Rohr, M.K., & Lang, F.R. (2014). The role of anticipated gains and losses on preferences about future caregiving. Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, doi:10.1093/geronb/gbu145
The Role of Anticipated Gains and Losses on Preferences About Future Caregiving Margund K. Rohr1 and Frieder R. Lang2
Objectives. A growing amount of research has suggested that caregiving is not only associated with burden but entails also the potential for positive outcomes. By contrast, less is known about the roles of gain–loss-anticipations on future caregiving. Method. We conducted a web-based study in which we compared three groups with differing preferences on future caregiving: being willing to provide care (potential caregivers; n = 189), remaining indecisive about whether to provide care (undecided; n = 121), and rejecting the idea to provide care (unwilling; n = 62). In addition, actual caregivers (n = 113) served as a reality check for these expectations. We assessed gain–loss anticipations with a newly developed instrument (k = 12) and offer information on its reliability and validity. Results. Groups reveal different patterns of gain–loss-anticipations. Potential caregivers resembled actual caregivers and highlighted the potential benefits of caregiving, whereas those who were undecided or unwilling to provide care perceived fewer gains and more losses. Conclusion. Preferences about future caregiving are not described solely by socio-demographic aspects but are also colored by anticipations of both gains and losses. Findings point to the need to focus on motivational factors to enhance our understanding in the context of caregiving decisions. Key Words: Caregiving—Future caregiving—Gain–loss expectations—Motivational factors—Preferences about caregiving.
F
or a long time, research has focused on the burden of caregiving and its detrimental effects on psychological and physiological health (Pinquart & Sörensen, 2003, 2007). More recently, a growing body of evidence has revealed that the caregiving role also offers potential gains (e.g., Broese van Groenou, Boer, & Iedema, 2013; Koerner, Kenyon, & Shirai, 2009; Tarlow et al., 2004). However, the ways in which anticipated losses and expected gains shape the willingness to provide care are not well understood. We submit that people are more willing to provide care when they expect gains from this role and do not perceive caregiving as solely a burdensome future experience. In this study, we explored whether the willingness to provide care depends on positive or negative anticipations of the future caregiving role above and beyond socio-demographic conditions. Gain and Loss Experiences in the Actual Caregiving Situation Research has demonstrated that experiencing caregivingrelated losses such as relational deprivation, feeling overwhelmed, or self-engulfment are associated with increased strain and diminished well-being (Adams, McClendon, & Smyth, 2008; Skaff & Pearlin, 1992). Likewise, perceptions of benefits from caregiving are associated with feeling
less burdened and experiencing lower depressive symptoms, better subjective health, and higher life satisfaction (e.g., Pinquart & Sörensen, 2004). For example, Cohen, Colantonio, and Vernich (2002) found that about three quarters of caregivers in their study perceived at least one benefit when providing care. Perceptions of gains related to companionship, to meaning, or to enjoyment were associated with lower depression, fewer strains, and improvements in reported health 5 years later. Also, when caregivers report benefits, they are less likely to mistreat the care recipient (e.g., Morse, Shaffer, Williamson, Dooley, & Schulz, 2012), and such care recipients have a lower likelihood of being institutionalized (Cohen, Gold, Shulman, & Zucchero, 1994; Gaugler, Kane, & Newcomer, 2007). Perceiving that one can gain something from taking on the role of a caregiver is influenced by a variety of individual and contextual influences such as socio-demographic conditions (e.g., Brody, Litvin, Hoffman, & Kleban, 1992; Cohen et al., 2002; Nijboer, Triemsta, Tempelaar, Sanderman, & van den Bos, 1999), the caregiver’s personality and goals (Hooker, Monahan, Bowman, Frazier, & Shifren, 1998; Koerner et al., 2009), or the relationship with the care recipient (Broese van Groenou et al., 2013; Raschick & IngersollDayton, 2004). For instance, being female, fewer financial resources, or lower education contribute to a more negative
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected]. Received May 23, 2014; Accepted September 5, 2014 Decision Editor: Bob G. Knight, PhD
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1 Institute of Psychology, University Leipzig, Germany. Institute of Psychogerontology, Friedrich-Alexander University Erlangen-Nuremberg, Germany.
2
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Gain and Loss Anticipations and Future Caregiving Few studies have considered preferences for future caregiving and the transition into caregiving (Burton, Zdaniuk, Schulz, Jackson, & Hirsch, 2003; Kramer & Lambert, 1999; Rohr et al., 2013). Most studies have focused on socio-structural determinants of caregiving decisions, have tried to capture the entrance into caregiving retrospectively, or have compared how the entrance into caregiving affects the caregiver’s mastery, feelings of being burdened, or well-being (Black, Reynolds, & Osman, 2008; Lawton, Moss, Hoffman, & Perkinson, 2000; Seltzer & Li, 2000). Entrance into the caregiving role was shown to depend on gender, marital status, occupational status, health, and relational aspects such as closeness or relationship satisfaction (e.g., Lee & Gramotnev, 2007). For example, women and married individuals tend to have a greater likelihood to take over care responsibilities (e.g., Neal, Ingersoll-Dayton, & Starrels, 1997). Furthermore, few studies that explore future care preferences and planning suggest that these preferences are not only shaped by socio-demographic conditions, but also by factors such as personality or relationship quality (e.g., Roberto, Allen, & Blieszner, 2001; Sörensen, 1998; Sörensen, Duberstein, Chapman, Pinquart, & Lyness, 2008). For instance, work by Sörensen and colleagues highlights the role of relationship quality on family members’ perception of potential care needs (i.e., potential caregivers), and stresses the impact of personality on care planning and preparation activities among older adults (i.e., potential care recipients). However, the effect of personal future anticipations on the willingness to provide care is not well understood. Although research has underscored the relevance of experienced gains and losses in the actual care situation, it is not well understood how anticipations of gains and losses are associated with the willingness to provide care in the future. Prior studies have explored the role of negative anticipations related to expectations of burdens, anxiety, and avoidance in the context of caregiving decisions (e.g., Karantzas, Evans, & Foddy, 2010). For instance, Wells and Over (1994) used a vignette approach to explore wives’ and
husbands’ willingness to provide care for their spouse. As expected, willingness was lower when providers expected strain and greater impairments in the care recipient. To sum up, the roles of positive and negative anticipations on preferences about future caregiving are not well understood. Only some studies have observed that anticipations of feeling burdened and expectations of strain lower people’s willingness to enter the caregiving role. In this study, we therefore examine how gain and loss anticipations concurrently shape the willingness to provide care above and beyond socio-demographic variables that are known to influence the entrance into the caregiving role. Thus, our goal is to enrich existing literature by focusing on underlying motivational factors and pay attention not only to the negative but also to the positive influences on potential caregiving decisions. The Present Study In a first step, we conducted a web-based cross-sectional study in which we sought to determine some major patterns of preferences about future caregiving. More concretely, we examined the future care preferences of three different groups: participants who reported their willingness to provide care to a person in need, participants who were undecided, and those who did not wish to take on care responsibilities. Moreover, we also compared these three groups with actual caregivers who had already decided to provide care for someone, possessed actual care experiences, and could thus serve as a kind of reference point for future expectations. Method Participants The majority of the 485 participants were female (77%). On average, participants were about 55.2 years of age (SD = 14.7). As shown in Table 1, actual caregivers and potential caregivers were older than those who were undecided or unwilling to take on care tasks, F(3, 481) = 8.5, p < .001. The majority of the participants were married or living in a partnership (64%). Actual caregivers were more likely to be married, whereas those who are unwilling to provide care are less likely to be married, χ2(15) = 27.8, p < .05. The sample was well-educated. Over half of the participants had received either the German high school degree Abitur (16%) or a university degree (37%). Whereas 39% were already retired, about 21% reported being employed. The groups differed significantly in their employment status, χ2(15) = 31.1, p < .01. Whereas actual caregivers were less likely to be employed, undecided participants were more likely to be students or were undergoing occupational training (cf. Table 1). Procedure We invited participants from two registered universitybased research participant pools via e-mail to complete
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view on caregiving, while factors such as better subjective health, being married or having a better relationship quality with the care recipient are associated with the perception of gains and benefits of providing care. Moreover, studies have demonstrated that caregivers with higher scores in neuroticisms are more likely to perceive losses due to caregiving and are subsequently more burdened than caregivers with lower scores in neuroticism (e.g., Bookwala & Schulz, 1998; Rohr, Wagner, & Lang, 2013). By contrast, the study by Koerner and colleagues (2009) links agreeableness and extraversion to the perception of benefits in the caregiving role.
7 (6.2) 64 (56.6)a 12 (10.6)a 4 (3.5) 18 (15.9) 8 (7.1) 1 (0.9) 19 (16.8) 31 (27.4) 13 (11.5) 35 (31.0) 12 (10.6) 2 (1.8) 13 (11.5)a 13 (11.5) 22 (19.5) 51 (45.1) 4 (3.5)a 10 (8.8)a
53 (10.9) 214 (44.1) 94 (19.4) 17 (3.5) 66 (13.6) 41 (8.5) 3 (0.6) 53 (10.9) 116 (23.9) 77 (15.9) 180 (37.1) 45 (9.3) 11 (2.3) 104 (21.4) 57 (11.8) 78 (16.1) 189 (39.0) 34 (7.0) 23 (4.7)
N (%) 93 (82.3)
N (%) 373 (76.9)
58.22a 12.27
55.17 14.68
5 (4.1)b
30 (24.8)b 15 (12.4) 19 (15.7) 37 (30.6) 15 (12.4)b
41 (21.7)b 22 (11.6) 30 (15.9) 82 (43.4) 9 (4.8)a 5 (2.6)b
27 (22.3) 52 (43.0) 7 (5.8) 1 (0.8)
26 (21.5)
0 (0.0) 8 (6.6)
16 (13.2) 47 (38.8) 26 (21.5) 4 (3.3) 17 (14.0) 11 (9.1)
96 (79.3)
N (%)
50.76b 15.88
27 (14.3) 65 (34.4) 22 (11.6) 7 (3.7)
45 (23.8)
2 (1.1) 21 (11.1)
20 (10.6) 86 (45.5) 44 (23.3) 4 (2.1) 21 (11.1) 14 (7.4)
136 (72.0)
N (%)
57.41a 14.01
Undecided (n = 121)
Groups Potential care-givers (n = 189)
3 (4.8)b
20 (32.3)b 7 (11.3) 7 (11.3) 19 (30.6) 6 (9.7)a
10 (16.1) 28 (45.2) 4 (6.5) 1 (1.6)
14 (22.6)
0 (0.0) 5 (8.1)
10 (16.1) 17 (27.4)b 12 (19.4) 5 (8.1) 10 (16.1) 8 (12.9)
48 (77.4)
N (%)
51.40b 15.70
Unwilling to provide care (n = 62)
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Note. Means and frequencies with different subscripts indicate significant differences (Scheffé post hoc test, p < .05, and standardized residuals higher than 2.0). *p < .05. **p < .01. ***p < .001.
Gender (= female) Family status Single Married In a partnership Separated Divorced Widowed Educational degree no degree Hauptschule (= 8 years of schooling) Realschule (= 10 years of schooling) Abitur (= equivalent to high school) University Occupational training Other Employment Employed full-time Employed part-time Unemployed Retired Student, in occupational training Other
Age (years) M SD
Total sample (N = 485) Actual caregivers (n = 113)
Table 1. Socio-Demographic Information About the Online Sample
χ2(15) = 31.1**
χ2(18) = 24.0, n.s.
χ2(15) = 27.8*
χ2(3) = 4.9, n.s.
F(3, 481) = 8.47***
Δ Groups
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Measures Patterns of preference about future caregiving.—Participants were asked to indicate a person in their surroundings who might need care in the future. If they were able to name a person, they were asked to indicate their willingness to take on these care responsibilities. More concretely, participants were questioned if they would provide care to this person. Three groups were generated based on the answers: potential caregivers, who were willing to provide care for the named person (= yes); participants who were undecided about becoming caregivers (= not sure); and those who were unwilling to step into the caregiving role (= no). Additionally, people who reported that they were already providing care for someone at the present time constituted the group of actual caregivers. The majority [93%] of the participants named kin relationships. The groups did not differ in the nomination of a non-kin person with future care needs. However, there were differences across groups in relationship status. In detail, potential caregivers were more likely to name their spouse, whereas those who were unwilling to provide care were more likely to refer to a grandparent. Actual caregivers mainly provided care to their partner [32.7%] or to their parents and parents-in-law [35.4%]. The reported care recipients were predominantly older than 60 years [about 86%, M = 75.6, SD = 18.6]. We do not have detailed information about type of impairment [e.g., physical or cognitive], but caregivers had to rate amount of care needed by the care recipient on a scale ranging from 0 to 100 [M = 65.0, SD = 27.8].
Gain–loss anticipations.—Current research has provided a great diversity of conceptual and methodological approaches to capture the benefits and strains that occur within the context of actual caregiving. These approaches often vary with respect to specific contents and foci: For example, whereas some research has highlighted the issue of meaningful in-depth experiences (Pakenham, 2005), other research has emphasized the potential of the caregiving role to provide personal growth (Leipold, Schacke, & Zank, 2008). Moreover, available instruments often focus on a certain type of disease and vary in the number of items and the response format (e.g., Tarlow et al., 2004 for an overview). All in all, three main topics can be differentiated: an individual level that encompasses caregivers’ competencies and abilities (e.g., mastery vs subjective burden), changes in the relationship with the care receiver (e.g., increases vs decreases in closeness), and modifications in social surroundings (e.g., increased coherence vs social deprivation; Braun et al., 2009; Tarlow et al., 2004). We assembled and modified items from these existing measures. A web-based pilot study with 181 adults (M = 38.7, SD = 16.6, 75% female) from a registered participant pool was conducted to evaluate the comprehensibility and usability of the scale. The final scale consists of 12 items, six items assessing anticipated gains (e.g., “As a caregiver, I would expect to find out more about myself, my strengths, and my shortcomings”) and six items reflecting anticipated losses (e.g., “As a caregiver, I would expect to lose my independence and autonomy”). Participants indicated how much they agreed with the listed expectations, ranging from 1 (do not agree at all) to 5 (fully agree). Previous research has demonstrated the impact of relationship status on caregiving experiences (Broese van Groenou et al., 2013; Raschick & Ingersoll-Dayton, 2004). Therefore, we additionally conducted an exploratory interview pilot study that examined gain–loss anticipations of 49 spouses (M = 69.1 years old, SD = 7.5) and 19 adult children (M = 49.3 years old, SD = 9.0) of an older person with health impairments. Positive and negative anticipations of future caregiving reflected independent dimensions, r = .06, p = .613. Moreover, anticipations of gains and losses in caregiving did not differ between the two groups with one exception. Spouses especially emphasized that caregiving may lead to stronger cohesion within the family (MS = 3.80, SD = 1.17, MAC = 2.83, SD = 1.20), F(1, 65) = 12.20, p < .01, η2 = .12. In the current study, confirmatory factor analysis showed acceptable model fit, χ2(54) = 180.5, RSMEA = .079, CFI = .930, SRMR = .056 (cf., Supplementary Figure 1). Reliability was good for both scales (αgains = .85, αlosses = .86) and comparable to the concrete caregiving experiences of actual caregivers (Supplementary Table 1). Based on previous research we assumed that gain anticipations are linked to variables such as openness to experience, agreeableness, and other-related goals. In contrast, loss anticipations should
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an online questionnaire (www.gerotest.de, www.psytests. de). In order to increase the proportion of actual caregivers, we additionally advertized on blogs addressing topics on caregiving. After welcoming and informing the participants about the contents of the study, participants were asked to indicate their current caregiving status and their motivation to provide care for a person in need. More precisely, participants chose a person in their social surroundings whom they expected would require future care. They were asked to name the person with the highest probability of needing future care. After nominating a person in need, the participants had to rate aspects that would impact their willingness to provide care (e.g., financial aspects, feelings of obligation, caregiver’s own health status) and were asked to characterize their relationship to the potential care recipient (e.g., relationship status, relationship quality). Furthermore, they also answered questions regarding their personality, life contexts, well-being, and physical health. At the end, all participants were informed about caregiving research and the goals of the study once again and received personalized feedback on their personalities. The total sample consisted of 592 participants. The current presentation focused on a subsample of 485 participants who were able to name a person with future care needs.
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versions. In this vein, authors such as Hahn, Gottschling, and Spinath (2012) argue that low internal consistency in constructs may not indicate low validity, but may reflect its heterogeneity and breath. Finally, participants were asked to rate the importance of self- and agency-related life goals (k = 4; e.g., one’s independence and autonomy; α = .78) and other-related communal life goals (k = 4, e.g., to be there for others and to support them; α = .60). A 5-point scale ranging from 1 (very unimportant) to 5 (very important) was used (Lang, Diewald, & Wendt, 2009). Lastly, using a single item, we also measured relationship satisfaction with the person who had the future care needs on a 5-point scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Statistical analyses.—We tested our hypotheses using logistic regression analyses and compared anticipations of gains and losses of potential caregivers (=1) with the expectations of those who were undecided or unwilling to provide care (=0) in two separate logistic regression analyses. Analyses were conducted with the statistical software IBM SPSS version 21.
Covariates.—To assess the convergent and discriminant validity of the scale on gain–loss expectations and to account for socio-demographic influences, we measured aspects that are known to affect the decision about whether to provide care or not: age, gender (1 = female), school (1 = Abitur), employment (1 = employed), and marital status (1 = married). Furthermore, we assessed several further variables that are known to influence gain–loss-anticipation expectations and experiences. First, participants had to rate their health on a 5-point scale ranging from 1 (very good) to 5 (poor). Scores were recoded so that higher scores indicated better subjective health. Second, we used a five-item version of the Beck Depression Inventory to assess depressive symptoms (Schmitt, Hübner, & Maes, 2010). Participants indicated the occurrence of negative feelings and attitudes on a scale ranging from 1 (never) to 5 (almost always). Reliability was satisfactory (α = .80). Third, personality was measured with a short version of the Big Five Personality Inventory (BFI-S; Lang, John, Lüdtke, Schupp, & Wagner, 2011). The five dimensions of personality, namely, neuroticism, extraversion, openness, agreeableness, and conscientiousness, were assessed by three items per subscale. Reliability analyses showed satisfactory internal consistency for four of the five subscales, ranging from α = .63 to .71. For agreeableness however, consistency was unexpectedly low in this sample (α = .49). However, previous research has proved validity and reliability of the BFI-S in comparison to longer
Results A comparison of means revealed that those who were unwilling to provide care (MUW = 3.77, SDUW = 0.85) reported more expected losses than potential caregivers (MPCG = 2.92, SDPCG = 1.06), F(3, 480) = 12.1, p < .001, η2 = .07. Interestingly, potential caregivers’ anticipation levels were similar to the loss levels that were experienced by actual caregivers (MACG = 3.07, SDACG = 1.18). By contrast, potential caregivers (MPCG= 3.28, SDPCG = 1.07) anticipated more gains than people who were undecided (MU = 2.87, SDU = 0.99) but did not differ from those who were unwilling to provide care (MUW = 3.27, SDUW = 0.91). Again, the anticipated gains of potential caregivers were comparable to the gain levels of actual caregivers (MACG = 3.48, SDACG = 0.96), F(3, 480) = 7.7, p < .001, η2 = .05. Do anticipations of gains and losses predict the willingness to provide care above and beyond socio-demographic variables? In line with our hypothesis, the willingness to
Table 2. Correlational Patterns of Variables for Groups in the Transition into Caregiving Variables 1
Depressive symptoms 2 Neuroticism 3 Extraversion 4 Openness 5 Conscientiousness 6 Agreeableness 7 Self-related goals 8 Other-related goals 9 Gains 10 Losses
M
SD
1
2
3
4
5
6
7
8
9
2.45 (2.47) 0.78 (0.87) — .13 (.18) −.21 (−.40) −.01 (−.11) −.08 (−.01) −.08 (−.19) −.03 (.08) −.04 (−.03) −.06 (−.14) 3.25 (3.27) 3.54 (3.60) 3.96 (3.83) 3.50 (3.53) 3.54 (3.58) 3.65 (3.63) 3.60 (3.54)
0.60 (0.57) 0.56 (0.61) 1.04 (0.72) 0.48 (0.40) 0.51 (0.57) 0.85 (0.94) 0.75 (0.77)
—
.06 (−.03) —
.06 (.04) .30 (.30) —
.26 (.08) .14 (.15) .01 (.09) —
.22 (.23) .28 (.21) .10 (.10) .08 (.01) —
.03 (−.01) .23 (.15) .19 (.12) .10 (.09) .06 (−.14) —
3.14 (3.48) 1.03 (0.96) 3.20 (3.07) 1.05 (1.18)
Note. Significant correlations are given in bold. N = 372. Scores for actual caregivers (n = 113) are included in parentheses.
.15 (.11) .32 (.34) .23 (.25) .01 (−.09) .19 (−.03) .52 (.35) —
10 .17 (.38)
.19 (.15) .00 (.14) .14 (.21) .10 (.00) .18 (.19) .02 (−.16) .16 (.18)
−.03 (.20) .05 (−.06) .09 (.06) .10 (.10) −.01 (.14) .25 (−.03) .19 (−.06)
—
.03 (−.11) —
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rather be associated with depression, neuroticism, and selfrelated goals. Table 2 indicates that associations with the Big Five constructs were small (r < .20). Anticipated gains were associated with openness, agreeableness, and otherrelated goals. Loss anticipations were linked to the endorsement of self- and agency-related goals such as autonomy and to depressive symptoms. Again, positive and negative anticipations of future caregiving seemed to represent two independent dimensions, r = .03, p = .618.
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Table 3. Prediction of Behavioral Patterns in the Transition to Caregiving by Gain–Loss Anticipations as well as Socio-Demographic Variables Undecided (0)–PCG (1)
R2
B
SE
OR
B
SE
OR
.04 −.06 −.48 .06 −.47 −.03 −.01 .47 −.43
.01 .32 .29 .28 .15 .28 .12 .13 .13
1.04 0.95 0.62 1.07 0.62 0.97 0.99 1.59 0.65
.02 .27 −.06 −.37 .25 .50 .55 .06 −.81
.01 .41 .38 .36 .19 .20 .15 .18 .19
1.02 1.31 0.95 0.69 1.28 1.64 1.73 1.06 0.44
.21
.32
Note. OR = odds ratio. Bold values are significant (p < .05). Gender (1 = female), school (1 = attained Abitur/high school degree), employment (1 = employed), and marital status (1 = married/in partnership) were dummy coded (indicated by D).
provide care was predicted by anticipations of gains and losses. In contrast to those who were unwilling to provide care, potential caregivers anticipated more gains (b = .47, SE = .13, p < .001) and fewer losses (b = −.43, SE = .13, p < .001) from the caregiving role. In addition, only age (b = .04, SE = .01, p < .05) and subjective health (b = −.47, SE = .15, p < .001) were significant predictors. More concretely, older age and better subjective health increased the likelihood of being a potential caregiver. All in all, the model explained 21% of the variance. By contrast, an unwillingness to provide care was linked solely to the anticipation of losses (b = −.81, SE = .19, p < .001), whereas anticipated gains were not predictive (b = .06, SE = .18, p = .756). Moreover, relationship satisfaction (b = .55, SE = .15, p < .001) was the only covariate that was linked to the willingness to provide care. The more satisfied people were with their relationship to the potential care recipient, the higher the likelihood that they belonged to the group of potential caregivers. All in all, the model explained 32% of the variance. Finally, all results remain stable even after controlling for kinship status (i.e., kin vs non-kin) or different relationship statuses (i.e., spouses vs non-spouses, adult children vs others). Discussion In this study, we investigated the role that anticipated gains and losses play when confronted with potential future caregiving responsibilities. As a first step, we conducted a cross-sectional study that examined different preferences about future caregiving: people who were willing to take on caregiving responsibilities, people who were ambivalent about entering the caregiving role, and those who were unwilling to provide care. Our findings confirm that individuals who are undecided or not willing to take on a caregiving role in their family differ from actual or potential caregivers not only with regard to loss expectations but also with regard to expected gains. First, the anticipation of losses in the caregiving role is associated with indecisiveness and unwillingness about
taking on the caregiving role. As expected, the more losses one anticipate (e.g., disruption of one’s life goals or social deprivation), the more one is uncertain or even unwilling to provide care. However, the anticipation of gains seems more important when someone is unsure about providing care. More specifically, those who are undecided anticipate the least positive aspects, and anticipating personal and social gains increases the likelihood of seeing oneself in the potential caregiving role instead of being undecided by about 0.5 times. These findings suggest that anticipations of gains and losses might have different influences in different stages during the transition to caregiving. Although longitudinal data are definitely needed, our findings show that gain–loss expectations of potential caregivers resemble the experiences of actual caregivers. Thus, increasing the salience of gains prior to entering the caregiving role may lead a person to better engage in the caregiving role and may therefore reflect accordant processes of goal endorsement. Second, the effects of anticipations of gains and losses remained robust after controlling for socio-demographic aspects such as gender, age, marital status, or employment. Moreover, whereas age and subjective health could be used to differentiate between those who were undecided and potential caregivers, relationship satisfaction was more crucial for explaining unwillingness. Thus, in the former case, a person may want to provide care but may lack the resources. In the latter case, relational aspects seem to be determining factors, and the perception of resources does not add to the explanation of variance. We also acknowledge some limitations that ought to be considered when interpreting the findings of this study. First, participants were asked to nominate the person with the highest probability of needing care in the future. Although no differences in the nomination of kin- versus non-kin relationships emerged, using this procedure, we cannot completely rule out the influence of relationship status. Clearly, the probability of needing care in the future is age-dependent, and thus, we were not able to disentangle the potential caregiver’s age from the potential care
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Age Gender (D) School (D) Employment (D) Subjective health Marital status (D) Relationship satisfaction Anticipated gains Anticipated losses
Unwilling (0)–PCG (1)
GAIN–LOSS DYNAMICS AND PREFERENCES ABOUT FUTURE CAREGIVING
In our cross-sectional design, we used actual caregivers as a reference group. We contend that with regard to gain–loss anticipations potential caregivers more strongly resembled actual caregivers than the other two groups. Thus, we suggest that willingness to provide care is more likely associated with entering an actual caregiving role. However, we cannot preclude that the transition into caregiving is more complex. Thus, we hope that the current study will stimulate further longitudinal efforts to study motivational processes in the transition to care and to better understand the process that turns everyday family and social relationships into caregiving relationships. Moreover, longitudinal data will also allow researchers to draw conclusions about the (dys-)functionality of anticipated gains and losses. Is it beneficial to perceive benefits before entering the caregiving role? Is there an optimal ratio that should be achieved between perceptions of gains and perceptions of losses? Are there points in time when focusing on gains might be associated with negative outcomes and it would be better to accept unavoidable losses? Among those, who were willing to provide care, we found that anticipation of gains was positively associated with being more neurotic. This may reflect unrealistic or even ambivalent wishful thinking. In this study, we were able to compare the potential caregivers with actual caregivers. In accordance with the literature, we find that actual caregivers with higher scores in neuroticism seem to be especially burdened by caregiving responsibilities. One reason for such findings may be related to possible unrealistic positive anticipations and subsequent higher burden among more the neurotic persons before entering into caregiving role (Hooker et al., 1998; Rohr et al., 2013). Thus, longitudinal approaches in which potential (non) caregivers are accompanied during their transition into the actual caregiving role would answer questions about underlying changes and reveal patterns of (dys-)functionality of motivational aspects at different times during this transitions. They also would enable to test the veridicality of preferences on future caregiving (i.e., as a hypothesized scenario) in comparison to actual caregiving behavior (i.e., objective and subjective indicators such as self-definition as caregivers, amount and type of caregiving tasks) while paying attention to modifying variables such as the type of impairment or the social embeddedness of the caregiver. Furthermore, in the current study, participants had to indicate if they would provide care (= yes), are unsure about future caregiving preferences (= unsure), or if they cannot image to take over care responsibilities (= no). We are aware that the transition into caregiving is more continuously than our distinction of groups according of willingness to provide care may suggest. Instead of using this rather strict categorical response a continuous assessment of this willingness would generate insight about the inter- and intra-individual variability of future care preferences and their change across different time points within the transition into caregiving.
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recipient’s age. However, different relationship systems (i.e., spouses, child-parent, extended kin) entail different regulatory principles (e.g., Neyer, Wrzus, Wagner, & Lang, 2011) that also affect caregiving. As we pointed out, previous research has demonstrated the impact of relationship status on caregiving experiences (Broese van Groenou et al., 2013; Raschick & Ingersoll-Dayton, 2004). To address this issue, we conducted an exploratory pilot interview study that examined gain–loss anticipations of spouses and adult children of an older person with health impairments. This pilot study revealed only small differences in the anticipations of gains and losses of spouses and adult children. More specifically, they differed in the evaluation of only one aspect. Spouses more strongly endorsed an increase in family coherence due to caregiving. Moreover, our results on the impact of gain–loss anticipations remained robust after controlling for the type of relationship (i.e., spousal vs other relationship) which underscores the consistent importance of gain and loss anticipations across different relationships. However, although differences in the current study were rather small, future research should use a personal network approach to systematically assess each network member, their probability of needing care in the near future, as well as a relationship-specific willingness to provide care. In our study, unwillingness to provide future care was linked with a higher likelihood of nominating a grandparent. Additionally, those who are unwilling reported to feel less close and be less satisfied with their relationship to the potential care recipient. Thus, willingness to provide care may strongly depend on having close family relationships. When such relationships are not available, more distant kin (e.g., grandchildren) are less likely to take over caregiving responsibilities. At the same time and in contrast to close family ties, relationship quality in this distant kin relationship seems to be more influential in deciding about future care preferences (Sörensen, 1998). This result points to the special vulnerability of those who lack close family members and underscores the need of researchers and practitioners to pay closer attention to older adults with higher vulnerability (e.g., Black et al., 2008). Second, we relied on a cross-sectional design to examine future caregiving preferences and the transition into caregiving based on three different groups of potential caregivers. Clearly, the current study only provides a first step and a longitudinal design is required to examine the roles of anticipated gains and losses in the context of caregiving decisions. So far, the process of transition into caregiving is not well understood, and calls for further, more processoriented research. Do potential caregivers indeed begin to provide care in the future? How are anticipated gains and losses affected by characteristics of the care situation such as perceived choice or type of disease? How do anticipated gains and losses change after one has actually entered the caregiving role? Longitudinal data will allow for the validation of potential caregiving scenarios with actual care decisions.
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group reporting the least amount of burden and the most gains; an ambiguous group, an intense group, and a distressed group that felt more burdened and less competent or rewarded by their role. Based on this four-dimensional pattern, the authors recommended that specific interventions be created based on group membership (Robertson, Zarit, Duncan, Rovine, & Femia, 2007). Moreover, effectiveness of intervention programs for caregivers may also depend on the congruence of expectations about the future care tasks with subsequent care experiences. Supplementary Material Supplementary material can be found at: http://psychsocgerontology. oxfordjournals.org/ Acknowledgments This research was supported by a grant from the Volkswagen Foundation in Germany to the second author (Az 86 759). The Volkswagen Foundation took no role in the design or conduct of this research. Correspondence Correspondence should be addressed to Margund K. Rohr, PhD, Institute of Psychology, University Leipzig, Neumarkt 9-19, 04109 Leipzig, Germany. E-mail: [email protected] References Adams, K. B., McClendon, M. J., & Smyth, K. A. (2008). Personal losses and relationship quality in dementia caregiving. Dementia: The International Journal of Social Research and Practice, 7, 301–319. doi: 10.1177/1471301208093286 Albert, S. M., Moss, M., & Lawton, M. P. (1996). The significance of the self-perceived start of caregiving. Journal of Clinical Geropsychology, 2, 161–174. Black, K., Reynolds, S. L., & Osman, H. (2008). Factors associated with advance care planning among older adults in southwest Florida. Journal of Applied Gerontology, 27, 93–109. doi: 10.1177/0733464807307773 Bookwala, J., & Schulz, R. (1998). The role of neuroticism and mastery in spouse caregivers’ assessment of and response to a contextual stressor. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53, P155–P164. doi:10.1093/geronb/53B.3.P155 Braun, M., Scholz, U., Bailey, B., Perren, S., Hornung, R., & Martin, M. (2009). Dementia caregiving in spousal relationships: A dyadic perspective. Aging & Mental Health, 13, 426–436. doi: 10.1080/13607860902879441 Brody, E. M., Litvin, S. J., Hoffman, C., & Kleban, M. H. (1992). Differential effects of daughters’ marital status on their parent care experiences. Gerontologist, 32, 58–67. doi: 10.1093/ geront/32.1.58 Broese van Groenou, M., Boer, A., & Iedema, J. (2013). Positive and negative evaluation of caregiving among three different types of informal care relationships. European Journal of Ageing, 10, 301–311. doi: 10.1007/s10433-013-0276-6 Burton, L. C., Zdaniuk, B., Schulz, R., Jackson, S., & Hirsch, C. (2003). Transitions in spousal caregiving. The Gerontologist, 43, 230–241. doi: 10.1093/geront/43.2.230 Cohen, C. A., Colantonio, A., & Vernich, L. (2002). Positive aspects of caregiving: Rounding out the caregiver experience. Int J Geriatr Psychiatry, 17, 184–188. doi: 10.1002/gps.561 Cohen, C. A., Gold, D. P., Shulman, K. I., & Zucchero, C. A. (1994). Positive aspects in care-giving: An overlooked variable in research. Canadian Journal on Aging, 13, 378–391. doi: 10.1002/gps.561
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Findings of this research also point to a need to closer look on what subjectively defines caregiving and caregiving tasks (Albert, Moss, & Lawton, 1996; Zarit & Reamy, 2013). Obviously, there exist interindividual differences in what is perceived as caregiving work, or previous caregiving experience. For instance, Kramer and Lambert (1999) demonstrated that husbands began to define themselves as caregivers much earlier than wives who were taking on caregiving role for a spouse. More concretely, the husbands referred to themselves as caregivers when they began to take over household chores. This points out the importance of how caregiving is defined for the assessment of benefits and challenges in the caregiving role. Future studies should examine how the number and kinds of caregiving tasks impact a person’s anticipations of gains and losses in the transition into caregiving. Moreover, in our study we applied a generic definition of caregiving. However, the anticipation of gains and losses might also depend on the (potential) type of care recipient’s impairment (Wells & Over, 1994). Thus, further studies should incorporate more information on this aspect and explore its influence on the anticipation of gains and losses as well as on the willingness to provide care in case of various impairment conditions. In this study, we examined how gain–loss anticipations were linked to patterns of caregiving in the transition to care. We showed that they were predictive above and beyond socio-demographic aspects. Furthermore, we also introduced a new measure to assess gain–loss expectations. It was derived from existing measures in caregiving research and showed good reliability and validity. The measure can be used to assess anticipations prior to the transition into the caregiving role and may thus reveal hopes and fears that are related to caregiving. Knowledge about the potential expectations that future caregivers may have may provide applied researchers and practitioners with the opportunity to tailor individual interventions and enhance caregiving decisions. Talking about future caregiving scenarios, identifying challenges and benefits, as well as deriving concrete steps that are based on individual gain–loss anticipations may enhance the transition into caregiving and decrease the subsequent burden (Steele, Pinquart, & Sörensen, 2003). Supporting this argumentation, Gaugler, Zarit, and Pearlin (2003) demonstrated that an abrupt and discontinuous entrance into the caregiving role was linked to feelings of greater burden and a higher likelihood of institutionalizing the care recipient. In this vein, a current study by Schulz and colleagues emphasizes that the perception of choice (resp. the subjective lack of choice) in the context of caregiving decisions has tremendous impact on subsequent caregiving experience (Schulz et al., 2012). Assessments of anticipations may also help to differentiate various groups and allow interventions to be tailored to individual needs. In this vein, Robertson and colleagues used positive (i.e., caregiving rewards) and negative affect (i.e., costs) to distinguish four groups of family caregivers: a well-adjusted
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Pakenham, K. I. (2005). The positive impact of multiple sclerosis (MS) on carers: Associations between carer benefit finding and positive and negative adjustment domains. Disability & Rehabilitation, 27, 985–997. doi: 10.1080/09638280500052583 Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18, 250–267. doi: 10.1037/0882-7974.18.2.250 Pinquart, M., & Sörensen, S. (2004). Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: A metaanalytic comparison. Aging & Mental Health, 8, 438–449. doi: 0.1080/13607860410001725036 Pinquart, M., & Sörensen, S. (2007). Correlates of physical health of informal caregivers: A meta-analysis. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 62, P126–P137. Raschick, M., & Ingersoll-Dayton, B. (2004). The costs and rewards of caregiving among aging spouses and adult children. Family Relations, 53, 317–325. doi: 10.1111/j.0022-2445.2004.0008.x Roberto, K. A., Allen, K. R., & Blieszner, R. (2001). Older adults’ preferences for future care: Formal plans and familial support. Applied Developmental Science, 5, 112–120. Robertson, S. M., Zarit, S. H., Duncan, L. G., Rovine, M. J., & Femia, E. E. (2007). Family caregivers’ patterns of positive and negative affect. Family Relations, 56, 12–23. doi: 10.1111/j.1741-3729.2007.00436.x Rohr, M. K., Wagner, J., & Lang, F. R. (2013). Effects of personality on the transition into caregiving. Psychology and Aging, 28, 692–700. doi: 10.1037/a0034133 Schmitt, M., Hübner, A., & Maes, J. (2010). Validierung des Vereinfachten Beck-Depre-ssions-Inventars (BDI-V) an Fremdeinschätzungen. Diagnostica, 56, 125–132. doi: 10.1026/0012-1924/a000019 Schulz, R., Beach, S. R., Cook, T. B., Martire, L. M., Tomlinson, J. M., & Monin, J. K. (2012). Predictors and consequences of perceived lack of choice in becoming an in-formal caregiver. Aging & Mental Health, 16, 712–721. doi: 10.1080/13607863.2011.651439 Seltzer, M. M., & Li, L. W. (2000). The dynamics of caregiving: Transitions during a three-year prospective study. The Gerontologist, 40, 165– 178. doi: 10.1093/ geront/36.5.614 Skaff, M., & Pearlin, L. (1992). Caregiving: Role engulfment and the loss of self. The Gerontologist, 32, 656–664. doi: 10.1093/geront/32.5.656 Sörensen, S. (1998). Predictors of anticipating caregiving in multigeneration families: An exploratory study. Journal of Applied Gerontology, 17, 499–520. doi: 10.1177/073346489801700406 Sörensen, S., Duberstein, P. R., Chapman, B., Pinquart, M., & Lyness, J. M. (2008). How are personality traits related to preparation for future care needs in older adults? The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 63, P328–P336. doi: 10.1093/geronb/63.6.P328 Steele, M., Pinquart, M., & Sörensen, S. (2003). Preparation dimensions and styles in long-term care. Clinical Gerontologist, 26, 105–122. doi: 10.1300/J018v26n03_09 Tarlow, B. J., Wisniewski, S. R., Belle, S. H., Rubert, M., Ory, M. G., & Gallagher-Thompson, D. (2004). Positive aspects of caregiving: Contributions of the REACH Project to the development of new measures for Alzheimer’s caregiving. Research on Aging, 26, 429– 453. doi: 10.1177/0164027504264493 Wells, Y., & Over, R. (1994). Willingness to provide spousal care if needed in the future. Australian Journal of Marriage & Family, 15, 76–85. Zarit, S. H., & Reamy, A. M. (2013). Future directions in family and professional caregiving for the elderly. Gerontology, 59, 152–158. doi: 10.1159/000342242
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Gaugler, J. E., Kane, R. L., & Newcomer, R. (2007). Resilience and transitions from dementia caregiving. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 62, P38–P44. doi: 10.1093/geronb/62.1.P38 Gaugler, J. E., Zarit, S. H., & Pearlin, L. I. (2003). The onset of dementia caregiving and its longitudinal implications. Psychology and Aging, 18, 171–180. doi: 10.1037/0882-7974.18.2.171 Hahn, E., Gottschling, J., & Spinath, F. M. (2012). Short measurements of personality—Validity and reliability of the GSOEP Big Five Inventory (BFI-S). Journal of Research in Personality, 46, 355–359. doi: 10.1016/j.jrp.2012.03.008 Hooker, K., Monahan, D. J., Bowman, S. R., Frazier, L. D., & Shifren, K. (1998). Personality counts for a lot: Predictors of mental and physical health of spouse caregivers in two disease groups. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53, P73–P85. doi: 10.1093/geronb/53B.2.P73 Karantzas, G. C., Evans, L., & Foddy, M. (2010). The role of attachment in current and future parent caregiving. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 65B, 573– 580. doi: 10.1093/geronb/gbq047 Koerner, S. S., Kenyon, D. B., & Shirai, Y. (2009). Caregiving for elder relatives: Which caregivers experience personal benefits/gains? Archives of Gerontology and Geriatrics, 48, 238–245. doi: 10.1016/j. archger.2008.01.015 Kramer, B. J., & Lambert, J. D. (1999). Caregiving as a life course transition among older husbands: A prospective study. The Gerontologist, 39, 658–667. doi: 10.1093/geront/39.6.658 Lang, F. R., Diewald, M., & Wendt, V. (2009). Skala zu Lebenszielen [Scales of Life Goals]. IDUN-Project. Lang, F. R., John, D., Lüdtke, O., Schupp, J., & Wagner, G. G. (2011). Short assessment of the Big Five: Robust across survey methods except telephone interviewing. Behavior Research Methods, 43, 548–567. doi: 10.3758/s13428-011-0066-z Lawton, M. P., Moss, M., Hoffman, C., & Perkinson, M. (2000). Two transitions in daughter’s caregiving careers. The Gerontologist, 40, 437–448. doi: 10.1093/geront/40.4.437 Lee, C., & Gramotnev, H. (2007). Transitions into and out of caregiving: Health and social characteristics of mid-age Australian women. Psychology & Health, 22, 193–209. doi: 10.1080/14756360600682202 Leipold, B., Schacke, C., & Zank, S. (2008). Personal growth and cognitive complexity in caregivers of patients with dementia. European Journal of Ageing, 5, 203–214. doi: 10.1007/ s10433-008-0090-8 Morse, J. Q., Shaffer, D. R., Williamson, G. M., Dooley, W. K., & Schulz, R. (2012). Models of self and others and their relation to positive and negative caregiving responses. Psychology and Aging, 27, 211–218. doi: 10.1037/a0023960 Neal, M. B., Ingersoll-Dayton, B., & Starrels, M. E. (1997). Gender and relationship differences in caregiving patterns and consequences among employed caregivers. The Gerontologist, 37, 804–816. doi: 10.1093/geront/37.6.804 Neyer, F. J., Wrzus, C., Wagner, J., & Lang, F. R. (2011). Principles of relationship differentiation. European Psychologist, 16, 267–277. doi: 10.1027/1016–9040/a000055 Nijboer, C., Triemstra, M., Tempelaar, R., Sanderman, R., & van den Bos, G. A. M. (1999). Determinants of caregiving experiences and mental health of partners of cancer patients. 86, 577–588. doi: 10.1002/ (sici)1097-0142(19990815)86:43.0.co;2-s
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The Role of Anticipated Gains and Losses on Preferences About Future Caregiving Margund K. Rohr1 and Frieder R. Lang2
Objectives. A growing amount of research has suggested that caregiving is not only associated with burden but entails also the potential for positive outcomes. By contrast, less is known about the roles of gain–loss-anticipations on future caregiving. Method. We conducted a web-based study in which we compared three groups with differing preferences on future caregiving: being willing to provide care (potential caregivers; n = 189), remaining indecisive about whether to provide care (undecided; n = 121), and rejecting the idea to provide care (unwilling; n = 62). In addition, actual caregivers (n = 113) served as a reality check for these expectations. We assessed gain–loss anticipations with a newly developed instrument (k = 12) and offer information on its reliability and validity. Results. Groups reveal different patterns of gain–loss-anticipations. Potential caregivers resembled actual caregivers and highlighted the potential benefits of caregiving, whereas those who were undecided or unwilling to provide care perceived fewer gains and more losses. Conclusion. Preferences about future caregiving are not described solely by socio-demographic aspects but are also colored by anticipations of both gains and losses. Findings point to the need to focus on motivational factors to enhance our understanding in the context of caregiving decisions. Key Words: Caregiving—Future caregiving—Gain–loss expectations—Motivational factors—Preferences about caregiving.
F
or a long time, research has focused on the burden of caregiving and its detrimental effects on psychological and physiological health (Pinquart & Sörensen, 2003, 2007). More recently, a growing body of evidence has revealed that the caregiving role also offers potential gains (e.g., Broese van Groenou, Boer, & Iedema, 2013; Koerner, Kenyon, & Shirai, 2009; Tarlow et al., 2004). However, the ways in which anticipated losses and expected gains shape the willingness to provide care are not well understood. We submit that people are more willing to provide care when they expect gains from this role and do not perceive caregiving as solely a burdensome future experience. In this study, we explored whether the willingness to provide care depends on positive or negative anticipations of the future caregiving role above and beyond socio-demographic conditions. Gain and Loss Experiences in the Actual Caregiving Situation Research has demonstrated that experiencing caregivingrelated losses such as relational deprivation, feeling overwhelmed, or self-engulfment are associated with increased strain and diminished well-being (Adams, McClendon, & Smyth, 2008; Skaff & Pearlin, 1992). Likewise, perceptions of benefits from caregiving are associated with feeling
less burdened and experiencing lower depressive symptoms, better subjective health, and higher life satisfaction (e.g., Pinquart & Sörensen, 2004). For example, Cohen, Colantonio, and Vernich (2002) found that about three quarters of caregivers in their study perceived at least one benefit when providing care. Perceptions of gains related to companionship, to meaning, or to enjoyment were associated with lower depression, fewer strains, and improvements in reported health 5 years later. Also, when caregivers report benefits, they are less likely to mistreat the care recipient (e.g., Morse, Shaffer, Williamson, Dooley, & Schulz, 2012), and such care recipients have a lower likelihood of being institutionalized (Cohen, Gold, Shulman, & Zucchero, 1994; Gaugler, Kane, & Newcomer, 2007). Perceiving that one can gain something from taking on the role of a caregiver is influenced by a variety of individual and contextual influences such as socio-demographic conditions (e.g., Brody, Litvin, Hoffman, & Kleban, 1992; Cohen et al., 2002; Nijboer, Triemsta, Tempelaar, Sanderman, & van den Bos, 1999), the caregiver’s personality and goals (Hooker, Monahan, Bowman, Frazier, & Shifren, 1998; Koerner et al., 2009), or the relationship with the care recipient (Broese van Groenou et al., 2013; Raschick & IngersollDayton, 2004). For instance, being female, fewer financial resources, or lower education contribute to a more negative
© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: [email protected]. Received May 23, 2014; Accepted September 5, 2014 Decision Editor: Bob G. Knight, PhD
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1 Institute of Psychology, University Leipzig, Germany. Institute of Psychogerontology, Friedrich-Alexander University Erlangen-Nuremberg, Germany.
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Gain and Loss Anticipations and Future Caregiving Few studies have considered preferences for future caregiving and the transition into caregiving (Burton, Zdaniuk, Schulz, Jackson, & Hirsch, 2003; Kramer & Lambert, 1999; Rohr et al., 2013). Most studies have focused on socio-structural determinants of caregiving decisions, have tried to capture the entrance into caregiving retrospectively, or have compared how the entrance into caregiving affects the caregiver’s mastery, feelings of being burdened, or well-being (Black, Reynolds, & Osman, 2008; Lawton, Moss, Hoffman, & Perkinson, 2000; Seltzer & Li, 2000). Entrance into the caregiving role was shown to depend on gender, marital status, occupational status, health, and relational aspects such as closeness or relationship satisfaction (e.g., Lee & Gramotnev, 2007). For example, women and married individuals tend to have a greater likelihood to take over care responsibilities (e.g., Neal, Ingersoll-Dayton, & Starrels, 1997). Furthermore, few studies that explore future care preferences and planning suggest that these preferences are not only shaped by socio-demographic conditions, but also by factors such as personality or relationship quality (e.g., Roberto, Allen, & Blieszner, 2001; Sörensen, 1998; Sörensen, Duberstein, Chapman, Pinquart, & Lyness, 2008). For instance, work by Sörensen and colleagues highlights the role of relationship quality on family members’ perception of potential care needs (i.e., potential caregivers), and stresses the impact of personality on care planning and preparation activities among older adults (i.e., potential care recipients). However, the effect of personal future anticipations on the willingness to provide care is not well understood. Although research has underscored the relevance of experienced gains and losses in the actual care situation, it is not well understood how anticipations of gains and losses are associated with the willingness to provide care in the future. Prior studies have explored the role of negative anticipations related to expectations of burdens, anxiety, and avoidance in the context of caregiving decisions (e.g., Karantzas, Evans, & Foddy, 2010). For instance, Wells and Over (1994) used a vignette approach to explore wives’ and
husbands’ willingness to provide care for their spouse. As expected, willingness was lower when providers expected strain and greater impairments in the care recipient. To sum up, the roles of positive and negative anticipations on preferences about future caregiving are not well understood. Only some studies have observed that anticipations of feeling burdened and expectations of strain lower people’s willingness to enter the caregiving role. In this study, we therefore examine how gain and loss anticipations concurrently shape the willingness to provide care above and beyond socio-demographic variables that are known to influence the entrance into the caregiving role. Thus, our goal is to enrich existing literature by focusing on underlying motivational factors and pay attention not only to the negative but also to the positive influences on potential caregiving decisions. The Present Study In a first step, we conducted a web-based cross-sectional study in which we sought to determine some major patterns of preferences about future caregiving. More concretely, we examined the future care preferences of three different groups: participants who reported their willingness to provide care to a person in need, participants who were undecided, and those who did not wish to take on care responsibilities. Moreover, we also compared these three groups with actual caregivers who had already decided to provide care for someone, possessed actual care experiences, and could thus serve as a kind of reference point for future expectations. Method Participants The majority of the 485 participants were female (77%). On average, participants were about 55.2 years of age (SD = 14.7). As shown in Table 1, actual caregivers and potential caregivers were older than those who were undecided or unwilling to take on care tasks, F(3, 481) = 8.5, p < .001. The majority of the participants were married or living in a partnership (64%). Actual caregivers were more likely to be married, whereas those who are unwilling to provide care are less likely to be married, χ2(15) = 27.8, p < .05. The sample was well-educated. Over half of the participants had received either the German high school degree Abitur (16%) or a university degree (37%). Whereas 39% were already retired, about 21% reported being employed. The groups differed significantly in their employment status, χ2(15) = 31.1, p < .01. Whereas actual caregivers were less likely to be employed, undecided participants were more likely to be students or were undergoing occupational training (cf. Table 1). Procedure We invited participants from two registered universitybased research participant pools via e-mail to complete
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view on caregiving, while factors such as better subjective health, being married or having a better relationship quality with the care recipient are associated with the perception of gains and benefits of providing care. Moreover, studies have demonstrated that caregivers with higher scores in neuroticisms are more likely to perceive losses due to caregiving and are subsequently more burdened than caregivers with lower scores in neuroticism (e.g., Bookwala & Schulz, 1998; Rohr, Wagner, & Lang, 2013). By contrast, the study by Koerner and colleagues (2009) links agreeableness and extraversion to the perception of benefits in the caregiving role.
7 (6.2) 64 (56.6)a 12 (10.6)a 4 (3.5) 18 (15.9) 8 (7.1) 1 (0.9) 19 (16.8) 31 (27.4) 13 (11.5) 35 (31.0) 12 (10.6) 2 (1.8) 13 (11.5)a 13 (11.5) 22 (19.5) 51 (45.1) 4 (3.5)a 10 (8.8)a
53 (10.9) 214 (44.1) 94 (19.4) 17 (3.5) 66 (13.6) 41 (8.5) 3 (0.6) 53 (10.9) 116 (23.9) 77 (15.9) 180 (37.1) 45 (9.3) 11 (2.3) 104 (21.4) 57 (11.8) 78 (16.1) 189 (39.0) 34 (7.0) 23 (4.7)
N (%) 93 (82.3)
N (%) 373 (76.9)
58.22a 12.27
55.17 14.68
5 (4.1)b
30 (24.8)b 15 (12.4) 19 (15.7) 37 (30.6) 15 (12.4)b
41 (21.7)b 22 (11.6) 30 (15.9) 82 (43.4) 9 (4.8)a 5 (2.6)b
27 (22.3) 52 (43.0) 7 (5.8) 1 (0.8)
26 (21.5)
0 (0.0) 8 (6.6)
16 (13.2) 47 (38.8) 26 (21.5) 4 (3.3) 17 (14.0) 11 (9.1)
96 (79.3)
N (%)
50.76b 15.88
27 (14.3) 65 (34.4) 22 (11.6) 7 (3.7)
45 (23.8)
2 (1.1) 21 (11.1)
20 (10.6) 86 (45.5) 44 (23.3) 4 (2.1) 21 (11.1) 14 (7.4)
136 (72.0)
N (%)
57.41a 14.01
Undecided (n = 121)
Groups Potential care-givers (n = 189)
3 (4.8)b
20 (32.3)b 7 (11.3) 7 (11.3) 19 (30.6) 6 (9.7)a
10 (16.1) 28 (45.2) 4 (6.5) 1 (1.6)
14 (22.6)
0 (0.0) 5 (8.1)
10 (16.1) 17 (27.4)b 12 (19.4) 5 (8.1) 10 (16.1) 8 (12.9)
48 (77.4)
N (%)
51.40b 15.70
Unwilling to provide care (n = 62)
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Note. Means and frequencies with different subscripts indicate significant differences (Scheffé post hoc test, p < .05, and standardized residuals higher than 2.0). *p < .05. **p < .01. ***p < .001.
Gender (= female) Family status Single Married In a partnership Separated Divorced Widowed Educational degree no degree Hauptschule (= 8 years of schooling) Realschule (= 10 years of schooling) Abitur (= equivalent to high school) University Occupational training Other Employment Employed full-time Employed part-time Unemployed Retired Student, in occupational training Other
Age (years) M SD
Total sample (N = 485) Actual caregivers (n = 113)
Table 1. Socio-Demographic Information About the Online Sample
χ2(15) = 31.1**
χ2(18) = 24.0, n.s.
χ2(15) = 27.8*
χ2(3) = 4.9, n.s.
F(3, 481) = 8.47***
Δ Groups
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Measures Patterns of preference about future caregiving.—Participants were asked to indicate a person in their surroundings who might need care in the future. If they were able to name a person, they were asked to indicate their willingness to take on these care responsibilities. More concretely, participants were questioned if they would provide care to this person. Three groups were generated based on the answers: potential caregivers, who were willing to provide care for the named person (= yes); participants who were undecided about becoming caregivers (= not sure); and those who were unwilling to step into the caregiving role (= no). Additionally, people who reported that they were already providing care for someone at the present time constituted the group of actual caregivers. The majority [93%] of the participants named kin relationships. The groups did not differ in the nomination of a non-kin person with future care needs. However, there were differences across groups in relationship status. In detail, potential caregivers were more likely to name their spouse, whereas those who were unwilling to provide care were more likely to refer to a grandparent. Actual caregivers mainly provided care to their partner [32.7%] or to their parents and parents-in-law [35.4%]. The reported care recipients were predominantly older than 60 years [about 86%, M = 75.6, SD = 18.6]. We do not have detailed information about type of impairment [e.g., physical or cognitive], but caregivers had to rate amount of care needed by the care recipient on a scale ranging from 0 to 100 [M = 65.0, SD = 27.8].
Gain–loss anticipations.—Current research has provided a great diversity of conceptual and methodological approaches to capture the benefits and strains that occur within the context of actual caregiving. These approaches often vary with respect to specific contents and foci: For example, whereas some research has highlighted the issue of meaningful in-depth experiences (Pakenham, 2005), other research has emphasized the potential of the caregiving role to provide personal growth (Leipold, Schacke, & Zank, 2008). Moreover, available instruments often focus on a certain type of disease and vary in the number of items and the response format (e.g., Tarlow et al., 2004 for an overview). All in all, three main topics can be differentiated: an individual level that encompasses caregivers’ competencies and abilities (e.g., mastery vs subjective burden), changes in the relationship with the care receiver (e.g., increases vs decreases in closeness), and modifications in social surroundings (e.g., increased coherence vs social deprivation; Braun et al., 2009; Tarlow et al., 2004). We assembled and modified items from these existing measures. A web-based pilot study with 181 adults (M = 38.7, SD = 16.6, 75% female) from a registered participant pool was conducted to evaluate the comprehensibility and usability of the scale. The final scale consists of 12 items, six items assessing anticipated gains (e.g., “As a caregiver, I would expect to find out more about myself, my strengths, and my shortcomings”) and six items reflecting anticipated losses (e.g., “As a caregiver, I would expect to lose my independence and autonomy”). Participants indicated how much they agreed with the listed expectations, ranging from 1 (do not agree at all) to 5 (fully agree). Previous research has demonstrated the impact of relationship status on caregiving experiences (Broese van Groenou et al., 2013; Raschick & Ingersoll-Dayton, 2004). Therefore, we additionally conducted an exploratory interview pilot study that examined gain–loss anticipations of 49 spouses (M = 69.1 years old, SD = 7.5) and 19 adult children (M = 49.3 years old, SD = 9.0) of an older person with health impairments. Positive and negative anticipations of future caregiving reflected independent dimensions, r = .06, p = .613. Moreover, anticipations of gains and losses in caregiving did not differ between the two groups with one exception. Spouses especially emphasized that caregiving may lead to stronger cohesion within the family (MS = 3.80, SD = 1.17, MAC = 2.83, SD = 1.20), F(1, 65) = 12.20, p < .01, η2 = .12. In the current study, confirmatory factor analysis showed acceptable model fit, χ2(54) = 180.5, RSMEA = .079, CFI = .930, SRMR = .056 (cf., Supplementary Figure 1). Reliability was good for both scales (αgains = .85, αlosses = .86) and comparable to the concrete caregiving experiences of actual caregivers (Supplementary Table 1). Based on previous research we assumed that gain anticipations are linked to variables such as openness to experience, agreeableness, and other-related goals. In contrast, loss anticipations should
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an online questionnaire (www.gerotest.de, www.psytests. de). In order to increase the proportion of actual caregivers, we additionally advertized on blogs addressing topics on caregiving. After welcoming and informing the participants about the contents of the study, participants were asked to indicate their current caregiving status and their motivation to provide care for a person in need. More precisely, participants chose a person in their social surroundings whom they expected would require future care. They were asked to name the person with the highest probability of needing future care. After nominating a person in need, the participants had to rate aspects that would impact their willingness to provide care (e.g., financial aspects, feelings of obligation, caregiver’s own health status) and were asked to characterize their relationship to the potential care recipient (e.g., relationship status, relationship quality). Furthermore, they also answered questions regarding their personality, life contexts, well-being, and physical health. At the end, all participants were informed about caregiving research and the goals of the study once again and received personalized feedback on their personalities. The total sample consisted of 592 participants. The current presentation focused on a subsample of 485 participants who were able to name a person with future care needs.
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versions. In this vein, authors such as Hahn, Gottschling, and Spinath (2012) argue that low internal consistency in constructs may not indicate low validity, but may reflect its heterogeneity and breath. Finally, participants were asked to rate the importance of self- and agency-related life goals (k = 4; e.g., one’s independence and autonomy; α = .78) and other-related communal life goals (k = 4, e.g., to be there for others and to support them; α = .60). A 5-point scale ranging from 1 (very unimportant) to 5 (very important) was used (Lang, Diewald, & Wendt, 2009). Lastly, using a single item, we also measured relationship satisfaction with the person who had the future care needs on a 5-point scale ranging from 1 (very dissatisfied) to 5 (very satisfied). Statistical analyses.—We tested our hypotheses using logistic regression analyses and compared anticipations of gains and losses of potential caregivers (=1) with the expectations of those who were undecided or unwilling to provide care (=0) in two separate logistic regression analyses. Analyses were conducted with the statistical software IBM SPSS version 21.
Covariates.—To assess the convergent and discriminant validity of the scale on gain–loss expectations and to account for socio-demographic influences, we measured aspects that are known to affect the decision about whether to provide care or not: age, gender (1 = female), school (1 = Abitur), employment (1 = employed), and marital status (1 = married). Furthermore, we assessed several further variables that are known to influence gain–loss-anticipation expectations and experiences. First, participants had to rate their health on a 5-point scale ranging from 1 (very good) to 5 (poor). Scores were recoded so that higher scores indicated better subjective health. Second, we used a five-item version of the Beck Depression Inventory to assess depressive symptoms (Schmitt, Hübner, & Maes, 2010). Participants indicated the occurrence of negative feelings and attitudes on a scale ranging from 1 (never) to 5 (almost always). Reliability was satisfactory (α = .80). Third, personality was measured with a short version of the Big Five Personality Inventory (BFI-S; Lang, John, Lüdtke, Schupp, & Wagner, 2011). The five dimensions of personality, namely, neuroticism, extraversion, openness, agreeableness, and conscientiousness, were assessed by three items per subscale. Reliability analyses showed satisfactory internal consistency for four of the five subscales, ranging from α = .63 to .71. For agreeableness however, consistency was unexpectedly low in this sample (α = .49). However, previous research has proved validity and reliability of the BFI-S in comparison to longer
Results A comparison of means revealed that those who were unwilling to provide care (MUW = 3.77, SDUW = 0.85) reported more expected losses than potential caregivers (MPCG = 2.92, SDPCG = 1.06), F(3, 480) = 12.1, p < .001, η2 = .07. Interestingly, potential caregivers’ anticipation levels were similar to the loss levels that were experienced by actual caregivers (MACG = 3.07, SDACG = 1.18). By contrast, potential caregivers (MPCG= 3.28, SDPCG = 1.07) anticipated more gains than people who were undecided (MU = 2.87, SDU = 0.99) but did not differ from those who were unwilling to provide care (MUW = 3.27, SDUW = 0.91). Again, the anticipated gains of potential caregivers were comparable to the gain levels of actual caregivers (MACG = 3.48, SDACG = 0.96), F(3, 480) = 7.7, p < .001, η2 = .05. Do anticipations of gains and losses predict the willingness to provide care above and beyond socio-demographic variables? In line with our hypothesis, the willingness to
Table 2. Correlational Patterns of Variables for Groups in the Transition into Caregiving Variables 1
Depressive symptoms 2 Neuroticism 3 Extraversion 4 Openness 5 Conscientiousness 6 Agreeableness 7 Self-related goals 8 Other-related goals 9 Gains 10 Losses
M
SD
1
2
3
4
5
6
7
8
9
2.45 (2.47) 0.78 (0.87) — .13 (.18) −.21 (−.40) −.01 (−.11) −.08 (−.01) −.08 (−.19) −.03 (.08) −.04 (−.03) −.06 (−.14) 3.25 (3.27) 3.54 (3.60) 3.96 (3.83) 3.50 (3.53) 3.54 (3.58) 3.65 (3.63) 3.60 (3.54)
0.60 (0.57) 0.56 (0.61) 1.04 (0.72) 0.48 (0.40) 0.51 (0.57) 0.85 (0.94) 0.75 (0.77)
—
.06 (−.03) —
.06 (.04) .30 (.30) —
.26 (.08) .14 (.15) .01 (.09) —
.22 (.23) .28 (.21) .10 (.10) .08 (.01) —
.03 (−.01) .23 (.15) .19 (.12) .10 (.09) .06 (−.14) —
3.14 (3.48) 1.03 (0.96) 3.20 (3.07) 1.05 (1.18)
Note. Significant correlations are given in bold. N = 372. Scores for actual caregivers (n = 113) are included in parentheses.
.15 (.11) .32 (.34) .23 (.25) .01 (−.09) .19 (−.03) .52 (.35) —
10 .17 (.38)
.19 (.15) .00 (.14) .14 (.21) .10 (.00) .18 (.19) .02 (−.16) .16 (.18)
−.03 (.20) .05 (−.06) .09 (.06) .10 (.10) −.01 (.14) .25 (−.03) .19 (−.06)
—
.03 (−.11) —
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rather be associated with depression, neuroticism, and selfrelated goals. Table 2 indicates that associations with the Big Five constructs were small (r < .20). Anticipated gains were associated with openness, agreeableness, and otherrelated goals. Loss anticipations were linked to the endorsement of self- and agency-related goals such as autonomy and to depressive symptoms. Again, positive and negative anticipations of future caregiving seemed to represent two independent dimensions, r = .03, p = .618.
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Table 3. Prediction of Behavioral Patterns in the Transition to Caregiving by Gain–Loss Anticipations as well as Socio-Demographic Variables Undecided (0)–PCG (1)
R2
B
SE
OR
B
SE
OR
.04 −.06 −.48 .06 −.47 −.03 −.01 .47 −.43
.01 .32 .29 .28 .15 .28 .12 .13 .13
1.04 0.95 0.62 1.07 0.62 0.97 0.99 1.59 0.65
.02 .27 −.06 −.37 .25 .50 .55 .06 −.81
.01 .41 .38 .36 .19 .20 .15 .18 .19
1.02 1.31 0.95 0.69 1.28 1.64 1.73 1.06 0.44
.21
.32
Note. OR = odds ratio. Bold values are significant (p < .05). Gender (1 = female), school (1 = attained Abitur/high school degree), employment (1 = employed), and marital status (1 = married/in partnership) were dummy coded (indicated by D).
provide care was predicted by anticipations of gains and losses. In contrast to those who were unwilling to provide care, potential caregivers anticipated more gains (b = .47, SE = .13, p < .001) and fewer losses (b = −.43, SE = .13, p < .001) from the caregiving role. In addition, only age (b = .04, SE = .01, p < .05) and subjective health (b = −.47, SE = .15, p < .001) were significant predictors. More concretely, older age and better subjective health increased the likelihood of being a potential caregiver. All in all, the model explained 21% of the variance. By contrast, an unwillingness to provide care was linked solely to the anticipation of losses (b = −.81, SE = .19, p < .001), whereas anticipated gains were not predictive (b = .06, SE = .18, p = .756). Moreover, relationship satisfaction (b = .55, SE = .15, p < .001) was the only covariate that was linked to the willingness to provide care. The more satisfied people were with their relationship to the potential care recipient, the higher the likelihood that they belonged to the group of potential caregivers. All in all, the model explained 32% of the variance. Finally, all results remain stable even after controlling for kinship status (i.e., kin vs non-kin) or different relationship statuses (i.e., spouses vs non-spouses, adult children vs others). Discussion In this study, we investigated the role that anticipated gains and losses play when confronted with potential future caregiving responsibilities. As a first step, we conducted a cross-sectional study that examined different preferences about future caregiving: people who were willing to take on caregiving responsibilities, people who were ambivalent about entering the caregiving role, and those who were unwilling to provide care. Our findings confirm that individuals who are undecided or not willing to take on a caregiving role in their family differ from actual or potential caregivers not only with regard to loss expectations but also with regard to expected gains. First, the anticipation of losses in the caregiving role is associated with indecisiveness and unwillingness about
taking on the caregiving role. As expected, the more losses one anticipate (e.g., disruption of one’s life goals or social deprivation), the more one is uncertain or even unwilling to provide care. However, the anticipation of gains seems more important when someone is unsure about providing care. More specifically, those who are undecided anticipate the least positive aspects, and anticipating personal and social gains increases the likelihood of seeing oneself in the potential caregiving role instead of being undecided by about 0.5 times. These findings suggest that anticipations of gains and losses might have different influences in different stages during the transition to caregiving. Although longitudinal data are definitely needed, our findings show that gain–loss expectations of potential caregivers resemble the experiences of actual caregivers. Thus, increasing the salience of gains prior to entering the caregiving role may lead a person to better engage in the caregiving role and may therefore reflect accordant processes of goal endorsement. Second, the effects of anticipations of gains and losses remained robust after controlling for socio-demographic aspects such as gender, age, marital status, or employment. Moreover, whereas age and subjective health could be used to differentiate between those who were undecided and potential caregivers, relationship satisfaction was more crucial for explaining unwillingness. Thus, in the former case, a person may want to provide care but may lack the resources. In the latter case, relational aspects seem to be determining factors, and the perception of resources does not add to the explanation of variance. We also acknowledge some limitations that ought to be considered when interpreting the findings of this study. First, participants were asked to nominate the person with the highest probability of needing care in the future. Although no differences in the nomination of kin- versus non-kin relationships emerged, using this procedure, we cannot completely rule out the influence of relationship status. Clearly, the probability of needing care in the future is age-dependent, and thus, we were not able to disentangle the potential caregiver’s age from the potential care
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Age Gender (D) School (D) Employment (D) Subjective health Marital status (D) Relationship satisfaction Anticipated gains Anticipated losses
Unwilling (0)–PCG (1)
GAIN–LOSS DYNAMICS AND PREFERENCES ABOUT FUTURE CAREGIVING
In our cross-sectional design, we used actual caregivers as a reference group. We contend that with regard to gain–loss anticipations potential caregivers more strongly resembled actual caregivers than the other two groups. Thus, we suggest that willingness to provide care is more likely associated with entering an actual caregiving role. However, we cannot preclude that the transition into caregiving is more complex. Thus, we hope that the current study will stimulate further longitudinal efforts to study motivational processes in the transition to care and to better understand the process that turns everyday family and social relationships into caregiving relationships. Moreover, longitudinal data will also allow researchers to draw conclusions about the (dys-)functionality of anticipated gains and losses. Is it beneficial to perceive benefits before entering the caregiving role? Is there an optimal ratio that should be achieved between perceptions of gains and perceptions of losses? Are there points in time when focusing on gains might be associated with negative outcomes and it would be better to accept unavoidable losses? Among those, who were willing to provide care, we found that anticipation of gains was positively associated with being more neurotic. This may reflect unrealistic or even ambivalent wishful thinking. In this study, we were able to compare the potential caregivers with actual caregivers. In accordance with the literature, we find that actual caregivers with higher scores in neuroticism seem to be especially burdened by caregiving responsibilities. One reason for such findings may be related to possible unrealistic positive anticipations and subsequent higher burden among more the neurotic persons before entering into caregiving role (Hooker et al., 1998; Rohr et al., 2013). Thus, longitudinal approaches in which potential (non) caregivers are accompanied during their transition into the actual caregiving role would answer questions about underlying changes and reveal patterns of (dys-)functionality of motivational aspects at different times during this transitions. They also would enable to test the veridicality of preferences on future caregiving (i.e., as a hypothesized scenario) in comparison to actual caregiving behavior (i.e., objective and subjective indicators such as self-definition as caregivers, amount and type of caregiving tasks) while paying attention to modifying variables such as the type of impairment or the social embeddedness of the caregiver. Furthermore, in the current study, participants had to indicate if they would provide care (= yes), are unsure about future caregiving preferences (= unsure), or if they cannot image to take over care responsibilities (= no). We are aware that the transition into caregiving is more continuously than our distinction of groups according of willingness to provide care may suggest. Instead of using this rather strict categorical response a continuous assessment of this willingness would generate insight about the inter- and intra-individual variability of future care preferences and their change across different time points within the transition into caregiving.
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recipient’s age. However, different relationship systems (i.e., spouses, child-parent, extended kin) entail different regulatory principles (e.g., Neyer, Wrzus, Wagner, & Lang, 2011) that also affect caregiving. As we pointed out, previous research has demonstrated the impact of relationship status on caregiving experiences (Broese van Groenou et al., 2013; Raschick & Ingersoll-Dayton, 2004). To address this issue, we conducted an exploratory pilot interview study that examined gain–loss anticipations of spouses and adult children of an older person with health impairments. This pilot study revealed only small differences in the anticipations of gains and losses of spouses and adult children. More specifically, they differed in the evaluation of only one aspect. Spouses more strongly endorsed an increase in family coherence due to caregiving. Moreover, our results on the impact of gain–loss anticipations remained robust after controlling for the type of relationship (i.e., spousal vs other relationship) which underscores the consistent importance of gain and loss anticipations across different relationships. However, although differences in the current study were rather small, future research should use a personal network approach to systematically assess each network member, their probability of needing care in the near future, as well as a relationship-specific willingness to provide care. In our study, unwillingness to provide future care was linked with a higher likelihood of nominating a grandparent. Additionally, those who are unwilling reported to feel less close and be less satisfied with their relationship to the potential care recipient. Thus, willingness to provide care may strongly depend on having close family relationships. When such relationships are not available, more distant kin (e.g., grandchildren) are less likely to take over caregiving responsibilities. At the same time and in contrast to close family ties, relationship quality in this distant kin relationship seems to be more influential in deciding about future care preferences (Sörensen, 1998). This result points to the special vulnerability of those who lack close family members and underscores the need of researchers and practitioners to pay closer attention to older adults with higher vulnerability (e.g., Black et al., 2008). Second, we relied on a cross-sectional design to examine future caregiving preferences and the transition into caregiving based on three different groups of potential caregivers. Clearly, the current study only provides a first step and a longitudinal design is required to examine the roles of anticipated gains and losses in the context of caregiving decisions. So far, the process of transition into caregiving is not well understood, and calls for further, more processoriented research. Do potential caregivers indeed begin to provide care in the future? How are anticipated gains and losses affected by characteristics of the care situation such as perceived choice or type of disease? How do anticipated gains and losses change after one has actually entered the caregiving role? Longitudinal data will allow for the validation of potential caregiving scenarios with actual care decisions.
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group reporting the least amount of burden and the most gains; an ambiguous group, an intense group, and a distressed group that felt more burdened and less competent or rewarded by their role. Based on this four-dimensional pattern, the authors recommended that specific interventions be created based on group membership (Robertson, Zarit, Duncan, Rovine, & Femia, 2007). Moreover, effectiveness of intervention programs for caregivers may also depend on the congruence of expectations about the future care tasks with subsequent care experiences. Supplementary Material Supplementary material can be found at: http://psychsocgerontology. oxfordjournals.org/ Acknowledgments This research was supported by a grant from the Volkswagen Foundation in Germany to the second author (Az 86 759). The Volkswagen Foundation took no role in the design or conduct of this research. Correspondence Correspondence should be addressed to Margund K. Rohr, PhD, Institute of Psychology, University Leipzig, Neumarkt 9-19, 04109 Leipzig, Germany. E-mail: [email protected] References Adams, K. B., McClendon, M. J., & Smyth, K. A. (2008). Personal losses and relationship quality in dementia caregiving. Dementia: The International Journal of Social Research and Practice, 7, 301–319. doi: 10.1177/1471301208093286 Albert, S. M., Moss, M., & Lawton, M. P. (1996). The significance of the self-perceived start of caregiving. Journal of Clinical Geropsychology, 2, 161–174. Black, K., Reynolds, S. L., & Osman, H. (2008). Factors associated with advance care planning among older adults in southwest Florida. Journal of Applied Gerontology, 27, 93–109. doi: 10.1177/0733464807307773 Bookwala, J., & Schulz, R. (1998). The role of neuroticism and mastery in spouse caregivers’ assessment of and response to a contextual stressor. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 53, P155–P164. doi:10.1093/geronb/53B.3.P155 Braun, M., Scholz, U., Bailey, B., Perren, S., Hornung, R., & Martin, M. (2009). Dementia caregiving in spousal relationships: A dyadic perspective. Aging & Mental Health, 13, 426–436. doi: 10.1080/13607860902879441 Brody, E. M., Litvin, S. J., Hoffman, C., & Kleban, M. H. (1992). Differential effects of daughters’ marital status on their parent care experiences. Gerontologist, 32, 58–67. doi: 10.1093/ geront/32.1.58 Broese van Groenou, M., Boer, A., & Iedema, J. (2013). Positive and negative evaluation of caregiving among three different types of informal care relationships. European Journal of Ageing, 10, 301–311. doi: 10.1007/s10433-013-0276-6 Burton, L. C., Zdaniuk, B., Schulz, R., Jackson, S., & Hirsch, C. (2003). Transitions in spousal caregiving. The Gerontologist, 43, 230–241. doi: 10.1093/geront/43.2.230 Cohen, C. A., Colantonio, A., & Vernich, L. (2002). Positive aspects of caregiving: Rounding out the caregiver experience. Int J Geriatr Psychiatry, 17, 184–188. doi: 10.1002/gps.561 Cohen, C. A., Gold, D. P., Shulman, K. I., & Zucchero, C. A. (1994). Positive aspects in care-giving: An overlooked variable in research. Canadian Journal on Aging, 13, 378–391. doi: 10.1002/gps.561
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Findings of this research also point to a need to closer look on what subjectively defines caregiving and caregiving tasks (Albert, Moss, & Lawton, 1996; Zarit & Reamy, 2013). Obviously, there exist interindividual differences in what is perceived as caregiving work, or previous caregiving experience. For instance, Kramer and Lambert (1999) demonstrated that husbands began to define themselves as caregivers much earlier than wives who were taking on caregiving role for a spouse. More concretely, the husbands referred to themselves as caregivers when they began to take over household chores. This points out the importance of how caregiving is defined for the assessment of benefits and challenges in the caregiving role. Future studies should examine how the number and kinds of caregiving tasks impact a person’s anticipations of gains and losses in the transition into caregiving. Moreover, in our study we applied a generic definition of caregiving. However, the anticipation of gains and losses might also depend on the (potential) type of care recipient’s impairment (Wells & Over, 1994). Thus, further studies should incorporate more information on this aspect and explore its influence on the anticipation of gains and losses as well as on the willingness to provide care in case of various impairment conditions. In this study, we examined how gain–loss anticipations were linked to patterns of caregiving in the transition to care. We showed that they were predictive above and beyond socio-demographic aspects. Furthermore, we also introduced a new measure to assess gain–loss expectations. It was derived from existing measures in caregiving research and showed good reliability and validity. The measure can be used to assess anticipations prior to the transition into the caregiving role and may thus reveal hopes and fears that are related to caregiving. Knowledge about the potential expectations that future caregivers may have may provide applied researchers and practitioners with the opportunity to tailor individual interventions and enhance caregiving decisions. Talking about future caregiving scenarios, identifying challenges and benefits, as well as deriving concrete steps that are based on individual gain–loss anticipations may enhance the transition into caregiving and decrease the subsequent burden (Steele, Pinquart, & Sörensen, 2003). Supporting this argumentation, Gaugler, Zarit, and Pearlin (2003) demonstrated that an abrupt and discontinuous entrance into the caregiving role was linked to feelings of greater burden and a higher likelihood of institutionalizing the care recipient. In this vein, a current study by Schulz and colleagues emphasizes that the perception of choice (resp. the subjective lack of choice) in the context of caregiving decisions has tremendous impact on subsequent caregiving experience (Schulz et al., 2012). Assessments of anticipations may also help to differentiate various groups and allow interventions to be tailored to individual needs. In this vein, Robertson and colleagues used positive (i.e., caregiving rewards) and negative affect (i.e., costs) to distinguish four groups of family caregivers: a well-adjusted
GAIN–LOSS DYNAMICS AND PREFERENCES ABOUT FUTURE CAREGIVING
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