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Family Systems and Aging Angela G. Rothrock, PhD Assistant Professor, Division of Gerontology, Geriatrics and Palliative Care Associate Director, UAB Geriatrics.

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Presentation on theme: "Family Systems and Aging Angela G. Rothrock, PhD Assistant Professor, Division of Gerontology, Geriatrics and Palliative Care Associate Director, UAB Geriatrics."— Presentation transcript:

1 Family Systems and Aging Angela G. Rothrock, PhD Assistant Professor, Division of Gerontology, Geriatrics and Palliative Care Associate Director, UAB Geriatrics Education Center and UAB Reynolds Program

2 What’s your family structure? Where do the members live? Have you provided care for a parent? Has a family member provided care to you? Our Family Structure

3 What defines “Family” Family Systems Perspective Intergenerational Relationships Family Interaction Patterns Family Assessment Culture and the Family – Living Arrangements – Caregiving Family Conferences Presentation Overview

4 Those who: – consider themselves economically and emotionally related to each other by blood, marriage, or commitment – are tied together through their common biological, legal, cultural, and emotional history and their implied future together Varies by size, composition, and closeness Most important system that we belong to Primary identification What Defines Family?

5 Nuclear – Married or committed pair – Dependent children – Independent household – Bound to outside kin by voluntary ties of affection or duty Three Traditional Family Types

6 Extended/Modified Extended – All relatives connected by blood or marriage Three Traditional Family Types

7 Surrogate Family/Support System – Any individuals – Join together to give support and assistance – Sometime for a specific purpose – Fictive Kinship - “She’s like a sister to me” Three Traditional Family Types

8 Considerable change in the 20 th /21 st centuries – Patterns of living arrangements – Divorce and remarriage – Decreases in fertility – More women working outside the home Older adults embedded in a complex web of ties “Beanpole” Families (Bengston, Rosenthal & Burton, 1990) Changing Family Structures

9 Family is an interdependent, emotional unit – Change or stress that affects one, affects all – Interaction patterns are repeating and hard to reorganize – Losses occur regarding Control Continuity Defined roles Significant relationships Sense of purpose Family Systems Perspective

10 Joint responsibility for problems Unresolved issues will resurface Crucial that families adapt to changing circumstances – Ex. Physical or cognitive decline of a member Family Systems Perspective

11 First presented in 1957, Evelyn Duvall Based on census data, post WWII Widely utilized Largely driven by the age of the oldest child 8 stages reflecting – Size of the family – Age of members – Types of challenges faced Family Life Cycle Theory Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134.

12 Families progress through eight stages: – Getting married – Childbearing – Preschool years – School-age years – Adolescent/Teenage years – Launching – Middle-aged parents – Aging family members Family Life Cycle Theory

13 Tasks must be completed before moving to the following stage Criticized for heavy reliance upon traditional/ idealized culture-specific assumptions regarding: – what constitutes a family – the experiences families will have – when these will occur Does not address intergenerational family issues Family Life Cycle Theory

14 Developmental task and needs of generations are no longer complementary Multiple iterations, now more focused on transitions of the family or its individuals – Emphasis on family dynamics – Successful transitioning may help to prevent disease and emotional or stress-related disorders. Family Life Cycle Theory

15 50% of older adults have daily contact with their children Intergenerational relationships between parents and adult children: – are frequently characterized by ambivalence 2 “sets of parents” Feelings regarding “role reversals” Competing priorities/goals – Carstensen’s Socioemotional Selectivity Theory Intergenerational Relationships

16 Socioemotional Selectivity Theory Social contact/Relationships are motivated by either: – Pursuit of knowledge – Desire to regulate emotion Knowledge Acquisition Emotion Regulation InfancyLate Life Carstensen, L.L (1987. 1991. 1992)

17 Implications for health and well-being – Family habits (eating, exercising) – Encouragement – Stress/burden (increase or decrease) – Feelings of well-being – Contributions Intergenerational Relationships

18 Bengston’s Theory of Intergenerational Solidarity (Bengston & Roberts, 1991) Generations relate to each other in terms of: – Living arrangement (structural) – Shared values (normative) – Norms (consensual) – Contact (associational) – Closeness (affectual) – Instrumental Support (functional) Financial, caregiving, etc Intergenerational Relationships

19 Dependence to independence – Filial Maturity Adult children learn to accept and meet parents’ dependency Involves being depended on and being dependable They are emotionally ready to relinquish earlier roles Obligation to volunteerism – Filial obligation, felt by children – Parents don’t want to be a burden Continuum of Social Family Norms

20 Compatible vs. Conflictual – Always in agreement or always arguing – Resurfacing of old conflicts Cohesive vs. Fragmented – Present as a unit or as individual members 5 Family Interaction Patterns (Blazer, 1998)

21 Productive vs. Non-Productive – Mobilize to create changes needed or powerless to act Fragile vs. Stable – Family stability or disruption in relationships Rigid vs. Flexible – Exchange and share roles and respond readily to crisis 5 Family Interaction Patterns (Blazer, 1998)

22 The Family APGAR (FAPGAR) (Smilkstein, 1978) Brief screening questionnaire – 5 closed-ended questions – Fitting for multiple family structures Family Assessment

23 A - Adaptation P - Partnership G - Growth A - Affection R - Resolve FAPGAR 5 Components of Family Function

24 Reflect a patient’s view of the functional state of their family Focus on family unit as part of medical care/treatment Useful for multiple cultures FAPGAR Results

25 Familial cultural norms are specialized in three ways – Specific to particular role relationships – Systematically related to social class, race, ethnicity, religion, or region – Vary across individual families (traditions) Research has focused on cultural differences in living arrangements and caregiving Culture and the Family

26 Affects the exchange of help and support Western countries and Japan (Sundstrom, 1993) – Decline in the proportion of older people living with adult children since 1950 – In US, decreased from 33% to 15% – In Sweden, decreased from 27% to 5% (most extreme change) Intimacy at a distance – Pattern of proximity but in separate households Culture and Living Arrangements

27 Korean families (Won & Lee, 1999) – 75% of those age 60+ live with their children – More likely to live with sons – More likely to live with married children Developing Countries (Hashimoto, 1991) – Brazil, Egpyt, India, South Korea, Singapore, Thailand, Zimbabwe – Older adults maintain co-residence with children – Lowest in Egypt and Brazil Culture and Living Arrangements

28 ~80% of informal care of frail elders is provided by family caregivers – Usually a single, primary caregiver – 1/3 are adult children Sandwich generation Family Caregiving

29 Gender and history of relationships are key to determining: (Matthews, 2002) – Which child provides care – How caregiving is shared among relatives Sibling conflict – How the older adult participates Some cultures don’t involve the elder in decisions Family Caregiving

30 Distinct cultural differences PBS series – Life, Part 2 – Ethnicity, Race and Aging episode – 2/ethnicity-race-aging 2/ethnicity-race-aging Culture and Family Caregiving

31 Family Conferences – Involve healthcare professionals and family members – Interdisciplinary team approach – Presentation of loved ones diagnoses, concerns – Improved quality of care – Considerations of various perspectives – Discussion of advanced care planning, resources – Engage multiple family caregivers – Sort out tasks and schedules Family Conferences Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992),The Family Conference in Geriatrics,Canadian Family Physician, p585-588

32 Bengtson, V.; Rosenthal, C. J.; and Burton, L. (1990). "Families and Aging: Diversity and Heterogeneity." In Handbook of Aging and the Social Sciences, 3rd edition, ed. R. H. Binstock and K. George. New York: Academic Press. 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. Blazer D (1998). Emotional problems in later life: Intervention strategies for professional caregivers. New York: Springer Carstensen, L.L. (1987). Age-related changes in social activity. In L.L. Carstensen & B.A. Edelstein (Eds.), Handbook of Clinical Gerontology (pp.222-237). New York: Pergamon Press. Carstensen, L.L. (1991). Selectivity theory: Social activity in life-span context. Annual Review of Gerontology and Geriatrics, 11, 195-217. Carstensen, L.L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity theory. Psychology and Aging, 7, 331-338. Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134. Hashimoto, A. (1991). "Living Arrangements of the Aged in Seven Developing Countries: A Preliminary Analysis." Journal of Cross-Cultural Gerontology 6:359–81. Matthews S (2002). S isters and Brothers/Daughters and Sons: Meeting the Needs of Old Parents. Bloomington: Unlimited Publishing; 2002. Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992),The Family Conference in Geriatrics, Canadian Family Physician, p585-588 Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. Journal of Family Practice, 6(6), 1231-1239. Sundstrom, G. (1993). "Care by Families: An Overview of Trends." In Caring for Frail Elderly People. Paris: Organization of Economic Co-operation and Development. Won, Y., and Lee, G. (1999). "Living Arrangements of Older Parents in Korea." Journal of Comparative Family Studies 30:315–28. References

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