Relationship, Choice, Health, and Typologies of Unpaid Care Labor for Older Adults

Abstract

Providing unpaid care labor to older adult friends and relatives is associated with deleterious health outcomes, especially among persons who feel they have no choice when taking on care responsibilities. We used hierarchical cluster analysis and structural equation modeling of data from the National Alliance for Caregiving’s Caregiving in the U.S. 2015 Survey to explore choice—outcome relationships. We identified three distinct care typologies, hands-on, household, and managerial care. Perceived lack of choice predicted emotional stress directly and indirectly through household and managerial care; predicted physical strain directly and indirectly through all care typologies; but only predicted negative health impact indirectly through mediation. Lack of choice had greater direct effects on emotional stress and negative health impact for adult–descendants compared to participants with other relationships with recipients, for whom the effects of lack of choice on outcomes were mediated through household and managerial care.

Impacts of Perceived Choice on Physical Strain, Emotional Stress and Health among Caregivers

“…7,9,12 Associations among caregivers' perceived choice and caregivers' health and well-being were also mediated by caregiver-to-care recipient relationship. 11,12 For instance, family caregivers of spouses and children report significantly worse psychological well-being than caregivers of other relatives and non-kin individuals. 11 On the contrary, neither choice nor degree of choice predicted caregiver health and well-being as measured by burden, anxiety, depression, stress, and positive aspects of caregiving in spousal caregivers of adults with dementia.…”

“…4,5 Given the importance of the concept of free choice in becoming a caregiver, recent research investigated whether informal caregivers perceived having a choice in becoming a caregiver and its consequences on caregivers' emotional well-being, physical well-being, and health status. 4,[6][7][8][9][10][11][12] The percentage of informal caregivers who reported a lack of choice in becoming a caregiver ranged between 18.7% and 82% in those previous studies, depending on the study design and sample. In a UK study conducted in 2009, 18.7% of 798 individuals were classified as "unfree" in choice in caregiving and 48.7% were classified as perceiving a "constrained choice" in caregiving.…”

“…7 Studies using the Caregiving in the U.S. 2015 dataset reported a higher prevalence of lack of choice in being a caregiver: 50% of 1,087 caregivers of adults aged 50 and older 9 and 51.3% of 1,067 caregivers of adults aged 65 and older. 12 Despite a wide range of a lack of choice in becoming a caregiver, the literature supported that the lack of choice was associated with higher levels of emotional stress, 7,8,12 higher levels of physical strain, 7 lower levels of happiness and life satisfaction, 4 and negative health impacts. 7,9,12 Associations among caregivers' perceived choice and caregivers' health and well-being were also mediated by caregiver-to-care recipient relationship.…”

“…12 Despite a wide range of a lack of choice in becoming a caregiver, the literature supported that the lack of choice was associated with higher levels of emotional stress, 7,8,12 higher levels of physical strain, 7 lower levels of happiness and life satisfaction, 4 and negative health impacts. 7,9,12 Associations among caregivers' perceived choice and caregivers' health and well-being were also mediated by caregiver-to-care recipient relationship. 11,12 For instance, family caregivers of spouses and children report significantly worse psychological well-being than caregivers of other relatives and non-kin individuals.…”

“…7 Studies using the Caregiving in the U.S. 2015 dataset reported a higher prevalence of lack of choice in being a caregiver: 50% of 1,087 caregivers of adults aged 50 and older 9 and 51.3% of 1,067 caregivers of adults aged 65 and older. 12…”