance of community institutions, such as churches, as sources of physical and emotional support for older Blacks. This work points to the considerable obstacles faced by many ethnic minority Americans in providing services to physically disabled and/or demented (and mentally ill) relatives.
5. Importance of Formal and Informal Care
5.1. Benefits of Support/Informal Care
Research has provided impressive evidence of the importance of social support throughout the life span, particularly to the elderly. Social support has salutatory effects on physical and mental health of older adults. Support reduces the negative effects of health problems, helps in coping with stressful life events, and buffers the impact of psychological distress. A lack of social support from family and friends is associated with poor psychological well-being (e.g., depression). The most important social support usually involves long-lasting, significant, and close relationships with a network of family, friends, and church members. The quality, rather than the quantity, of the support relationship has been shown to contribute most significantly to health and well-being. In ethnic minority families, informal support has served to counteract the overall deleterious effects of adverse environmental, social, and economic conditions.
5.2. Sources and Types of Informal Support/Care
Studies that examine the beneficial effects that care networks have on health and well-being find that support derives from many sources, including spouse, children, siblings, and friends. Racial and ethnic minority families, in comparison with White families, tend to have larger multigenerational households. On the one hand, investigators report that generations live together out of economic necessity due to low socioeconomic status, poverty, and generally few resources and opportunities available to ethnic minorities. On the other hand, some researchers assert that intergenerational households may be more the product of cultural norms such as familism, filial piety, and familial obligation. In any case, the large family provides a functional, mutually beneficial network from which to give and receive care. Common characteristics of ethnic minority families are the importance of strong family bonds, exchanging of resources, and caring for the elderly.
As they age, many elderly individuals perceive that family and friends can be relied on to help with increasing needs. Family, friends, neighbors, and fictive kin play an important role in the care of ethnic minority elders. Mutual assistance, exchanges, and reciprocity involving informal and formal exchanges characterize the support patterns. A variety of tangible and emotional resources are exchanged within racial and ethnic minority populations, including goods and services as well as financial, emotional, and affective support. Instrumental aid (e.g., food, money, transportation) and emotional support (e.g., advice, counseling, visiting, companionship) are exchanged throughout the life course. These exchanges allow elderly individuals to remain viable and independent in their communities.
The elderly prefer assistance in a manner depending on need. Members of helping networks provide different types of support. Some members may give emotional support, such as listening and advice, whereas others may provide instrumental support, such as sick care and financial help. Family assistance may be more appropriate for long-term care, addressing impairments in activities of daily living (ADLs) and limitations in instrumental activities of daily living (IADLs). Friends and neighbors, in close proximity to elders, may help with daily or short-term needs. Friends may also be a source of companionship and emotional support.
Research provides a wealth of information concerning formal and informal church support. The special role of church support is separate from its religious role for Black elderly individuals. Black churches have proven to be responsive to the needs of communities that have limited access to general societal support systems. Church members exchange instrumental, financial, emotional, and spiritual assistance with each other. This support includes food, clothing, and sick care as well as advice, encouragement, and information.
5.3. Reciprocity
Overall, older individuals are more satisfied with their relationships and have increased well-being if they are involved in reciprocal relationships. The nature of reciprocity exchanges is dependent on the nature of the relationships. Some relationships require immediate and in-kind or equivalent value return of services or goods. Other more intimate or lifelong relationships have more mutually satisfying exchanges over time and less immediacy to the exchanges. For example, receiving more aid than giving aid can result in feelings of guilt and indebtedness. One theory that addresses this issue is Antonucci’s notion of a support bank or support reserves. The concept explains how many elderly individuals are able to maintain positive psychological well-being when they are in need of support but are unable to reciprocate. To illustrate, older minorities usually have fewer resources than do younger network members. By participating in years of giving and mutual exchanges, it becomes psychologically acceptable for the elderly to receive care without giving something in return. There is also evidence that some elderly individuals may reduce the size of their social exchange networks so as not to feel indebted to too many people. It is important to keep in mind that the elderly are not necessarily unable to render some type of reciprocity. For example, they might provide child-rearing assistance, including child care and advice, to younger parents in their networks.
5.4. Formal Care
At times, the elderly may need more professional care than family and friends can provide. When necessary, family, friends, and church members are instrumental in providing referrals to formal services such as professional home care providers. Ethnic minority elders also use formal services in the absence of spouses, children, or other informal helpers. Traditionally, the minority elderly have had few links to formal service. In the past, service delivery organizations rarely acknowledged cultural or family generational lifestyles differences, thereby perhaps contributing to mistrust of formal service organizations.
In general, the ethnic minority elderly are involved in long-term associations involving reciprocal support and care exchanges. More information is needed, however, about how societal changes affect these relationships. For example, younger people who become more educated and economically successful might need to move farther away from their family homes, thereby affecting the availability of care for elderly family members. Furthermore, people are living longer and having fewer children, and more middle-aged adult daughters are working outside the home. These changes also may contribute to a decrease in the number of people available for caring for elderly family members. Among recent immigrants, assimilation and acculturation issues also may complicate familial and friend relationships. The degree of assimilation varies and has effects on the provision of care. Despite histories of disadvantage, including poverty and poor medical care, ethnic minority groups have been creative at developing resources and effective coping strategies to alleviate these deleterious situations. Consequently, they have high levels of satisfaction with life, even in circumstances of relatively poorer health than that of Whites.
6. Receiving Care
Although it has been noted that ethnic minority elderly have viable support systems, the helping literature suggests that receiving aid may have negative psychological consequences for care recipients who have health limitations. The logistical differences between receiving social support in general and receiving care for functional limitations are vague. Past research indicates that older Blacks have varied social support networks consisting of family as well as friends. But little research has examined the adequacy, satisfaction, or psychological implications of transitioning from self-sufficiency to dependency among older Blacks. The psychological effects of actual dependency differ from the psychological benefits of participating in social support exchanges. Studies have focused on the psychological and physical effects of providing care to functionally limited elders, but little is known about care recipients’ perceptions of the caregiving relationship.
It is often implicitly assumed that if care recipients with IADL limitations and ADL impairments have caregivers who adequately meet their physical needs, they are likely to be functioning satisfactorily both physically and mentally. In general, giving help is beneficial and should be encouraged; however, it is also complex and multifaceted.
Responses to aid depend on many factors, including the relationship and history of the donor with the recipient, the characteristics of the donor and the recipient (e.g., age, race, socioeconomic status, gender), and the appropriateness of aid to the needs of recipients (e.g., the context in which the aid is given). Research indicates that all of these factors can affect the recipient’s sense of control. For example, if the help is threatening to feelings of personal control, it can lead to negative psychological outcomes for the recipient. However, if the help is supportive and appropriate to the needs of the recipient, it may reduce any threat to the recipient’s concerns about control. Having some sense of control over who provides care and how much is provided may help to limit psychological distress.
Sense of control is a psychological resource that is effective in helping people to overcome environmental threats. Believing that one has control over negative events reduces possible adverse effects and promotes positive psychological outcomes. Control is indicative of psychological resilience and is effective in buffering the effects of stress. Perceptions of control have beneficial effects on individuals, whereas diminished control over undesirable events induces stress and anxiety and may lead to learned helplessness and depression. A sense of not being in control reduces motivation and adversely affects coping strategies, adaptation, and problem solving.
Some studies show an increase in control with age, whereas others demonstrate a decrease in control with age. The elderly usually encounter more loss and negative life events than do younger individuals. Events such as loss of one’s spouse, physical limitations, and increased contact with health care providers are often associated with a decrease in control and adverse psychological outcomes. However, it is important to examine control within a specific context. Individuals do not feel the same extent of control over all sectors of their lives; degree of control varies from one aspect of life to another. For example, control over career and social relations increases with age, whereas control over health and physical functioning decreases with age. How older people adapt to a new care-receiving situation may depend on caregiving factors noted earlier and control beliefs. Successful adjustment means better mental health outcomes. Believing that one has control over challenges and difficulties results in positive outcomes in various domains, such as psychological adjustment. Research has determined that the perception that an individual has control over his or her life is a stronger predictor of psychological wellbeing than is actual control. Thus, threats to perceived control in important domains of life may have particularly salient effects on overall health and well-being.
7. Importance of Perceived Control to Physical and Mental Health Outcomes
Control has been studied in relation to a number of psychological constructs and has been found to be a strong predictor of physical and mental well-being. These constructs include life satisfaction, coping, depression, mortality, and morbidity. There is a strong relationship between helplessness (i.e., the opposite of control) and depression. Sense of control over both good and bad outcomes is associated with low levels of depression. Studies also indicate that people with a high sense of control are more satisfied with life and are more willing to face challenges than are those with a low sense of control. Attributing control to luck or chance fosters uncertainty and anxiety and may lead to depression. When people believe that they have a low or no degree of control, they become passive and withdrawn. People who believe that they have a higher level of control develop habits to solve and prevent problems.
Feelings of control are especially important for vulnerable populations. Sense of control not only affects psychological functioning but also affects the actions that people pursue as well as people’s cognitions and emotions. For example, control influences how people characterize an event. Those who have low control expectations will attribute declining health to the aging process and, thus, do little to change or prevent further problems. Those with a higher sense of control will participate in intervention and prevention activities to improve their health. Elders receiving care due to physical impairments or health problems may be feeling particularly susceptible to concerns about loss of control. Sense of control is an important construct in predicting adjustment among the elderly, particularly those with ADL impairments, such as problems with cooking, housework, shopping, and walking.
The infirm elderly may find themselves with care providers who prefer compliant care recipients who easily relinquish control in exchange for care. There may be expectations that care recipients should accept decisions made for them about who provides care and how much care is provided. These uncontrollable stressors, including physical limitations and problems in caregiving, may magnify the sense of loss of control and lead to depressive symptoms for elderly individuals receiving care. To illustrate, research suggests that when older people move into their children’s homes, they often experience feelings of depression and increased helplessness and dependency, a diminished sense of personal control over their environment, and a loss of control over their destinies. However, when elderly people in care-receiving situations are given responsibility for some of their daily activities, they experience higher levels of control and fewer symptoms of depression and less dependency. Elderly people experience less psychological distress when they are able to control the course of events in their lives.
For people in poor health, a high sense of control is usually associated with high levels of psychological well-being. However, it should be noted that high perceptions of control have also been linked to poorer psychological well-being in people with health problems. This may be because people with a high sense of control and health problems may feel as though they are losing their independence. Specifically in the caregiving context, recipients with physical impairments may consider the assistance they receive to be intrusive. Nevertheless, the caregiving assistance is needed. Therefore, those who are impaired and have a high sense of control may be at greater risk for depressive symptoms than are those without a high sense of control. Traditionally, people with a low sense of control depend on others for help, whereas a high sense of control is related to greater motivation for making the decisions that affect people’s own lives. Care receivers with a low sense of control may be better at adapting to relinquishing control of their daily lives to their caregivers. This relinquishing of control may result in positive psychological outcomes for care recipients as well as feelings of satisfaction with their relationships with caregivers. On the other hand, people with a high sense of control might feel more independent and perceive themselves as not giving up their autonomy and self-sufficiency in exchange for care. Consequently, these individuals might be at risk for poor care or, worse, for no care providers, eventually resulting in institutionalization.
Levels of sense of control may have unique effects on psychological well-being for ethnic minorities. Research suggests that because of past histories of discrimination, ethnic minorities might interpret some negative life events as uncontrollable. However, these interpretations are often associated with positive outcomes of psychological well-being. Racial and ethnic minorities may be well adapted to dealing with stressful negative life events and to acknowledging and accepting when they are unable to control or change the course of those events. When opportunities and resources are low, or when advantages are few, it may be healthier and more prudent to assume a low sense of control. Usually, an external sense of control is associated with unhealthy physical and mental health outcomes, but for the ethnic minority elderly, an external view may serve as a buffer to the effects of uncontrollable negative life events.
8. Receiving Care, Sense Of Control, and Psychological Well-Being
8.1. Caregivers
8.1.1. Burden, Stress, Depression as a Result of Providing Care
The caregiving literature reveals that spouses are the first choice for providing care. Spouses are willing and committed to helping each other, but often the outcome for caregiving spouses is depressive symptoms, anxiety, stress, and physical impairment. Spouses in caregiving situations may be at advanced ages with limited physical strength and stamina for the tasks of caregiving and sole responsibility of performing household tasks and home maintenance that were previously shared. The added responsibilities may lead to burden, stress, and depressive symptoms for caregiving spouses.
Adult children are also preferred over other nonrelative care providers. However, caregiving adult children usually have other obligations, including the needs of their spouses, children, and career goals. These other demands can be negatively affected by providing care to elderly parents. Some adult children providing care for parents often forfeit or delay career advancements due to the responsibilities of caregiving. Furthermore, adult children may experience role reversal due to caring for their parents. Role exchange, career delay, and multirole responsibilities can have negative psychological consequences, such as role strain, depression, and poor physical health, for caregivers.
Studies comparing caregivers’ psychological wellbeing indicate that Black caregivers report better psychological well-being and less negative psychological consequences of caregiving than do White caregivers. Investigators attribute these differences to cultural norms and beliefs and to patterns of living. For example, some studies show that Black caregivers report lower levels of caregiver burden and stress, and greater levels of caregiving mastery and satisfaction, than do White caregivers. Furthermore, ethnic minority caregivers often have less social and high-status career obligations to relinquish when assuming caregiver responsibilities than do Whites. As a result, they usually have less to lose economically than do their White counterparts.
8.2. Care Recipients
8.2.1. Effects of Caregiving on Care Recipients’ Psychological Well-Being
Care recipients who must learn to master a new environment due to physical limitations or some other transition in their lives find that they would rather have the freedom to choose who helps, when they need help, or when they would rather do tasks themselves. When help is needed, recipients of aid are usually more willing to receive help from family and friends than from strangers. The more intimate the relationship with the helper, the better for the care recipient. Receiving help from family and friends permits care recipients to use little or no formal services and to remain in the community.
Although care recipients rely heavily on family, they also weigh the costs of time and effort to their caregivers. If the cost to the caregiver is low, the care recipient may be more comfortable in asking for or receiving help. If the caregiver is a spouse, it may be less costly than it would be for an adult child who has a family and other job and career responsibilities. However, some research has found that recipients’ psychological well-being sometimes is negatively affected in caregiving contexts with both spouses and adult children. Other work has found that the elderly prefer to have less control, particularly during major health-related difficulties. Giving up control to family or health care professionals can often be a relief if control is not possible. In most day-to-day living circumstances, the elderly desire to have a routine schedule, to be independent, and to make decisions for themselves.
The literature suggests that care recipients with spouses or other family care providers feel dependent on caregivers and depressed. In his research on receiving help, Newsom reported that recipients often have negative cognitive and emotional reactions to receiving care, including feelings of dependency, indebtedness, incompetence, and worthlessness. Furthermore, having family caregivers sometimes exacerbates those perceptions, especially if recipients perceive that family members are burdened, stressed, and depressed by providing care or if care is not appropriate for the IADL limitations (i.e., too much or too little).
8.2.2. Spouse Caregiver
The caregiving literature indicates that spousal care is less costly in terms of time constraints than is care from others. On the other hand, recipients with spouse caregivers report being more worried, depressed, and dependent than do recipients with younger relative caregivers. These negative effects can be attributed to concerns about overtaxing the elder caregiving spouse with additional responsibilities and tasks. The spouse receiving care may harbor a sense of guilt, realizing that he or she can no longer share the responsibilities of housekeeping tasks and other marital obligations and that the extra burden of caregiving and added household responsibilities could jeopardize the health of the caregiving spouse. In addition, research indicates that the quality of marital relations affects caregiving perceptions and psychological well-being for both spouses. Poorer quality relationships are exacerbated by caregiver burden and stress. These effects on the caregiving spouse may be manifested in the quality of care given and contribute to increased depressive symptoms for recipients with either a low or high sense of control.
Research shows that the quality of spousal care has a strong influence on care recipients’ psychological well-being. However, the literature also presents evidence that even spousal care is not always helpful. Unhelpful care can lead to negative self-perceptions and to negative perceptions about caregivers. Spouse caregivers who over or underestimate the abilities of care recipients can inadvertently criticize recipients’ recovery efforts. These criticisms erode self-esteem, decrease sense of control, and contribute to increased depressive symptoms in recipients. In general, spousal caregivers provide appropriate care; however, the effect of poor-quality care is more detrimental to mental health than high-quality care is beneficial to mental health. Inappropriate help can, at times, reduce the actual and perceived capabilities of recipients. Help implicitly threatens the sense of control of recipients, depending on the nature of the need and the help given.
8.2.3. Adult Children
Most care recipients have good relationships with their adult children caregivers; however, there are elderly individuals with adult children caregivers who perceive themselves as burdensome to their children. In a review of the caregiving literature within Hispanic communities, it was concluded that familial support systems for the impaired elderly could have detrimental consequences for both care recipients and adult child caregivers. The more dependent elders were on their children, the more depressive symptoms the elders reported. Depressive symptoms and dependency can be a result of role reversal and of the feeling of being a burden on children. Receiving support for shopping, cooking, and household tasks from children indicates that individuals are no longer self-sufficient, causing care recipients to feel as though they are losing control of their lives and their independence. Most elderly individuals would prefer to live independently from their adult children and to receive emotional support rather than instrumental support. Care recipients fear burdening their children and experience more psychological problems receiving help when adult children have to adjust their lives, including work schedules, to provide any type of support.
In addition, with family members performing chores and tasks for care recipients, time for social interactions with recipients may be reduced. After completing caregiving tasks, adult children may lack the time or energy to show affection or emotional support, resulting in elder recipients feeling lonely as well as burdensome to their children. Lack of affection can cause negative psychological consequences for recipients, particularly if the stress and burden that family members feel as a result of providing care is manifested in their behaviors, attitudes, and quality of care toward recipients. The elderly desire to continue familial relationships, but they also want to live independently.
8.2.4. Other Relatives, Friends, and Church Members
The literature indicates that the ethnic minority elderly in the community without family often have several sources of support. Studies have examined the similarities and difference in the structure, demographics, and living arrangements of elderly Black and White social and caregiving networks and found that elderly Blacks are more likely to have nonfamily and unpaid caregivers than are elderly Whites. Many elderly individuals may feel less of a burden to other relatives and friend caregivers than to spouses and adult children care providers. Nonfamily members may be providing care out of kindness and genuine concern, but the care might not be consistent, steady, or dependable. For example, neighbors or friends going to the market may offer to purchase groceries or prepare extra food, and church friends may provide emotional support and transportation. However, providing care on a daily basis, such as for bathing, dressing, and taking medication, might require more commitment than friends and neighbors are able to give. If help is required too often, care recipients may begin to feel burdensome to nonfamily members. Receiving help from nonfamily members may be distressing but necessary to overcome care needs. The familiarity found in families is usually not present with nonfamily caregivers. In addition, nonfamily members may begin to feel beset by too many requests for assistance.
Because of the need for help with physical limitations, such as eating, bathing, and walking, recipients with nonfamily caregivers might need more professional help than spouses or family members can possibly offer. Some daily tasks are more appropriate for trained formal caregivers. Having physical or medical needs met, however, does not guarantee that recipients are comfortable with the caregiving situations or with the caregivers. Elderly individuals who are reluctant to voice disapproval or who have no control (whether actual or perceived) over ineffective or excessive care are at risk for depression.
9. Racial And Ethnic Minority Elderly As A Resource
The information in this research paper is important for practitioners dealing with elderly care recipients. Frequently, psychological well-being, such as depressive symptoms in the elderly, are ignored or misdiagnosed, resulting in early morbidity and mortality among older persons receiving care. Research indicates that some health care professionals believe that the symptoms of depression are inevitable in the elderly and focus more on physical and medical problems. This research paper suggests that elderly care recipients’ psychological needs are also important and that certain aspects of the caregiving relationship are related, for example, to an increase in depressive symptoms. Unfortunately, most care recipients often feel that they should be appreciative of any help they receive and will not complain, even when the help is inappropriate and causes poor psychological well-being.
Consideration should be given to elder care recipients as a resource. The elderly often possess valuable knowledge, skills, and insights that they can share with others. The elderly generally have more positive perceptions about the quality of their lives when their relationships with family and friends are of a reciprocal or interdependent nature than when they are simply receiving help from others. Elderly individuals receiving care are not necessarily unable to reciprocate in the caregiving relationship. Elderly parents are more satisfied if they can exchange support with care providers. For example, care recipients often provide emotional and financial support to caregivers, serve as confidants and sources of advice, and provide child care and sick care. The relationships between caregivers and care recipients are found to be supportive and reciprocal for both parties when recipients are given some responsibilities. Recipients can help with child care for their adult children who work and provide caregiving. The elderly can also share their skills and knowledge with family caregivers and grandchildren. They can help teach younger children to read and write, and care recipients who have hobbies (e.g., knitting) can teach skills to younger generations, further helping adult children and strengthening family intergenerational bonds. The elderly often help to relate and preserve family heritage and serve as socialization agents. Moreover, although frail or disabled older adults may be dependent on family members for care and support, there is some indication that various caregivers are dependent on care recipients for economic and housing assistance. For example, when adult children are in the divorce process or are experiencing temporary unemployment, parents are usually their first source of help.
Caregivers should also be aware of the importance of the emotional needs of care recipients and how to provide necessary care in a nonintrusive way. Care recipients should have as much control as possible over who provides care. Caregivers should allow care recipients to become involved in the planning of their daily care. For example, recipients may help to create grocery lists to purchase foods of their liking and help to prepare meals of their choice. The literature indicates that when care recipients are allowed to make decisions about their routines and are given some responsibility for their well-being and the important events in their lives, their emotional and physical well-being improves. Recipients who must learn to master a new environment due to disabilities need the freedom to choose when they need help or which tasks they would rather perform themselves. Their perceptions of their needs may be different from their actual needs, but it should be possible to provide care in a way that is not perceived as intrusive, overwhelming, or useless. To provide the best possible experiences for both receivers and caregivers, practitioners should assess and evaluate emotional and psychological aspects, and not only physical and medical aspects, of caregiving situations.
9.1. Implications
One of the major implications of the literature in the area of caregiving and care receiving is that recipients can have poor psychological health even when caregivers are providing for their physical needs and IADL limitations. Recipients’ psychological health is an important factor to consider when examining the caregiving environment.
As noted previously, research that has investigated care recipients and caregivers has largely addressed the medical and physical limitations of care recipients. It is erroneously assumed that if caregivers are available to help with those limitations, recipients are functioning satisfactorily. Contrary to expectations, being cared for by family for some limitations and by nonfamily members for others might not always be beneficial to recipients’ psychological well-being. Sense of control may be related to decreased psychological well-being, such as depressive symptoms, and there is compelling evidence that receiving and giving care is multifaceted and complex, especially among racial and ethnic minority elders. The authors believe that more research is needed on recipients’ psychological well-being, especially sense of control, within the caregiving relationship.
10. Conclusions
This research paper has reviewed some implications of research findings in the areas of socioeconomic status, social support systems, well-being, and family patterns, focusing specifically on perceptions of control and family caregiving and care receiving. It discussed how these findings are important for an applied psychology of aging, particularly within a biopsychosocial model of human development and aging. As indicated at the beginning of the research paper, the population of the United States continues to grow, especially in racial and ethnic diversity. Along with this complex demographic growth are social, health, and well-being considerations that affect the structure and functioning of the entire society. A clearer understanding of the influence of ethnic, racial, and cultural dimensions on social and psychological processes of aging and human development is necessary to address this complicated change in the size, diversity, and needs of the expanding older population.
References:
- Antonucci, T. C., & Jackson, J. (1997). The role of reciprocity in social support. In B. R. Sarason (Ed.), Social support: An interactional view (pp. 173–198). New York: John Wiley.
- Jackson, J. S. (1993). Racial influences on adult development and In R. Kastenbaum (Ed.), The encyclopedia of adult development (pp. 18–26). Phoenix, AZ: Oryx.
- Jackson, J. S. (Ed.). (2000). New directions: African Americans in a diversifying nation. Washington, DC: National Policy Association.
- Jackson, J. S., Chatters, L. M., & Taylor, R. J. (1993). Aging in Black America. Newbury Park, CA: Sage.
- Lustbader, W. (1991). Counting on kindness: The dilemmas of dependency. New York: Maxwell Macmillan.
- Rodin, J. (1987). Personal control through the life course. In R. P. Ables (Ed.), Life-span perspectives and social psychology (pp. 103–119). Hillsdale, NJ: Lawrence Erlbaum.
- Taylor, J., Chatters, L. M., & Jackson, J. S. (1997). Changes over time in support network involvement among Black Americans. In R. J. Taylor, L. M. Chatters, & J. S. Jackson (Eds.), Family life in Black America (pp. 293–316). Thousand Oaks, CA: Sage.
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