After reading this article, I have greater appreciation for the development of the family science field and its family-focused theories. Rather than focusing solely on the individual like the field of psychology or focusing on society like sociology, the field started looking at the family as a collection of individuals who are affected by life cycles with defined stages. This family life cycle had two major stages. The first is expansion when children are born and raised. The second stage is contraction when the children leave the home and parents are left with an "empty nest."
Evelyn Duvall and Ruben Hill first presented their version of the family life cycle in 1948. They developed tasks that would be done by both the parents and the child. The tasks were then grouped into eight stages.
The eight stages of the family life cycle include married couple, childbearing, pre-school age, school-age, teenage, launching center, middle-aged parents, and aging family members. These are the normative events that occur in many families. Family development theorists focus on these "normal" events rather than crisis within a family.
It appears that these stages of the family development theory have been debated for years. Other theorists expanded or decreased the stages and some questioned or supported its ability to be tested. Some theorists decided to abandon the eight stages of the family development theory and instead adopted the life course perspective.
Basic Assumptions
Families undergo stages of development, just like individuals: The family development theory focuses on the development of the individual within the family. In order for the family to move to the next stage, the family is dependent on the individual members development. In order for my spouse and me to transition from a married couple to childbearing, we both have had to be ready for the very big change of child rearing. In order for our family to move into the launching center stage, hopefully we will have given our son the skills he needs to leave home.When families move to the next stage this changes family relationships. Individual changes will cause the family to transition to another stage.
There are tasks associated with each stage of development: Certain tasks should be mastered before an individual and their family move to the next stage. An individual or family can move to the next stage and not have mastered the tasks of the previous stage, however they may experience more issues. For instance, my son may move out of our house, but if my spouse and I have not maintained our relationship, we may encounter problems as we enter the middle-aged parents stage.
Development is reciprocal: The development of each family member affects other family members including the whole family. If a child never leaves the home the parents may never be able to have the time to refocus on their marriage.
Families must be viewed in multiple levels of analysis: Family development theory allows us to look at the family and its individual members in different contexts (society, family, individual). For instance cell phone or e-mail technology have greatly affected our society and the way family members communicate over the last fifteen years. It appears to me that young adults appear to be more dependent on their parents than my cohort was. If true, one cause of this could be that young adults are able to communicate with their parents at any time whether by cell phone, e-mail or text. When I was in college, no one had cell-phones or even e-mail. Our parents were lucky to get one call a week and then it was short, because it was a long-distance call, so cost money. Do you think you rely on your parents more since you can contact them so easily?
Families should be viewed over time: Families change over time and should be studied over a long period of time. Time can be looked at in three different ways. The first ontogenetic time (age) is an individuals awareness of time. Although, I'm getting close to 40 and considered "middle-age," I didn't get married until I was 31 or have a child until I was 34. Since I started my family of procreation late, I feel a lot younger than "middle-age." I may be more willing to be "middle-age" at 45, but not 37. Generational time (cohort) refers to how an individual experiences time in a family or cohort group. For instance teenagers in a family will have a very different experience than their sibling who is still a toddler if their parent's divorce. The toddler won't ever remember mom and dad living together and how their family was then. The third type is historical time (period effect) which refers to how time is experienced in a social context. My cohort of college graduates were able to find good paying jobs within six months of graduating. Unfortunately, due to the current recession it is taking college graduates a lot longer to find a job and it may not have the pay or benefits that we were able to start our careers with.
As we discussed in class, the family life cycle is not perfect. It does not represent all families. The family life cycle can be interrupted by death of a spouse, divorce or a dependent child who is never able to leave home. Also, a family can be in many stages at one time. My parents had me launched and out of their house 13 years before my sister. Because they had a second child in their late thirties and she stayed a home until she was 28, they never really had their middle years. Especially since they are both already retired.
IngoldsbyIngoldsby, S. R. Smith, & J. E. Miller, (eds). Exploring family theories, (pp. 29-37). Los Angeles, CA: Roxbury. [Chapter 2]
Sunday, September 19, 2010
Friday, September 17, 2010
Chapter Seven: Family Systems Theory
I think this chapter did a beautiful job at describing how complex a family system is. The theory started its evolution in 1926 when Ernest Burgess referred to the family as "a unity of interacting personalities" where everyone had their roles to play and how these roles could conflict. In 1938, Waller elaborated on Burgess' work by defining the family as a "closed system of social interaction." He looked at how children and their parents influence each other and how he witnessed patterns of behavior between the family members.
Systems theory was starting to be developed by biologist Ludwig von Bertalanffy in 1969. How families fit into the systems theory was not examined until family therapists wanted to know why they were seeing patterns of communication or behavior that were leading to dysfunction within families. What I really like about the family systems theory is how it's concepts and assumptions can so easily be used by therapists in practice with families and individuals.
Another area to take into account are the four basic systems that make up the ecological theory of human development. For instance in my family's situation, our microsystem would include our home, my son's day care, our church, and our play and library groups we attend. My son's behavior changes based on what environment we are in. The second level is the mesosystem, which would look at how the environments my son spends his time in are not independent. For instance, when he started day care he saw the other children using pull-ups rather than diapers, so he started refusing to wear diapers at home. His environment at day care affected our environment at home. The third area is how larger institutions or exosystems affect a child's home environment. Many childrens' homes are being affected by lay-offs, jobs cutting benefits and foreclosures due to the economic recession. Last is the macrosystem, which includes societal norms and laws, such as not speeding or driving under the influence of drugs. You have to take into account that the child's environment is always changing or it is a chronosystem.
Basic Assumptions:
The whole is greater than the sum of the parts: My family of origin includes me, my sister, and my married parents. My family of origin was its own natural social system. My family like every other had its own "rules, roles we each played , communication patterns and power structures" within our family. The experiences I had in my family continue to affect my personality both positively and negatively. When I married my spouse, I started my family of procreation.
The locus of pathology is not within the person but is a system dysfunction: If one member of the family is having problems rather than blaming the individual, the problems are seen as coming from a dysfunctional family system. This allows the therapist to focus on how to resolve the conflict rather than blame the individual family members. It helps the therapist stop dysfunctional behavior that may have been learned generations ago.
Circular causality guides behavior: The therapist's focus is not on what a conflict is about, but rather how members of a family are communicating regardless of what they are fighting about and how they can help them communicate more effectively.
Rules are discovered in retrospect: All families have patterns in their behavior and communication. These patterns become rules of interaction between family members. Some rules can be healthy, such as everyone eats dinner together. Some rules can be dysfunctional such as it is the oldest child's responsibility to get the youngest children ready for school if mom can't get out of bed in the morning. Therapists help families change their dysfunctional rules once they are identified.
Rules result from the redundancy principle: Family patterns of behavior and communication is created as soon as you start dating your future spouse. This is the redundancy principle, when patterns in behavior and communication become family rules. Humans do not like change, so it is very difficult for a therapist to intervene in changing family rules.
Feedback loops guide behavior: When individual family members try to change their dysfunctional communication and behavior or when a member is not fulfilling their defined role within the family system, other members will provide them with negative feedback to get them to behave. Positive feedback is when the person is encouraged either by a therapist due to positive change or when the family is encouraging the dysfunctional communication or behavior.
Pathological communication causes relationship problems: I personally do not know one couple, family or business that doesn't have problems with pathological communication to some extent. Maybe we should all take a class in elementary school on how to communicate, so we help foster healthy relationships within our families and communities. There are so many forms of pathological communication, such as denial of a problem, not being direct with your needs or wants, and my favorite, passive-aggressive communication (See link below for serenity online therapy- I thought they did a good job of describing four basic styles of communication). Another type of pathological communication is double bind. It occurs when someone gives you two contradictory messages. I know in my family of origin, I have noticed a discrepancy that what my family members say is not always consistent with how they act. An example, is when my sister was younger she would send me e-mails saying how much she missed me and how she can't wait to spend time with me. Then when she would have the opportunity to spend time with me she would be on the phone, on the computer or doing something else. She is nine years younger then me, so I would excuse her behavior as youthful silliness. Is this an example of double blind behavior?
All family members take on roles: This concept is part of the redundancy principle, which again states that all families have patterns of behavior and communication. There are so many different roles individual family members play and they can change over time. There are roles that are very common and therapists see them over and over again when working with families especially where addictions and/or mental illness are found. Some of those include, the addicted spouse as the dependent, the other spouse as the enabler, the oldest child as the hero who keeps everything going smoothly, the delinquent who is the problem child and distracts the family from the real problem, the invisible child who tries to keep a low profile, and the clown who uses humor to help the family cope.
Family types are based on the rigidity of family boundaries: Three family types have been defined. The first, is open families which we defined in class as having flexible boundaries. To me this is the healthiest and I strive to be this family type now with my spouse and child. The second type is random family, which we defined in call as having no boundaries/ no rules. The members are disengaged and doing their own thing. The final type is a closed family, where the members have very little outside contact.
They have found a link between self-esteem and how functional or dysfunctional your family of origin behaves or communicates . I have been working very hard to recognize and stop some of the dysfunctional ways of communicating that I learned or needed to develop in order to survive in my family of origin. It's not easy! I'm sure some of these behaviors and communication patterns go back many generations!
Ingoldsby, B. B., Smith, S. R., & Miller, J. E. (2004). Family systems theory. In B. B. Ingoldsby, S. R. Smith, & J. E. Miller, (eds). Exploring family theories, (pp. 167-174). Los Angeles, CA: Roxbury. [Chapter 7]
http://serenityonlinetherapy.com/assertiveness.htm
Systems theory was starting to be developed by biologist Ludwig von Bertalanffy in 1969. How families fit into the systems theory was not examined until family therapists wanted to know why they were seeing patterns of communication or behavior that were leading to dysfunction within families. What I really like about the family systems theory is how it's concepts and assumptions can so easily be used by therapists in practice with families and individuals.
Another area to take into account are the four basic systems that make up the ecological theory of human development. For instance in my family's situation, our microsystem would include our home, my son's day care, our church, and our play and library groups we attend. My son's behavior changes based on what environment we are in. The second level is the mesosystem, which would look at how the environments my son spends his time in are not independent. For instance, when he started day care he saw the other children using pull-ups rather than diapers, so he started refusing to wear diapers at home. His environment at day care affected our environment at home. The third area is how larger institutions or exosystems affect a child's home environment. Many childrens' homes are being affected by lay-offs, jobs cutting benefits and foreclosures due to the economic recession. Last is the macrosystem, which includes societal norms and laws, such as not speeding or driving under the influence of drugs. You have to take into account that the child's environment is always changing or it is a chronosystem.
Basic Assumptions:
The whole is greater than the sum of the parts: My family of origin includes me, my sister, and my married parents. My family of origin was its own natural social system. My family like every other had its own "rules, roles we each played , communication patterns and power structures" within our family. The experiences I had in my family continue to affect my personality both positively and negatively. When I married my spouse, I started my family of procreation.
The locus of pathology is not within the person but is a system dysfunction: If one member of the family is having problems rather than blaming the individual, the problems are seen as coming from a dysfunctional family system. This allows the therapist to focus on how to resolve the conflict rather than blame the individual family members. It helps the therapist stop dysfunctional behavior that may have been learned generations ago.
Circular causality guides behavior: The therapist's focus is not on what a conflict is about, but rather how members of a family are communicating regardless of what they are fighting about and how they can help them communicate more effectively.
Rules are discovered in retrospect: All families have patterns in their behavior and communication. These patterns become rules of interaction between family members. Some rules can be healthy, such as everyone eats dinner together. Some rules can be dysfunctional such as it is the oldest child's responsibility to get the youngest children ready for school if mom can't get out of bed in the morning. Therapists help families change their dysfunctional rules once they are identified.
Rules result from the redundancy principle: Family patterns of behavior and communication is created as soon as you start dating your future spouse. This is the redundancy principle, when patterns in behavior and communication become family rules. Humans do not like change, so it is very difficult for a therapist to intervene in changing family rules.
Feedback loops guide behavior: When individual family members try to change their dysfunctional communication and behavior or when a member is not fulfilling their defined role within the family system, other members will provide them with negative feedback to get them to behave. Positive feedback is when the person is encouraged either by a therapist due to positive change or when the family is encouraging the dysfunctional communication or behavior.
Pathological communication causes relationship problems: I personally do not know one couple, family or business that doesn't have problems with pathological communication to some extent. Maybe we should all take a class in elementary school on how to communicate, so we help foster healthy relationships within our families and communities. There are so many forms of pathological communication, such as denial of a problem, not being direct with your needs or wants, and my favorite, passive-aggressive communication (See link below for serenity online therapy- I thought they did a good job of describing four basic styles of communication). Another type of pathological communication is double bind. It occurs when someone gives you two contradictory messages. I know in my family of origin, I have noticed a discrepancy that what my family members say is not always consistent with how they act. An example, is when my sister was younger she would send me e-mails saying how much she missed me and how she can't wait to spend time with me. Then when she would have the opportunity to spend time with me she would be on the phone, on the computer or doing something else. She is nine years younger then me, so I would excuse her behavior as youthful silliness. Is this an example of double blind behavior?
All family members take on roles: This concept is part of the redundancy principle, which again states that all families have patterns of behavior and communication. There are so many different roles individual family members play and they can change over time. There are roles that are very common and therapists see them over and over again when working with families especially where addictions and/or mental illness are found. Some of those include, the addicted spouse as the dependent, the other spouse as the enabler, the oldest child as the hero who keeps everything going smoothly, the delinquent who is the problem child and distracts the family from the real problem, the invisible child who tries to keep a low profile, and the clown who uses humor to help the family cope.
Family types are based on the rigidity of family boundaries: Three family types have been defined. The first, is open families which we defined in class as having flexible boundaries. To me this is the healthiest and I strive to be this family type now with my spouse and child. The second type is random family, which we defined in call as having no boundaries/ no rules. The members are disengaged and doing their own thing. The final type is a closed family, where the members have very little outside contact.
They have found a link between self-esteem and how functional or dysfunctional your family of origin behaves or communicates . I have been working very hard to recognize and stop some of the dysfunctional ways of communicating that I learned or needed to develop in order to survive in my family of origin. It's not easy! I'm sure some of these behaviors and communication patterns go back many generations!
Ingoldsby, B. B., Smith, S. R., & Miller, J. E. (2004). Family systems theory. In B. B. Ingoldsby, S. R. Smith, & J. E. Miller, (eds). Exploring family theories, (pp. 167-174). Los Angeles, CA: Roxbury. [Chapter 7]
http://serenityonlinetherapy.com/assertiveness.htm
Monday, September 13, 2010
Intergenerational Solidarity in Aging Families: An Example of Formal Theory Construction
After reading this article, I hoped to have had a better understanding of how the theory of intergenerational solidarity and how theories were developed. However, I found the article quite difficult to follow. I was not familiar with a lot of the terminology used and it wasn't helpful that the terms appeared to change throughout the article. I'll do my best to discuss this article and maybe by the time I'm done, I'll and those who read my blog will have a better understanding of it, too.
First, the authors define six constructs that appeared to have been already developed and tested. These six areas were theorized to be necessary if a child and a parent were to have a good relationship during their adult lives. Please see Table 1 page 857 for more details. The constructs are association (how often parent and child have contact such as holidays or Sunday dinners), affection (how the parent and child feel about each other such as closeness and respect), consensus (agreement on values and beliefs such as political or religious beliefs), resource sharing (exchanging of resources such as money, free childcare), strength of family norms (having the common belief that family is important) and, finally, the opportunity structure for interaction (how often can they interact, such as do they live in the same city or are the parent's home bound).
As stated above, these constructs were not new. They came from social theory, social psychology and family sociology. The initial attempt to predict interrelations was made in 1976. Bengtson, Olandaer and Haddad (1976) theorized that affection, association and consensus were interdependent or in order to have a good relationship you would have high levels of affection, association and consensus between the parent and the child. This theory was tested twice and each time the researchers did not find that affection, association and consensus were interdependent. However, they did find some correlation between affection and association. I think this makes sense. I have very different political and religious views from my two best friends. However, I still have a lot of affection and association for both of them. When you are eight years old, you don't pick your friends for their political or religious views and you can't pick your family at all.
Second, the authors change the initial theory based on the results of the two empirical tests. They added strength of family norms (normative), resource sharing (functional) and opportunity structure for interaction (structural solidarity). As you can see, they changed the names (new name in parenthesis) of the constructs. Why? Does this give them more of a sense of ownership? They make consensus independent and focus on individual levels of strength of family norms (normative integration), affection and resource sharing.
Their first proposition asked if a parent and a child both have the expectation that family is important it will increase their affection and how often they spend time together. They treat consensus independently, such as if a parent and child have different political views, it's not going to affect their affection or the amount of time they spend together. Their second proposition showed that if I were to take my mom to her doctor appointments and she were to watch my son (resource sharing), we would have more affection for each other, and this would increase how often we spend time together. Their third proposition in their new theory asked about opportunity structure, such as if a son or daughter live far away from their parents, will it affect how often they see each other and if they can share resources. The fourth proposition theorized if I have affection for my parents then I would spend more time with them.
The third step in developing their intergenerational solidarity theory was to test their revised model using empirical data. Please see their complete list of nine propositions they were able to test on pages 861 and 862. To test these propositions, they analyzed responses of 363 older parents and 246 middle-aged children who took part in a longitudinal study.
Lets jump to the interesting part or their results. Please see their new model on page 867 figure 4. The data from the longitudinal study supported some of their propositions. They found that if the parent and child both had the expectation that family was important the greater the affection felt by both of them (P1&P2) They found that if a parent had a greater expectation that family was important the more contact they had with the child (P2b). However, they did not find that a child would have more contact with their parents even though they had a greater expectation that family was important (P2b). They also found that if the child and parent were able to spend time together, such as living close to each other then they saw each other more often. (P3). Finally, if a child showed affection for their parent it had a greater influence on the parent's affection for their child. However, the affection a parent felt for their child did not affect how much affection a child had for their parent (P4).
The one finding I thought most interesting was P2b. Why did they not find an increase in a child's association (how often parent and child have contact such as holidays or Sunday dinners) if the child had a strong sense of family norms (having the common belief that family is important)? The authors try to explain this by saying the children may have felt so much guilt by not being able to have more association with their parents due to other obligations such as work and family that they put a higher expectation on family norms.
While reading this article, I thought of a daughter who has been caring for of one my clients with Alzheimer's Disease for over a year. She described to me a sense of family expectation that she is responsible to care for her mom because her mother cared for her grandmother. Unfortunately, there is not much affection felt by either of them and there never was. This daughter has sacrificed a lot over the last year and is extremely burned out. She is now looking at institutional care for her mom. I have to wonder if there were a little more affection between them whether she would be ready to put her in institutional care.
One more thought and then I will close. Regarding the finding that a child's affection for their parent was found to have a much greater influence on a parent's affection for the child than vice versa (P4). I think in our society a family norm is that a parent will always have affection for their child no matter what they do. Does this finding say that a parent has to earn affection from their child and that it is not an automatic given that your child will have affection for you because you are their mother or father?
Bengtson, V. L., & Roberts, R. E. L. (1991). Intergenerational solidarity in aging families: An example of formal theory construction. Journal of Marriage and the Family, 53, 856-870.
.
First, the authors define six constructs that appeared to have been already developed and tested. These six areas were theorized to be necessary if a child and a parent were to have a good relationship during their adult lives. Please see Table 1 page 857 for more details. The constructs are association (how often parent and child have contact such as holidays or Sunday dinners), affection (how the parent and child feel about each other such as closeness and respect), consensus (agreement on values and beliefs such as political or religious beliefs), resource sharing (exchanging of resources such as money, free childcare), strength of family norms (having the common belief that family is important) and, finally, the opportunity structure for interaction (how often can they interact, such as do they live in the same city or are the parent's home bound).
As stated above, these constructs were not new. They came from social theory, social psychology and family sociology. The initial attempt to predict interrelations was made in 1976. Bengtson, Olandaer and Haddad (1976) theorized that affection, association and consensus were interdependent or in order to have a good relationship you would have high levels of affection, association and consensus between the parent and the child. This theory was tested twice and each time the researchers did not find that affection, association and consensus were interdependent. However, they did find some correlation between affection and association. I think this makes sense. I have very different political and religious views from my two best friends. However, I still have a lot of affection and association for both of them. When you are eight years old, you don't pick your friends for their political or religious views and you can't pick your family at all.
Second, the authors change the initial theory based on the results of the two empirical tests. They added strength of family norms (normative), resource sharing (functional) and opportunity structure for interaction (structural solidarity). As you can see, they changed the names (new name in parenthesis) of the constructs. Why? Does this give them more of a sense of ownership? They make consensus independent and focus on individual levels of strength of family norms (normative integration), affection and resource sharing.
Their first proposition asked if a parent and a child both have the expectation that family is important it will increase their affection and how often they spend time together. They treat consensus independently, such as if a parent and child have different political views, it's not going to affect their affection or the amount of time they spend together. Their second proposition showed that if I were to take my mom to her doctor appointments and she were to watch my son (resource sharing), we would have more affection for each other, and this would increase how often we spend time together. Their third proposition in their new theory asked about opportunity structure, such as if a son or daughter live far away from their parents, will it affect how often they see each other and if they can share resources. The fourth proposition theorized if I have affection for my parents then I would spend more time with them.
The third step in developing their intergenerational solidarity theory was to test their revised model using empirical data. Please see their complete list of nine propositions they were able to test on pages 861 and 862. To test these propositions, they analyzed responses of 363 older parents and 246 middle-aged children who took part in a longitudinal study.
Lets jump to the interesting part or their results. Please see their new model on page 867 figure 4. The data from the longitudinal study supported some of their propositions. They found that if the parent and child both had the expectation that family was important the greater the affection felt by both of them (P1&P2) They found that if a parent had a greater expectation that family was important the more contact they had with the child (P2b). However, they did not find that a child would have more contact with their parents even though they had a greater expectation that family was important (P2b). They also found that if the child and parent were able to spend time together, such as living close to each other then they saw each other more often. (P3). Finally, if a child showed affection for their parent it had a greater influence on the parent's affection for their child. However, the affection a parent felt for their child did not affect how much affection a child had for their parent (P4).
The one finding I thought most interesting was P2b. Why did they not find an increase in a child's association (how often parent and child have contact such as holidays or Sunday dinners) if the child had a strong sense of family norms (having the common belief that family is important)? The authors try to explain this by saying the children may have felt so much guilt by not being able to have more association with their parents due to other obligations such as work and family that they put a higher expectation on family norms.
While reading this article, I thought of a daughter who has been caring for of one my clients with Alzheimer's Disease for over a year. She described to me a sense of family expectation that she is responsible to care for her mom because her mother cared for her grandmother. Unfortunately, there is not much affection felt by either of them and there never was. This daughter has sacrificed a lot over the last year and is extremely burned out. She is now looking at institutional care for her mom. I have to wonder if there were a little more affection between them whether she would be ready to put her in institutional care.
One more thought and then I will close. Regarding the finding that a child's affection for their parent was found to have a much greater influence on a parent's affection for the child than vice versa (P4). I think in our society a family norm is that a parent will always have affection for their child no matter what they do. Does this finding say that a parent has to earn affection from their child and that it is not an automatic given that your child will have affection for you because you are their mother or father?
Bengtson, V. L., & Roberts, R. E. L. (1991). Intergenerational solidarity in aging families: An example of formal theory construction. Journal of Marriage and the Family, 53, 856-870.
.
Monday, September 6, 2010
Caregiving: Physically, Mentally, Financially, Spiritally, and Emotionally Demanding
One of the questions that Dr. Radina wanted us to discuss in class was how physical and mental health problems affect an older person's family, friends, and neighbors. In my professional experience, the individuals in this support system are normally referred to as caregivers. I can not tell you how much respect I have for the caregivers I see every day doing everything they can to keep their loved ones at home and out of institutions. I have never met an older adult who wanted to go to a nursing home and caregivers support this choice every day.
While I work with caregivers, caregiving is not an area I have had much interest, although I am always empathetic with the caregivers' situations in juggling so many responsibilities, such as work and their family's needs. I refer caregivers to local support groups or to the Council on Aging and Alzheimer Association's caregiver support programs. The more I think about caregiving, the more I realize that I'm actually dreading becoming a caregiver for my parents and in-laws. Through my work and other life experiences, I know that being a caregiver is one of the hardest jobs there is to do! It is physically, mentally, financially, spiritually and emotionally demanding!
In 2004, the National Alliance for Caregiving and AARP, conducted a national caregiver survey of adult caregivers in the U.S. This study found that "the typical caregiver is a 46 year old woman with some college experience and provides more than 20 hours of care each week to her mother" (NAC, 2004, p.6). I guess that makes me feel a little better knowing that I have another ten years before I'll become one of "the estimated 44.4 million caregivers or an estimated 21% of the adult population in the U.S. providing unpaid care to another adult" (NAC, 2004, p.6).
There is great potential for chaos in a decade! My son will be a teenager and in many after-school activities. I will be done with my graduate degree and working full-time. Will I really be able to provide my parents and in-laws 20 hours a week to help them stay at home? Oh, my parents live 45 minutes one-way and my in-laws are 7 hours away.You can see that in the above scenario, I could easily be just like the caregivers who report having difficulty "finding time for one’s self (35%), managing emotional and physical stress (29%), and balancing work and family responsibilities (29%)" (NAC, 2004, p.8). I would love to be able to say that my parents and in-laws will be in great health since they will only be in their mid-seventies in ten years. Unfortunately, they already suffer from many of the major physical and mental health problems outlined in Aging, the Individual, and Society. Those include Heart Disease, Arthritis, Osteoporosis, and Depression. Let's hope they continue to be able to manage those chronic health conditions with medication and exercise and they don't develop any acute illnesses.
I am fortunate, that my parents and in-laws have resources, including long-term care insurance that will help meet their future needs. If needed, I won't hesitate to connect them with community resources to help them stay at home. I have learned from my clients' caregivers that I can't do it alone. They say it takes a village to raise a child and I believe it takes a village to keep an older adult safe at home. I'll let that village help me when it's my turn to take care of my parents and in-laws.
NAC, 2004: National Alliance for Caregiving/AARP, Caregiving in the U.S., 2004,
http://assets.aarp.org/rgcenter/il/us_caregiving_1.pdf
Miller, S.M., & Barrow, G.M., (2007) Aging, the Individual, and Society. United States.
While I work with caregivers, caregiving is not an area I have had much interest, although I am always empathetic with the caregivers' situations in juggling so many responsibilities, such as work and their family's needs. I refer caregivers to local support groups or to the Council on Aging and Alzheimer Association's caregiver support programs. The more I think about caregiving, the more I realize that I'm actually dreading becoming a caregiver for my parents and in-laws. Through my work and other life experiences, I know that being a caregiver is one of the hardest jobs there is to do! It is physically, mentally, financially, spiritually and emotionally demanding!
In 2004, the National Alliance for Caregiving and AARP, conducted a national caregiver survey of adult caregivers in the U.S. This study found that "the typical caregiver is a 46 year old woman with some college experience and provides more than 20 hours of care each week to her mother" (NAC, 2004, p.6). I guess that makes me feel a little better knowing that I have another ten years before I'll become one of "the estimated 44.4 million caregivers or an estimated 21% of the adult population in the U.S. providing unpaid care to another adult" (NAC, 2004, p.6).
There is great potential for chaos in a decade! My son will be a teenager and in many after-school activities. I will be done with my graduate degree and working full-time. Will I really be able to provide my parents and in-laws 20 hours a week to help them stay at home? Oh, my parents live 45 minutes one-way and my in-laws are 7 hours away.You can see that in the above scenario, I could easily be just like the caregivers who report having difficulty "finding time for one’s self (35%), managing emotional and physical stress (29%), and balancing work and family responsibilities (29%)" (NAC, 2004, p.8). I would love to be able to say that my parents and in-laws will be in great health since they will only be in their mid-seventies in ten years. Unfortunately, they already suffer from many of the major physical and mental health problems outlined in Aging, the Individual, and Society. Those include Heart Disease, Arthritis, Osteoporosis, and Depression. Let's hope they continue to be able to manage those chronic health conditions with medication and exercise and they don't develop any acute illnesses.
I am fortunate, that my parents and in-laws have resources, including long-term care insurance that will help meet their future needs. If needed, I won't hesitate to connect them with community resources to help them stay at home. I have learned from my clients' caregivers that I can't do it alone. They say it takes a village to raise a child and I believe it takes a village to keep an older adult safe at home. I'll let that village help me when it's my turn to take care of my parents and in-laws.
NAC, 2004: National Alliance for Caregiving/AARP, Caregiving in the U.S., 2004,
http://assets.aarp.org/rgcenter/il/us_caregiving_1.pdf
Miller, S.M., & Barrow, G.M., (2007) Aging, the Individual, and Society. United States.
Wednesday, September 1, 2010
What are the major mental health concerns facing older adults and why?
In my professional work experience, I would say that depression and suicide are two of the major mental health concerns facing older adults. So many of the clients I work with are experiencing depression from losses in their lives, such as family and friends dying and not being able to do the things they have always been able to do. Many of the clients I work with are home bound and need help with their activities of daily living (ADLs), such as bathing and dressing and instrumental activities of daily living (IADLs), such as meal preparation and shopping. Many of my clients are on an anti-depressant and fortunately, the program I work for now is part of the PEARLS (The Program to Encourage Active and Rewarding Lives for Seniors) program that screens for depression and offers in-home counseling if my clients want it. However, I've noticed that there is a stigma placed on counseling, especially by my male clients. For instance, I've had more than one occurrence where a client triggers a PEARLS referral and while fighting back tears, says to me, "I'm fine, I don't need help." I can only hope that I can change their mind during future visits.
While depression is not a normal part of aging, there are so many older adults who experience depression and have not been treated. They experience a sense of hopelessness that it puts them at a higher risk of suicide. According to the National Institute of Mental Health and my own work experience, as an older adults physical impairments increase and they are not able to do what they want to do, their risk of depression increases (2007). The statistics also show that the risk of depression increases as older adults need more formalized care, such as health care and hospitalization. According to the Centers for Disease Control and Prevention (CDC), older white males age 85 and older have the highest suicide rate. They are more successful on the first time attempt to take their lives and are more likely to use a gun (2010).
I was trained to take every suicide threat seriously. In my work experience, if you work with older adults suicidal ideation is something that you will encounter both on the phone and in-person. Since many of you will be returning to your home states, you may find a lot of different resources compared to here in Ohio where you are likely completing your practicum. From my experience, working in both Ohio and Kentucky you will have different resources available for you and your clients depending on funding available. As I stated above, now that I'm working in Ohio again, I have so many more resources available to help my clients. I can offer a client a referral to the PEARLS program for counseling. If someone is actively telling me they are thinking about suicide or I pickup on clues then I can make a referral to the Mobile Crisis Unit. However, when I was in Kentucky they had long waiting lists for counseling and if you did have a client who verbalized suicide, you had to call 911 and medics who may not have mental health training would have to intervene with your client. My advice to those of you who are beginning to work with older adults, please make sure you take every threat seriously and make sure you know the suicide prevention resources in the geographic area you are working. Also, make sure you know your agency's policy.
In conclusion, I remember when my Grandpa was very ill, he told me he was ready to leave this world and couldn't understand why he was still here. He said everyone who knew him when he was young was gone and he was ready to be with them again. I have to admit that I didn't completely understand since he had his daughters and grandchildren, but I think I'm beginning to catch a glimmer of what he was saying. Older adults may face a lot of loss, whether it is due to physical impairment or loss of loved ones. For instance, we had a client this week who lost his wife of 80 years! Can you imagine how lost you would feel? Fortunately, he has good family support to get him through this difficult time. It is up to us to pick up on sometimes subtle hints that our clients are depressed and connect them with resources that may help them before it's too late.
National Institute of Mental Health (April 2007) Older Adults: Depression and Suicide Fact Sheets (Fact Sheet). Retrieved from http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml#part-of-aging
Centers for Disease Control and Prevention (Summer 2010) Suicide Facts at a Glance. Retrieved from
http://www.cdc.gov/violenceprevention/pdf/Suicide_DataSheet-a.pdf
While depression is not a normal part of aging, there are so many older adults who experience depression and have not been treated. They experience a sense of hopelessness that it puts them at a higher risk of suicide. According to the National Institute of Mental Health and my own work experience, as an older adults physical impairments increase and they are not able to do what they want to do, their risk of depression increases (2007). The statistics also show that the risk of depression increases as older adults need more formalized care, such as health care and hospitalization. According to the Centers for Disease Control and Prevention (CDC), older white males age 85 and older have the highest suicide rate. They are more successful on the first time attempt to take their lives and are more likely to use a gun (2010).
I was trained to take every suicide threat seriously. In my work experience, if you work with older adults suicidal ideation is something that you will encounter both on the phone and in-person. Since many of you will be returning to your home states, you may find a lot of different resources compared to here in Ohio where you are likely completing your practicum. From my experience, working in both Ohio and Kentucky you will have different resources available for you and your clients depending on funding available. As I stated above, now that I'm working in Ohio again, I have so many more resources available to help my clients. I can offer a client a referral to the PEARLS program for counseling. If someone is actively telling me they are thinking about suicide or I pickup on clues then I can make a referral to the Mobile Crisis Unit. However, when I was in Kentucky they had long waiting lists for counseling and if you did have a client who verbalized suicide, you had to call 911 and medics who may not have mental health training would have to intervene with your client. My advice to those of you who are beginning to work with older adults, please make sure you take every threat seriously and make sure you know the suicide prevention resources in the geographic area you are working. Also, make sure you know your agency's policy.
In conclusion, I remember when my Grandpa was very ill, he told me he was ready to leave this world and couldn't understand why he was still here. He said everyone who knew him when he was young was gone and he was ready to be with them again. I have to admit that I didn't completely understand since he had his daughters and grandchildren, but I think I'm beginning to catch a glimmer of what he was saying. Older adults may face a lot of loss, whether it is due to physical impairment or loss of loved ones. For instance, we had a client this week who lost his wife of 80 years! Can you imagine how lost you would feel? Fortunately, he has good family support to get him through this difficult time. It is up to us to pick up on sometimes subtle hints that our clients are depressed and connect them with resources that may help them before it's too late.
National Institute of Mental Health (April 2007) Older Adults: Depression and Suicide Fact Sheets (Fact Sheet). Retrieved from http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts-fact-sheet/index.shtml#part-of-aging
Centers for Disease Control and Prevention (Summer 2010) Suicide Facts at a Glance. Retrieved from
http://www.cdc.gov/violenceprevention/pdf/Suicide_DataSheet-a.pdf
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