Family relationships

Definition

The English word family comes from the Latin familia, which meant a household that included servants as well as relatives of the head of the household. As this derivation indicates, the family for most of human history was an economic unit as well as a kinship structure. It has only been within the past two centuries that the family in Western societies has come to represent primarily a source of emotional nurture and support as well as caregiving for the very young and the very old.

A common distinction that is made is between the so-called nuclear (or conjugal or immediate) family, consisting of a married couple and their children; and the extended family, which is the network of relatives by blood or marriage who do not belong to the nuclear family. Extended families often serve as small communities that reinforce or supplement the nuclear families within the network. In some societies, particularly those in Asia and Africa, the extended family is considered more important than the nuclear family.

Description

Background

In Western societies, family relationships have become increasingly difficult to define and describe because of a number of social and cultural changes since the 1950s. The traditional nuclear family is no longer the typical American household; whereas nuclear families comprised 40.3% of households in 1970, they account for only 24% as of 2008. Some of the reasons for the demographic change include:

• An intensified emphasis on personal freedom and individualism. While self-sufficiency and independence have always been part of the American concept of adult maturity, some observers think that these values are no longer balanced by a corresponding sense of loyalty to the family (or to any other social group). Among other developments, the rise in the divorce rate since the 1950s is considered to reflect a preference for self-satisfaction over commitments to others. The increased frequency of divorce is not confined to younger adults; the most rapid increase in the divorce rate since the 1990s is among adults over 50. Although the most common reason given for divorce among older adults is verbal or physical abuse, a desire for greater personal fulfillment or greater freedom is also high on the list. What this change means is that older married adults can no longer take for granted that their spouse will be there to care for them when their health fails. In addition, the divorce of an older couple is often a traumatic experience for their grown children.
• Population mobility. The frequent moves that many people make for the sake of their education and later employment opportunities weaken family ties.
• Emergence of so-called nontraditional or alternative family arrangements. These include communes, homosexual civil unions, single parenting, and cohabitation. Although these arrangements may be emotionally satisfying for those who choose them, they are difficult to fit into extended family networks. In addition, there is no evidence as of the early 2000s that homosexual partnerships are more stable or durable than traditional marriages.
• Smaller nuclear families. The high cost of rearing children to adulthood (calculated at $165,000 per child for a middle-class family in the United States as of 2008) means that many parents opt to have only one or two children. This drop in the birth rate means that there are fewer younger family members to care for older ones as they age. In addition, the number of married couples who choose not to have children has increased, as has the number of single adults.

Decline in companionship

Families have traditionally been a source of companionship and love, a place for parents and older children to relax and recover from the stresses of the workplace or school. At least one-third of seniors living in the community live alone. Although most of these older adults prefer their independence, many also report feeling lonely or socially isolated. About 80% of seniors who have had children live within 20 minutes of at least one child; this group does not include those who have never married or never had children.

About 5% of seniors over the age of 65 have never been married or are divorced or widowed. Some have maintained close relationships with friends or siblings; however, the growing proportion of only children in the general population means that a larger number of unmarried seniors will not have siblings for companionship in their later years.

Caregiving and family stress

Although extended as well as nuclear families can be brought closer together by the challenges of caring for a dependent senior, they can also be stressed by disagreements over the various family members' roles and responsibilities. These disagreements may be intergenerational; between husband and wife; or among siblings and their respective spouses.

Intergenerational difficulties are most common for the so-called sandwich generation—baby boomers who may have children of their own at home at the same time they are trying to care for elderly parents. It can be tiring and frustrating for the adults in the middle to weigh their obligations to both sets of dependents.

Disagreements between husband and wife can result from having to care for both spouses' parents at the same time as well as from general conflicts between the demands of caregiving and the need to maintain the marriage. Most people feel a stronger sense of obligation to relatives by blood than to relatives by marriage; thus the needs or demands of one's in-laws may feel like a greater burden than caring for one's own parents, and husband and wife may disagree as to which parent(s) should receive priority.

Disagreements among siblings about caring for parents can result from a number of factors. One factor is population mobility; it is unlikely that all the siblings in a family will live equally close to aging parents. Another is financial and occupational differences; not all the siblings may have jobs that allow them to take time off from work for caregiving, or to pay for home health care. Last, the lingering belief that caregiving is primarily women's responsibility means that the sisters in the family may be expected to do much more than the brothers. All of these factors can contribute to considerable anger and resentment among siblings. Many geriatric care managers recommend holding a family meeting, if necessary with a counselor present. This approach lowers the risk of family conflicts over the care of the elderly person, and ensures that everyone's viewpoint is heard.

Viewpoints

Seniors as family caregivers

One of the noteworthy developments in family relationships since the early 1980s is the emergence of older adults as family caregivers, either for their own parents or for grandchildren. One of the byproducts of increasing longevity in the United States is that some families now consist of children in their 60s caring for parents in their 80s or 90s; 30% of caregivers for the elderly as of 2008 are themselves 65 or older. This trend can be found across all races and ethnic groups.

A corresponding development has been the larger numbers of grandparents rearing grandchildren in the absence of their parents. The 2000 Census reported that 4.5 million children in the United States (6.3% of the population younger than 18) are being cared for by their grandparents—a 30% increase from 1990. Thirteen percent of African American children, 8% of Hispanic children, and 4% of Caucasian or Asian children are living with grandparents. In some Native American tribes the figure is close to 60%. While some of these children are being cared for by grandparents because their parents are deployed in the military, alcohol and drug abuse, mental illness, imprisonment, child abuse, HIV infection, and the death of a parent are the most common reasons for grandparents becoming the primary caregivers for their grandchildren.

Role of government

One of the long-term social trends since the early twentieth century has been the tendency of governments in the developed countries to take over certain functions that once belonged to families. Education is one example of this trend; support of retirees is another. The aging of the population in developed countries is a major concern to policy makers because of the strain on health care systems and public financing of retirement. As seniors live longer and each retiree is supported by fewer younger workers paying into social security systems, governments in developed countries are facing hard choices between cutting benefits to the elderly, increasing the tax burden on younger adults, or reducing the role of the government in providing health care.

The long-term economic problem of supporting an aging population has intensified an ongoing debate about the relative roles of government and the family in caring for older adults. It is estimated that the services of family caregivers in the United States are worth $306 billion per year, and that family caregivers represent 13% of the adult American workforce. Placing greater responsibility for caregiving on family members is economically unrealistic; as it is, American businesses lose as much as $34 billion each year because of employees' need to take off time to care for a spouse or family member over the age of 50.

KEY TERMS

Cohabitation —Living together as a couple without being married.

Commune —A group of unrelated adults and children living together on a communal basis, often in a rural area.

Extended family —A network of relatives consisting of parents and children along with grandparents, the siblings of the parents and their spouses, cousins, and adopted or foster children.

Nuclear family —A family unit consisting of a married couple and their children. It is also known as a conjugal family or immediate family.

Dysfunctional families

One of the striking features of newer publications about caregiving is frank discussion of family dysfunction. Not all older adults are pleasant or admirable characters; some have long-standing personality disorders or were always difficult to get along with. The illnesses and physical complaints of old age, of course, can make these seniors even more disagreeable to care for. In general, the children of such older adults are advised not to expect the parent to mellow or to become the kind of parent the grown son or daughter may still long for simply because the parent is now dependent on the child. A common suggestion to the younger adults is “to accept what never was and can never be,” and to seek love and friendship from friends and other relatives who are capable of genuine affection.

Another source of family dysfunction is alcohol or drug abuse. It is the second most common reason for divorce among people in their 50s and 60s; it is also the reason why some seniors are estranged from their families. Many elderly alcoholics have little or no contact with their siblings or offspring.

Substance abuse disorders are also a factor in elder abuse. The Merck Manual of Geriatrics notes that many elderly persons agree to share their homes with a family member who has a drug or alcohol problem or has a history of mental illness. Sadly, another common pattern in elder abuse is a payback mentality; the adult son or daughter may feel entitled to mistreat or exploit a parent who had abused them when they were younger.

Resources

BOOKS

Bair, Deirdre. Calling It Quits: Late-Life Divorce and Starting Over. New York: Random House, 2007.

Beers, Mark H., M. D., and Thomas V. Jones, MD. Merck Manual of Geriatrics, 3rd ed., Chapter 15, “Social Issues.” Whitehouse Station, NJ: Merck, 2005.

Bellah, Robert N., et al. Habits of the Heart: Individualism and Commitment in American Life. New York: Harper and Row, Publishers, 1986.

Hotchkiss, Sandy. Why Is It Always about You? Saving Yourself from the Narcissists in Your Life, Chapter 17, “Narcissism and Aging: The Mirror Cracks.” New York: The Free Press, 2002.

Mace, Nancy L., and Peter V. Rabins. The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life, 4th ed. Baltimore, MD: Johns Hopkins University Press, 2006.

Mintz, Suzanne Geffen. A Family Caregiver Speaks Up: “It Doesn't Have to Be This Hard.” Sterling, VA: Capital Books, 2007.

Morris, Virginia. How to Care for Aging Parents, 2nd ed. New York: Workman Publishing Co., 2004.

Storkey, Elaine. The Search for Intimacy, Chapter 11, “Intimacy and the Family.” Grand Rapids, MI: William B. Eerdmans Publishing Company, 1995.

PERIODICALS

Bennett, K. M. “Does Marital Status and Marital Status Change Predict Physical Health in Older Adults?” Psychological Medicine 36 (September 2006): 1313–1320.

Hash, K. “Caregiving and Post-Caregiving Experiences of Midlife and Older Gay Men and Lesbians.” Journal of Gerontological Social Work 47 (March-April 2006):121–138

McAlpine, C. H. “Elder Abuse and Neglect.” Age and Ageing 37 (March 2008): 132–133.

Sattar, S. P., P. R. Padala, D. McArthur-Miller, et al. “Impact of Problem Alcohol Use on Patient Behavior and Caregiver Burden in a Geriatric Assessment Clinic.” Journal of Geriatric Psychiatry and Neurology 20 (June 2007): 120–127.

Tompkins, C. “Who Will Care for the Grandparents? Exploring Relationships between Grandparents and Grandchildren.” Journal of Psychosocial Nursing and Mental Health Services 45 (May 2007): 19–22.

OTHER

Administration on Aging (AoA) Fact Sheet. Family Caregiving. Washington, DC: Department of Health and Human Services, 2003. http://www.aoa.gov/press/oam/May_2003/media/fact_sheets/National%20Family%20Caregiver%20Support%20Program.pdf [cited February 19, 2008].

American Geriatrics Society Foundation for Health in Aging. How We Age. http://www.healthinaging.org/agingintheknow/topics_trial.asp?id=1 [posted February 2005; cited March 26, 2008].

Belden Russonello and Stewart. In the Middle: A Report on Multicultural Boomers Coping with Family and Aging Issues. Washington, DC: American Association of Retired Persons, 2001. http://www.aarp.org/research/family/relationships/aresearch-import-789-D17446.html [cited March 28, 2008].

Davies, Curt, and Dameka Williams. Lean on Me: Support and Minority Outreach for Grandparents Raising Grandchildren. Washington, DC: American Association of Retired Persons, 2003. http://www.aarp.org/research/family/grandparenting/aresearch-import-483.html [cited March 27, 2008].

Montenegro, Xenia. The Divorce Experience: A Study of Divorce at Midlife and Beyond. Washington, DC: American Association of Retired Persons, 2004. http://www.aarp.org/research/reference/publicopinions/aresearch-import-867.html [cited March 26, 2008].

Sellas, Monique I., and Laurel H. Krouse. “Elder Abuse.” eMedicine, June 19, 2006. http://www.emedicine.com/emerg/topic160.htm [cited March 27, 2008].

ORGANIZATIONS

Administration on Aging (AoA), One Massachusetts Avenue, Washington, DC, 20201, (202) 619-0724, [email protected], http://www.aoa.gov/index.asp.

American Association of Retired Persons (AARP), 601 E Street NW, Washington, DC, 20049, (800) OUR-AARP (687-2277), http://www.aarp.org/.

Family Caregiver Alliance (FCA) National Center on Caregiving, 180 Montgomery Street, Suite 1100, San Francisco, CA, 94104, (415) 434-3388, (800) 445-8106, [email protected], http://www.caregiver.org/caregiver/jsp/home.jsp.

Rebecca J. Frey Ph.D.