Sage Journals: Discover world-class research

Abstract

A burgeoning literature considers caregiving in a relationship context and examines how the quality of caregivers’ relationships with care recipients influences their own appraisals of caregiving. Yet, extant research has mostly relied on cross-sectional data and utilized a unidimensional approach to examining relationship quality. This study extended prior research by examining (a) how positive and negative relationship qualities are associated with changes in caregiving appraisals over time, and (b) whether these associations vary by care recipients’ age and disabilities. We examined a longitudinal cohort of caregivers (N = 1,453, M_age = 62.11) from the National Study of Caregiving (wave 1: 2015, wave 2: 2017), in which caregivers rated positive and negative qualities of their relationships with care recipients aged 65+ (N = 1,047, M_age = 82.89), and reported on difficulties, burden, and rewards while serving as caregivers. Path analyses revealed that negative relationship quality at wave 1 was associated with increased difficulties and burden of caregiving over time, whereas positive relationship quality at wave 1 was associated with increased caregiver rewards. The associations between relationship qualities and caregiving difficulties as well as rewards varied depending on care recipients’ age and disabilities. Having negative relationships with care recipients was only associated with increased difficulties for caregivers who had younger care recipients, whereas having positive relationships was only linked to increased rewards for those with older care recipients. We also found that positive relationships were significantly associated with increased rewards in caregivers whose care recipients had fewer disabilities. This study refines our understanding of the role relationship quality plays in caregiving and highlights the lasting effects of relationships with care recipients on caregivers’ appraisals. Findings may help identify caregivers at greater risk for negative outcomes and suggest incorporation of relationship therapies in interventions to facilitate affection and attenuate conflicts in caregiving relationships.

Keywords

affection conflict age disability National Study of Caregiving

Introduction

About one in every four Americans live with a disability in at least one activity of daily living (e.g., mobility), and the prevalence increases dramatically with age (Chatterji et al., 2015; Okoro et al., 2018). Older adults with disabilities often receive intensive care from their family members and friends, who serve as informal caregivers providing unpaid assistance at considerable emotional, physical, and financial costs (Cooper et al., 2007; Cuijpers, 2005; Zarit et al., 2019). Much of the literature has portrayed caregiving as a stressful task that compromises caregivers’ well-being (Davis et al., 2011; Zarit et al., 2019). Yet, more recently, scholars have paid greater attention to how caregivers appraise both burden and rewards of their duties, which influence the consequences of caregiving-related stressors (e.g., care recipients’ physical and cognitive limitations) for caregiver well-being (Galvin et al., 2020; Pristavec, 2019). Indeed, caregivers’ experience of difficulties and burden may not only reduce their own health, but also exacerbate care recipients’ well-being, such as increasing their hospitalization or mortality rates (Hooley et al., 2005; Lwi et al., 2017). Rewards of caregiving, however, can protect caregivers and alleviate their depressive symptoms (Abdollahpour et al., 2018; Fauth et al., 2012). It is thus crucial to identify factors that can shape caregivers’ appraisals of caregiving in a more positive and less negative manner, which may in turn benefit both members of the caregiving dyad.

Some studies and interventions have been designed to help informal caregivers, but they have either focused on educating caregivers or mobilizing multiple sources of support outside of the caregiving dyad (i.e., other family members, formal/paid services; Crellin et al., 2014; Zarit et al., 2014). A growing body of research emphasizes the ongoing relationship between caregivers and care recipients, where care occurs and evolves (Ablitt et al., 2009; Rippon et al., 2020; Quinn et al., 2009; Wadham et al., 2016). Yet, studies have primarily relied on cross-sectional data and revealed mixed findings of the impact this relationship had on caregiving experiences and outcomes (Hooker et al., 2015; Tough, Siegrist, & Fekete, 2017). Caregiving is not a static process, and caregivers’ appraisals of caregiving may change over time. The current study drew on longitudinal data to examine how the quality of caregivers’ relationships with care recipients contributes to the change in these caregivers’ appraisals over time.

Further, we asked whether the association between caregivers’ relationships with care recipients and their appraisals of caregiving varied depending on care recipients’ age and disabilities. Care recipients’ age and disabilities can elicit caregivers’ perceptions on care recipients’ limited time left (Sullivan-Singh et al., 2015; Wang et al., 2020; Wu et al., 2016), which may impact their attitudes towards care recipients and caregiving demands (Fingerman & Charles, 2010). Although the risk and prevalence of disabilities increase with age (Guay et al., 2014), age and disabilities may independently signal closeness to death and differentially influence how caregivers’ social experiences with care recipients shape their appraisals of caregiving work. Findings will help us identify caregivers at greater risk for negative health outcomes and allocate more appropriate resources towards this vulnerable population.

Positive and negative relationship qualities

The literature has linked relationship quality to caregiving outcomes (Rippon et al., 2020; Quinn et al., 2012; Tough, Siegrist, & Fekete, 2017), but we aimed to extend prior research by considering both positive and negative qualities of caregivers’ relationships with their care recipients. Scholars have increasingly recognized that such a 2-dimensional approach reveals both affection and conflict in a relationship and proves more informative than an overall/unidimensional measure of relationship quality (Mattson et al., 2007). Positive relationships are generally regarded as social resources that allow individuals to better cope with acute and chronic stress in life. Indeed, theorists suggest that social support, the main function of positive relationships, not only benefits individuals directly, but also may protect them from stress (Brady et al., 2013; Creaven et al., 2020; Greenglass et al., 2006). Negative relationships (e.g., marital strain), however, compromise individuals’ well-being and increase their reactivity to stress (August et al., 2007); these consequences are more salient than those of positive experiences (Rook et al., 2015).

Relationship qualities and caregiving appraisals

Previous research has mostly drawn on cross-sectional data to examine the impact of prior (pre-caregiving) or current relationship quality on caregiver outcomes (Ablitt et al., 2009; Lum et al., 2014; Rippon et al., 2020). Here, we focused on what happened after caregivers took on their roles: We assessed the quality of caregivers’ relationships with care recipients at a certain time-point and examined how it influenced changes in caregivers’ appraisals of caregiving in subsequent years. The Stress Process Model highlights that caregivers’ appraisals play major roles in the process where exposure to caregiving-related stressors (e.g., care recipients’ limitations, caregiving demands) influences their own well-being (Goode et al., 1998; Pearlin et al., 1990). Yet, we still know little about how factors specific to each caregiving relationship may shape caregivers’ appraisals.

In the current study, we considered caregivers’ appraisals of difficulties, burden, and rewards in assuming their duties. Some recent studies suggest that positive relationships may increase caregivers’ feelings of difficulties and burden by eliciting their emotional contagion to care recipients’ suffering (Kiecolt-Glaser & Wilson, 2017; Monin et al., 2017). Yet, overall, as posited by the stress-buffering hypothesis, positive relationships may still impart important social resources under stress, which protect caregivers’ well-being in the long run (Cohen et al., 2015; Cohen & Wills, 1985). Further, a burgeoning literature has explicitly shown that individuals with more positive relationships may be better able to identify positive aspects and rewards of caregiving (e.g., gains, gratification, increased family cohesion; Carbonneau et al., 2010; Yu et al., 2018).

Several additional models help us understand the exacerbating effect of negative relationship quality on caregivers’ appraisals. The Stress-Exacerbation Model suggests that individuals who report more negative relationships or experience social isolation are more reactive to stressors (August et al., 2007). More specific to caregiving, the Informal Caregiving Integrative Model posits that negative relationships with care recipients likely shape the way caregivers appraise caregiving-related stressors, which can make them more prone to caregiver burnout and distress (Gérain & Zech, 2019). Indeed, negative relationship quality often co-occurs with a lack of support and appreciation, which over time may deprive caregivers of psychological resources that can help them effectively cope with stressors.

Taken together, we hypothesized that caregivers with more positive and/or less negative relationships with their care recipients would report reduced appraisals of difficulties and burden, as well as increased rewards over time, when their baseline appraisals were considered.

Caring for persons of different ages and disabilities

We further examined whether the lasting impact of relationship qualities on caregivers’ appraisals of caregiving varies by care recipient age and disabilities. Age and disabilities are both common indicators of limited time left in one’s life (Carstensen & Fredrickson, 1998; Sullivan-Singh et al., 2015; Wang et al., 2020), which, according to the Social Input Model, may influence caregivers’ social experiences with care recipients and their caregiving appraisals in a relational context. The Social Input Model posits that individuals regulate their emotions and modify behaviors considering their social partners’ limited time left (Fingerman & Charles, 2010). For example, individuals are more likely to behave positively when interacting with an older adult (Fingerman et al., 2008). It is possible that caregivers who have care recipients with presumably less time left due to advanced age and/or disabilities would identify greater rewards from having more positive relationships with these care recipients and improving their quality of life by providing care. Prior research following the Social Input Model has also found that adults of all ages tend to downplay negative emotions when they are involved in a tension with an older adult (Luong et al., 2011). Individuals are less likely to confront and argue if they were told that some social transgressions or rude comments were made by an older social partner, compared to a younger social partner (Miller et al., 2009). Moreover, middle-aged children have been found to avoid conflicts with their older parents who had more disabilities (Wang et al., 2020).

It is worth noting that although individuals likely develop more severe disabilities as they age (Guay et al., 2014; Okoro et al., 2018), aging and disabilities do not always co-occur. The time left in life may become smaller with age, but research has considered health indicators (e.g., HIV, cancer, disabilities that often result from chronic health conditions) to disentangle age from closeness to death (Carstensen & Fredrickson, 1998; Sullivan-Singh et al., 2015; Wang et al., 2020). As such, we asked whether caregivers of care recipients who are older and who have more disabilities would be more buffered by positive relationships with these care recipients and less bothered by negative moments in their relationships.

In sum, this study tested whether and how the baseline positive and negative relationship qualities were associated with changes in caregivers’ appraisals of difficulties, burden, and rewards over time (Hypothesis 1; see Figure 1). We expected to observe weaker associations between relationship qualities and appraisals for caregivers whose care recipients were older or had more disabilities (Hypothesis 2). We adjusted for additional care recipient and caregiver covariates when testing these hypotheses, including gender, age, education, minority status, work status, type of relationship between care recipient and caregiver (e.g., spousal caregiver, child caregiver), self-rated health, having young children to take care of, and coresidence status between the caregiver and the care recipient. Lastly, prior research has found that caregiving setting (caring for an older adult in the community vs. an older adult in residential care settings) influences caregivers’ relationships with care recipients and the amount of assistance they provide. Thus, we adjusted for caregiving setting and the level of care activities.

Figure 1.

Conceptual model for caregivers’ appraisals of caregiving between waves. Note. RQ = relationship quality.

Materials and methods

Data and sample

Data for the current study were derived from the National Health and Aging Trends Study (NHATS) and the supplemental National Study of Caregiving (NSOC). The NHATS began in 2011 with Medicare beneficiaries aged 65 and older (“sample persons”), who have been interviewed on an annual basis. Participants were recruited across the United States, with stratified sampling used to ensure recruitment from each region of the country. Some sample persons reported receiving unpaid help with daily activities (i.e., mobility activities, self-care activities, and household activities) and family members and unpaid caregivers who helped these sample persons (i.e., their informal caregivers) were identified and contacted to participate in the NSOC (Freedman et al., 2019). In 2011 and 2015, caregivers reported on aspects of their caregiving work, demographic information, and well-being (interviewed caregiver N = 2,007 in 2011 and N = 2,204 in 2015). The NSOC followed the 2015 caregiver cohort and interviewed them again in 2017 (the 2015 cohort was the only longitudinal cohort available in the NSOC). This study thus used longitudinal data from both 2015 and 2017 waves. Please see detailed data collection procedures in the NSOC User Guide (Freedman et al., 2019). In total, 2,204 caregivers caring for 1,458 sample persons participated in the NSOC in 2015, and 1,453 of these caregivers returned in 2017. Of the 751 non-returning caregivers, most dropped out of the study because their care recipients: (a) were deceased (n = 164), (b) were too till to participate (n = 81), (c) refused to participate (n = 141), and (d) could not be contacted or located (n = 30). The remaining 335 caregivers dropped out due to personal reasons. The final sample included 1,453 caregivers who participated in both waves of data collection (wave 1: 2015, wave 2: 2017), and cared for 1,047 care recipients (i.e., sample persons). To clarify, care recipients might have had multiple caregivers, but the majority of the sample (69%) had only one caregiver. Because some caregivers devoted similar number of hours to caregiving, we adjusted for the level of care activities as illustrated in the measures below, rather than identifying a primary caregiver for each care recipient. These 1,453 caregivers were older and more likely to be a child of care recipients than the 751 caregivers who did not return. It is also worth noting that 201 care recipients (19%) could not provide self-reports on their disabilities due to illnesses such as dementia; we adjusted for an indicator of the source of reports on care recipients (1 = care recipient self-report,0 = proxy report).

Measures

Relationship qualities

In the NSOC, caregivers rated the extent to which (a) they enjoyed being with care recipients, (b) they felt appreciated by care recipients, (c) care recipients argued with them, and (d) care recipients got on their nerves (Moon et al., 2017). Responses were coded from 1 (not at all) to 4 (a lot). Mean scores were calculated to assess positive (ρ = .57; the first two items) and negative relationship quality (ρ = .71; the last two items; Eisinga et al., 2013), respectively.

Caregivers’ appraisals of caregiving

In this study, we considered three indicators of caregiving appraisals: difficulties, burden, and rewards. In the NSOC, caregivers indicated whether helping care recipients was (a) financially, (b) emotionally, and (c) physically difficult for them, and if so, how difficult it was (Wolff et al., 2016). Responses to these three items were rated from 0 (not at all difficult) to 5 (very difficult), and we calculated a mean score to measure difficulties of caregiving (wave 1 α = .64; wave 2 α = .65).

Caregivers also indicated caregiver burden by rating the extent to which (a) they were exhausted when they went to bed at night, (b) they had more things to do than they could handle, (c) they did not have time for themselves, and (d) as soon as they got a routine going, care recipients’ needs changed (Skolarus et al., 2017). Responses were rated from 1 (not so much) to 3 (very much), and we generated a mean score (wave 1 α = .74; wave 2 α = .76).

For rewards of caregiving, caregivers reported the extent to which helping care recipients (a) has made them more confident about their abilities, (b) has taught them to deal with difficult situations, (c) has brought them closer to care recipients, and (d) gives them satisfaction that care recipients are well cared for (Polenick et al., 2020). Responses were rated from 1 (not so much) to 3 (very much), and were averaged across items (wave 1 α = .72; wave 2 α = .71).

Care recipient age and physical disability

The NHATS collected information about care recipients’ age in years, and whether they received assistance in a variety of mobility activities, self-care activities, and household activities (Freedman et al., 2019). Mobility activities included getting around outside, getting around inside, and getting out of bed; self-care activities included eating, bathing, showering or washing up, getting to or using the toilet, and dressing; household activities included doing laundry, shopping for personal items, preparing hot meals, paying bills or banking, keeping track of medications, sitting in medical appointments, and making medical or insurance decisions. Assistance in each activity was coded as 1 (yes) or 0 (no), and we calculated a sum score of the items to measure disabilities (α = .84; range = 1–15).

Covariates

We adjusted for some caregiver and care recipient characteristics. The NHATS collected information on care recipient gender (1 = male, 0 = female), education in sequential categories (1 = no formal education, 2 = 1^st–8^th grade, 3 = 9^th–12^th grade, 4 = high school graduate, 5 = vocational, technical, business or trade school certificate, 6 = some college but no degree, 7 = Associate’s degree, 8 = Bachelor’s degree, 9 = Master’s, professional, or Doctoral degree), racial/ethnic minority status (1 = Hispanic/Latinx, Black, Asian or other races, 0 = non-Hispanic/Latinx White), and whether they coresided with each of their caregivers (1 = yes, 0 = no). Caregivers reported age, gender (1 = male, 0 = female), two dummy variables each indicating whether the caregiver was a spouse/partner (1 = yes, 0 = no) or a child/stepchild/child-in law (1 = yes, 0 = no), work status (1 = working for pay, 0 = not working for pay/retired), having any young child (under age 18), education in categories, and self-rated health (1 = poor to 5 = excellent; Idler & Kasl, 1995). We also considered whether reports on care recipients’ characteristics were provided by themselves (1 = yes, 0 = no), whether care recipients lived in the community (1) or in residential settings (0), and the level of care activities caregivers engaged in. Caregivers reported on the frequency with which they provided help with chores, shopping, personal care, getting around home, and transportation, on a scale from 1 (rarely) to 4 (every day). Following prior research, we created a sum score (α = .67; Moon et al., 2017).

Analysis

We estimated path analyses with Mplus 8.3, adjusting for the clustering of household (i.e., multiple caregivers could be responsible for one care recipient) and applying a full information maximum likelihood (FIML) procedure to handle missing data. We first tested whether the positive and negative relationship qualities at wave 1 were associated with caregivers’ appraisals of caregiving (difficulties, burden, and rewards) at wave 2 (Hypothesis 1)—controlling for the wave 1 appraisals. We examined this hypothesis in one model, allowing the covariance between residuals of these three outcome variables. Given that we adjusted for appraisal outcomes at wave 1, the models tested subsequent changes rather than exact levels of caregiving appraisals (Castro-Schilo & Grimm, 2018; Rovine & Liu, 2012). Next, to examine whether the association between relationship qualities and caregivers’ appraisals varied by care recipient age and disabilities (Hypothesis 2), we tested interaction terms of care recipient age and disabilities. We adjusted for caregiver covariates (i.e., gender, age, education, self-rated health, racial/ethnic minority status, work status, type of relationship with care recipient, having any young child under the age of 18, coresidence status, the level of care activities) and care recipient covariates (i.e., gender, source of report, caregiving setting). All continuous variables were centered on the sample mean, and simple slopes analysis was conducted to understand significant interactions; thus, we examined the associations between relationship qualities and outcome variables at different levels of the moderator (1SD above and below the sample mean).

Results

Table 1 describes the sample characteristics. Caregivers were on average 62 years old (Mean = 62.11, Median = 63, SD = 13.61, range = 18–94) and mostly female (69%). The sample was diverse, in that almost 40% of the caregivers did not self-identify as non-Hispanic/Latinx White, with 28% identified as non-Hispanic/Latinx Black, 5% as Hispanic/Latinx, 2% as American Indian/Asian/Native Hawaiian/Pacific Islander, and 3% as multi-racial. The most common relational status reported by caregivers was being a child of care recipients (58%), followed by a spouse/partner (23%), and then others (19%; including extended family members, friends, neighbors, and acquaintances). About one third of caregivers were still working for pay, and half lived in the same households with their care recipients. Overall, caregivers in this sample provided moderate levels of assistance to their care recipients, and reported low levels of difficulties, moderate levels of burden, as well as high levels of rewards of caregiving. Paired t tests showed that both caregivers’ feelings of difficulties (t = 4.83, p < .001) and rewards (t = 4.21, p < .001) increased over time, whereas burden of caregiving was relatively stable over time (t = 0.73, p = .47). With regard to care recipients, they were almost 83 years old on average (Mean = 82.89, Median = 83, SD = 8.12, range = 65–109) and they were also mostly female (67%). In total, about 19% of care recipients (n = 201) did not provide self-reports on disabilities due to illnesses; proxy reports were collected instead. The majority of care recipients (84%) were living in the community (vs. 16% in residential care settings). Supplementary Table 1 presents bivariate correlations among all key variables.

Table 1.

Summary of sample characteristics.

	Caregivers		Care recipients
Variable	M	(SD)	M	(SD)
Male, %	31		33
Age	62.11	(13.61)	82.89	(8.22)
Education^a	5.85	(2.04)	—	—
Self-rated health^b	3.50	(1.06)	—	—
Racial/ethnic minority, %	39		—
Works for pay, %	31		—
Spouse/partner caregiver, %	23		—
Child caregiver, %	58		—
Other caregiver, %	19		—
Has any younger child under 18, %	13		—
Coresides with care recipient, %	47		—
Level of care activities^c	14.17	(4.69)	—	—
Disability^d	—	—	6.71	(3.34)
Offers self-reports, %	—		81
Lives in the community, %	—		84
Positive relationship quality^e	3.81	(0.44)	—	—
Negative relationship quality^e	2.00	(0.86)	—	—
Difficulties of caregiving^f
Wave 1	0.82	(1.12)	—	—
Wave 2	0.96	(1.21)	—	—
Burden of caregiving^g
Wave 1	1.57	(0.56)	—	—
Wave 2	1.54	(0.54)	—	—
Rewards of caregiving^g
Wave 1	2.55	(0.48)	—	—
Wave 2	2.60	(0.45)	—	—

Note. Caregiver N = 1,453; Care recipient N = 1,047.

^a1 = no formal education, 2 = 1^st–8^th grade, 3 = 9^th–12^th grade, 4 = high school graduate, 5 = vocational, technical, business or trade school certificate, 6 = some college but no degree, 7 = Associate’s degree, 8 = Bachelor’s degree, and9 = Master’s, professional, or Doctoral degree.

^b1 = poor to 5 = excellent.

^cSum of five items rated 1 = rarely to 4 = every day.

^dSum of difficulties with 12 physical movements.

^eMean of two items rated 1 = not at all to 4 = a lot.

^fMean of three items rated 0 = not at all difficult to 5 = very difficult.

^gMean of four items rated 1 = not so much to 3 = very much.

The model testing our first hypothesis exhibited good model fit (RMSEA = .07, CFI = .98; see Table 2). As expected, caregivers who had more negative relationships with care recipients reported more increased feelings of difficulties (B = 0.13, p < .001) and burden (B = 0.04, p = .050), whereas those who had more positive relationships with care recipients reported more increased rewards of caregiving over time (B = 0.09, p = .006).

Table 2.

Path analyses predicting caregiving appraisals at wave 2 from relationship qualities.

	Difficulties		Burden		Rewards
Variable	B	(SE)	B	(SE)	B	(SE)
Intercept	−0.39	(0.47)	0.31	(0.26)	1.06***	(0.21)
Positive relationship quality	0.00	(0.07)	0.01	(0.04)	0.09**	(0.03)
Negative relationship quality	0.13***	(0.04)	0.04*	(0.02)	−0.01	(0.01)
Caregiver covariates
Male	−0.07	(0.06)	−0.06*	(0.03)	0.01	(0.02)
Age	−0.00	(0.00)	0.00	(0.00)	0.00	(0.00)
Education	0.06***	(0.01)	0.01	(0.01)	−0.01	(0.01)
Self-rated health	−0.10***	(0.03)	−0.05***	(0.01)	−0.01	(0.01)
Racial/ethnic minority	−0.07	(0.06)	−0.04	(0.03)	0.08***	(0.02)
Works for pay	0.10	(0.06)	0.02	(0.03)	0.03	(0.02)
Spousal/partner caregiver^a	0.27	(0.12)	0.06	(0.06)	−0.05	(0.05)
Child caregiver^a	0.15	(0.06)	0.11**	(0.04)	−0.04	(0.03)
Any young child under age 18	−0.02	(0.09)	0.10*	(0.05)	−0.01	(0.03)
Coresides with care recipient	−0.12	(0.07)	−0.05	(0.04)	0.00	(0.03)
Level of care activities	0.02**	(0.01)	0.02***	(0.00)	0.01*	(0.00)
Appraisal outcome at wave 1^b	0.52***	(0.03)	0.46***	(0.03)	0.52***	(0.03)
Care recipient covariates
Male	0.06	(0.06)	0.06	(0.03)	0.02	(0.02)
Age	0.00	(0.00)	0.00	(0.00)	0.00	(0.00)
Disabilities	0.02	(0.01)	−0.00	(0.01)	−0.00	(0.00)
Offers self-reports	−0.14	(0.09)	−0.09	(0.05)	−0.09**	(0.03)
Lives in the community	−0.04	(0.08)	0.04	(0.04)	−0.01	(0.03)
R ²	.41		.38		.41

Note. Caregiver N = 1,453; Care recipient N = 1,047.

^aOmitted category = other caregiver.

^bSame variable as the outcome.

*p < .05. **p < .01. ***p < .001.

With regard to the moderating effects of care recipient age and disabilities (Hypothesis 2), we estimated another model (RMSEA = .02, CFI = .96; see Table 3). For caregivers’ feelings of difficulties, we found one significant interaction of negative relationship quality × care recipient age (B = −0.01, p = .011). Simple slopes analysis revealed that caregiver-reported negative relationship quality was associated with increased feelings of difficulties over time only among caregivers caring for younger care recipients (B = 0.22, p < .001), but not those caring for older care recipients (B = 0.04, p = .43; see Figure 2(a)). We also observed one significant interaction of positive relationship quality × care recipient disabilities predicting changes in caregiver burden over time (B = 0.03, p = .022). Simple slopes analysis, however, revealed two non-significant associations between positive relationship quality and caregiver burden for caregivers of care recipients with fewer disabilities (B = −0.08, p = .10) and caregivers of care recipients with more disabilities (B = 0.10, p = .10; see Figure 2(b)).

Table 3.

Care recipient age and disability as moderators in the association of relationship qualities with caregiving difficulties and rewards.

	Difficulties		Rewards
Variable	B	(SE)	B	(SE)
Intercept	1.05***	(0.12)	2.66***	(0.05)
Positive relationship quality	−0.02	(0.07)	0.09**	(0.03)
Care recipient age	−0.01	(0.01)	0.01**	(0.00)
Care recipient disabilities	0.04	(0.02)	−0.02*	(0.01)
Negative relationship quality	0.13***	(0.04)	−0.00	(0.00)
Care recipient age	−0.01*	(0.00)	0.00*	(0.00)
Care recipient disabilities	0.00	(0.01)	0.00	(0.00)
Caregiver covariates
Male	−0.07	(0.06)	0.01	(0.02)
Age	0.00	(0.00)	−0.00	(0.00)
Education	0.06***	(0.01)	−0.01	(0.01)
Self-rated health	−0.10***	(0.03)	−0.01	(0.01)
Racial/ethnic minority	−0.07	(0.06)	0.08***	(0.02)
Works for pay	0.11	(0.06)	0.03	(0.02)
Spousal/partner caregiver^a	0.24*	(0.12)	−0.04	(0.05)
Child caregiver^a	0.15*	(0.06)	−0.04	(0.03)
Any young child under age 18	−0.02	(0.09)	−0.01	(0.03)
Coresides with care recipient	−0.12	(0.07)	0.00	(0.03)
Level of care activities	0.02**	(0.01)	0.01	(0.00)
Appraisal outcome at wave 1^b	0.52***	(0.03)	0.53***	(0.03)
Care recipient covariates
Male	0.06	(0.06)	0.01	(0.02)
Age	0.00	(0.00)	0.00	(0.00)
Disabilities	0.02	(0.01)	−0.00	(0.00)
Offers self-reports	−0.15	(0.09)	−0.08**	(0.03)
Lives in the community	−0.05	(0.08)	−0.00	(0.03)
R ²	.41		.43

Note. Caregiver N = 1,453; Care recipient N = 1,047.

^aOmitted category = other caregiver.

^bSame variable as the outcome.

*p < .05. **p < .01. ***p < .001.

Figure 2.

Interaction plots predicting difficulties and burden of caregiving at wave 2. Note. Interactions of relationship quality with (a) care recipient age and (b) care recipient disabilities predicting difficulties and burden of caregiving. ***p < .001.

For rewards of caregiving, we observed two significant interactions of positive relationship with (a) care recipient age (B = 0.01, p = .004) and (b) care recipient disabilities (B = −0.02, p = .040). Simple slopes analysis revealed that positive relationships with care recipients were associated with increased rewards of caregiving only for caregivers of relatively older care recipients (B = 0.18, p < .001)—but not for those with younger care recipients (B = 0.00, p = .89; see Figure 3(a)). Positive relationship quality was also associated with greater rewards of caregiving only for caregivers whose care recipients reported lower levels of disabilities (B = 0.15, p < .001), but not for those caring for recipients with higher levels of disabilities (B = 0.03, p = .36; see Figure 3(b)).

Figure 3.

Interaction plots predicting rewards of caregiving at wave 2. Note. Interactions of relationship quality with (a) care recipient age and (b) care recipient disabilities predicting rewards of caregiving. ***p < .001.

Post-hoc tests

We performed some post-hoc tests. Given the potential co-existence of positive and negative feelings in caregiving relationships, we re-estimated our models, treating ambivalence as the key predictor. In line with prior research (Gilligan et al., 2015), we calculated an ambivalence score by integrating both positive and negative relationship qualities. Findings revealed that caregivers who experienced greater ambivalence in their relationships with care recipients tended to report more increased feelings of difficulties (B = 0.10, p < .001) and reduced rewards over time (B = −0.02, p = .034). Also, this association varied depending on care recipient age (B = −0.01, p = .038), suggesting a stronger association among caregivers with younger care recipients (B = 0.14, p < .001).

We re-estimated models to examine differences by gender. We tested interaction terms of relationship qualities × caregiver gender and relationship qualities × care recipient gender and examined them in the same models. We did not find any gender differences. We also considered the moderating effect of coresidence but did not find any significant results.

Lastly, to address the potential impact of relationship type, we estimated additional models with interaction terms involving relationship type (caregivers other than a spouse/partner or a child were treated as the reference group). Findings revealed a stronger association between negative relationship quality and rewards of caregiving among adult child caregivers, as compared to other caregivers (B = 0.09, p = .010).

Discussion

The current study adds to the existing literature by presenting a longitudinal investigation of the association between relationship qualities and caregivers’ appraisals of caregiving, and specifying the distinct roles positive versus negative relationship qualities play. We found that caregivers who had more negative relationships with care recipients experienced more negative appraisals (i.e., a greater increase in difficulties and burden) over time, whereas caregivers with more positive relationships indicated a greater increase in rewards of caregiving. We also observed interesting variations in these associations between relationship qualities and caregiving appraisals, depending on care recipient characteristics. More negative relationships with care recipients were associated with increased difficulties only among caregivers with younger care recipients, whereas for caregivers with older care recipients, positive relationships co-occurred with increased rewards of caregiving over time. Interestingly, however, despite an established positive correlation between age and disabilities, we found that positive relationships between caregivers and care recipients were associated with increased rewards of caregiving only among caregivers whose care recipients reported fewer disabilities. Findings advance our understanding of social factors related to late life caregiving, and provide empirical evidence that may help better identify caregivers at greater risk for poor outcomes and inform non-drug interventions intended to benefit both members of the caregiving dyad in the long run.

Relationship qualities and caregiving appraisals

Along with the advocation for viewing caregiving as a relational process, there has been increasing interest in the impact of relationship quality on caregiver outcomes. More specifically, prior research has primarily relied on cross-sectional data when examining the buffering effect of high-quality relationships (Hooker et al., 2015; Lum et al., 2014; Tough, Brinkhof, et al., 2017). To extend prior research, we examined independent impacts of positive and negative relationship qualities, and asked how these relationship qualities at baseline were associated with changes in caregiving appraisals over time. We found that negative relationships further increased caregivers’ difficulties and burden, whereas positive relationships brought about more rewards. As such, our findings offer additional support for the recently proposed Informal Caregiving Integrative Model (Gérain & Zech, 2019), which has particularly considered negative relationship quality as one of the main determinants of caregiver burnout and distress. Additionally, negative relationships likely co-occur with low empathy, which underlies poor quality communication and support exchanges (Huo et al., 2019; 2020; Verhofstadt et al., 2016) that may eventually lead to unmet needs (Cohen-Mansfield, 2000). Caregivers who report more negative relationships with their care recipients may have difficulty perceiving and addressing their care recipients’ needs, which over time could reduce the quality of their caregiving and further elicit their feelings of frustration and burden (Gaugler et al., 2005; Monin et al., 2020; van der Roest et al., 2007).

Our findings also contribute to the growing body of research on positive aspects of caregiving. Although most research has focused on identifying and lessening caregiver burden, more recent notions emphasize the importance of increasing rewards of caregiving (Yu et al., 2018). Our findings were in line with qualitative research that identified love as a key factor that helped caregivers maintain positive attitudes towards caregiving (Lloyd et al., 2016). Caregivers may simultaneously have positive and negative appraisals of their caregiving experiences, and interventions would be more effective if targeting both aspects. This study offers insights into the development of such interventions. For example, intervention practitioners may consider adding relationship therapies that not only promote understanding and affection in caregiving dyads, but also help improve coping strategies in the face of negative experiences.

Caring for persons of different ages and disabilities

This study tested variations in the lasting impact of relationship qualities on caregiving appraisals by care recipient age and disabilities. We observed that negative relationships were only associated with increased caregiving difficulties when care recipients were relatively younger, and positive relationships were only associated with increased caregiving rewards when care recipients were older. These findings offer empirical support to the Social Input Model in the caregiving context (Fingerman & Charles, 2010). Caregivers may perceive limited time left in older relatives’ lives and feel more motivated to dampen negative feelings and focus on positive experiences when caring for older care recipients. Indeed, our post-hoc tests examining ambivalence—co-occurrence of positive and negative feelings in a relationship found that caregivers of younger care recipients were more vulnerable to ambivalence. Further, consistent with socioemotional selectivity theory, older care recipients may be better able to sustain pleasant encounters and to deal with unpleasant tensions with their caregivers due to age-related strengths in emotion regulation (Charles & Carstensen, 2010), which could presumably increase rewards and reduce difficulties for these caregivers. Prior research has mostly documented that the link between negative relationship quality and poor well-being may be weaker among older individuals (especially those aged 80+; Birditt et al., 2018). Our study corroborated these findings by suggesting both a boosting effect of age on the benefits of positive relationships and a buffering effect of age on the downsides of negative relationships.

Interestingly, we found that having positive relationships with care recipients seemed to be more important to caregivers whose care recipients had lower levels of disabilities. Caregivers’ positive relationships with care recipients were not associated with changes in caregiving rewards over time if these care recipients reported greater disabilities. People with fewer disabilities require less assistance from their caregivers, so it is possible that these caregivers can more effectively contribute to these care recipients’ welfare and thus to experience greater rewards related to relationship gains or sense of duty (Lloyd et al., 2016). For caregivers whose care recipients struggle with greater disabilities, however, they may not be able to enjoy caregiving even if they maintain highly positive relationships with these care recipients. Scholars suggest that positive relationships can trigger distress when these relationships involve health concerns and suffering (Kiecolt-Glaser & Wilson, 2017; Monin et al., 2017). It is worth noting that the data we drew from did not reveal specific causes of care recipients’ disabilities, which may or may not result from a life limiting illness (e.g., Parkinson’s or Alzheimer’s). Future research may benefit from examining relationship quality in more depth, such as by exploring the role of specific social experiences that may occur in more positive caregiving relationships (e.g., dyadic coping, mutual understanding).

Limitations and conclusion

There are several limitations that warrant consideration. Relationship quality was solely reported by caregivers, but prior research has documented discrepancy in spousal reports on relationship quality (Carr & Boerner, 2009), especially among caregiving couples (Clare et al., 2012). The 2-item measures of relationship quality used in the NSOC data are also limited. For example, the measure of positive relationship quality only tapped companionship enjoyment and appreciation—not love, affection, or support. Moreover, little context was provided regarding how long caregivers had been helping care recipients, and what their relationship was like prior to the 2015 measure. We drew on 2-wave data collected with an interval of 2 years. Researchers may examine even longer-term effects of relationship quality when future waves become available. Further, although we adjusted for care recipients’ physical disability at baseline, it would be helpful to obtain more information regarding how long they have been disabled. Indeed, the progression of disability may occur at different paces in different phases. Some older adults may live with one disability for many years, whereas those who have been restricted in many aspects of daily living may live under stress and are more likely to develop chronic health conditions and additional disabilities (Almeida, 2005; Knight et al., 2021). Lastly, it is worth noting that the small coefficients reported in this study, although statistically significant, should be interpreted with caution.

Despite these limitations, the current study offers a longitudinal investigation that advances our understanding of how the baseline quality of relationships between care recipients and caregivers may influence caregivers’ appraisals of caregiving over time. Our findings revealed both positive and negative impacts of caregiving relationships and identified individual differences in these impacts depending on care recipient characteristics. This study provides further empirical evidence regarding the need for dyadic interventions that foster mutually beneficial relationships between caregivers and their care recipients (Rausch et al., 2017). It is crucial to focus on both lessening negative appraisals of caregiving and promoting positive appraisals. We also argue that these interventions may be more effective for improving quality of life for caregivers caring for older care recipients, or those with lower levels of disabilities.

Supplemental Material

Supplemental Material - Lasting impact of relationships on caregiving difficulties, burden, and rewards

Supplemental Material for Lasting impact of relationships on caregiving difficulties, burden, and rewards by Meng Huo and Kyungmin Kim in Journal of Social and Personal Relationships

Footnotes

Author contributions

M. Huo planned the study, reviewed the literature, performed all statistical analyses and wrote the paper. K. Kim helped to plan the study, supervised data analysis, and contributed to revising the paper.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Meng Huo

Kyungmin Kim

Open research statement

As part of IARR’s encouragement of open research practices, the author(s) have provided the following information: This research was not pre-registered. The data and materials used in the research are available to registered users, and can be obtained at .

Supplemental Material

Supplemental material for this article is available online.

References

Abdollahpour

Nedjat

Salimi

(2018). Positive aspects of caregiving and caregiver burden: A study of caregivers of patients with dementia. Journal of Geriatric Psychiatry and Neurology, 31(1), 34–38. https://doi.org/10.1177/0891988717743590

Ablitt

Jones

G. V.

Muers

(2009). Living with dementia: A systematic review of the influence of relationship factors. Aging & Mental Health, 13(4), 497–511. https://doi.org/10.1080/13607860902774436

Almeida

D. M.

(2005). Resilience and vulnerability to daily stressors assessed via diary methods. Current Directions in Psychological Science, 14(2), 64–68. https://doi.org/10.1111/j.0963-7214.2005.00336.x

August

K. J.

Rook

K. S.

Newsom

J. T.

(2007). The joint effects of life stress and negative social exchanges on emotional distress. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 62(5), S304–S314. https://doi.org/10.1093/geronb/62.5.S304

Birditt

K. S.

Tighe

L. A.

Nevitt

M. R.

Zarit

S. H.

(2018). Daily social interactions and the biological stress response: Are there age differences in links between social interactions and alpha-amylase? The Gerontologist, 58(6), 1114–1125. https://doi.org/10.1093/geront/gnx168

Brady

T. J.

Murphy

O’Colmain

B. J.

Beauchesne

Daniels

Greenberg

House

Chervin

(2013). A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program. Preventing Chronic Disease, 10, 120112. https://doi.org/10.5888/pcd10.120112

Carbonneau

Caron

Desrosiers

(2010). Development of a conceptual framework of positive aspects of caregiving in dementia. Dementia, 9(3), 327–353. https://doi.org/10.1177/1471301210375316

Carr

Boerner

(2009). Do spousal discrepancies in marital quality assessments affect psychological adjustment to widowhood? Journal of Marriage and Family, 71(3), 495–509. https://doi.org/10.1111/j.1741-3737.2009.00615.x

Carstensen

L. L.

Fredrickson

B. L.

(1998). Influence of HIV status and age on cognitive representations of others. Health Psychology, 17(6), 494–503. https://doi.org/10.1037/0278-6133.17.6.494

10.

Castro-Schilo

Grimm

K. J.

(2018). Using residualized change versus difference scores for longitudinal research. Journal of Social and Personal Relationships, 35(1), 32–58. https://doi.org/10.1177/0265407517718387

11.

Charles

S. T.

Carstensen

L. L.

(2010). Social and emotional aging. Annual Review of Psychology, 61(1), 383–409. https://doi.org/10.1146/annurev.psych.093008.100448

12.

Chatterji

Byles

Cutler

Seeman

Verdes

(2015). Health, functioning, and disability in older adults: Present status and future implications. Lancet, 385(9967), 563–575. https://doi.org/10.1016/S0140-6736(14)61462-8

13.

Clare

Nelis

S. M.

Whitaker

C. J.

Martyr

Markova

I. S.

Roth

Woods

R. T.

Morris

R. G.

(2012). Marital relationship quality in early-stage dementia: Perspectives from people with dementia and their spouses. Alzheimer Disease and Associated Disorders, 26(2), 148–158. https://doi.org/10.1097/WAD.0b013e318221ba23

14.

Cohen

Janicki-Deverts

Turner

R. B.

Doyle

W. J.

(2015). Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychological Science, 26(2), 135–147. https://doi.org/10.1177/0956797614559284

15.

Cohen

Wills

T. A.

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310

16.

Cohen-Mansfield

(2000). Theoretical frameworks for behavioral problems in dementia. Alzheimer’s Care Today, 1(4), 8–21.

17.

Cooper

Balamurali

T. B.

Livingston

(2007). A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia. International Psychogeriatrics, 19(2), 175–195. https://doi.org/10.1017/S1041610206004297

18.

Creaven

A.-M.

Higgins

N. M.

Ginty

A. T.

Gallagher

(2020). Social support, social participation, and cardiovascular reactivity to stress in the Midlife in the United States (MIDUS) study. Biological Psychology, 155, 107921. https://doi.org/10.1016/j.biopsycho.2020.107921

19.

Crellin

N. E.

Orrell

McDermott

Charlesworth

(2014). Self-efficacy and health-related quality of life in family carers of people with dementia: A systematic review. Aging & Mental Health, 18(8), 954–969. https://doi.org/10.1080/13607863.2014.915921

20.

Cuijpers

(2005). Depressive disorders in caregivers of dementia patients: A systematic review. Aging & Mental Health, 9(4), 325–330. https://doi.org/10.1080/13607860500090078

21.

Davis

L. L.

Gilliss

C. L.

Deshefy-Longhi

Chestnutt

D. H.

Molloy

(2011). The nature and scope of stressful spousal caregiving relationships. Journal of Family Nursing, 17(2), 224–240. https://doi.org/10.1177/1074840711405666

22.

Eisinga

Te Grotenhuis

Pelzer

(2013). The reliability of a two-item scale: Pearson, Cronbach, or Spearman-Brown? International Journal of Public Health, 58(4), 637–642. https://doi.org/10.1007/s00038-012-0416-3

23.

Fauth

Hess

Piercy

Norton

Corcoran

Rabins

Lyketsos

Tschanz

(2012). Caregivers’ relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers’ physical health and psychological well-being. Aging & Mental Health, 16(6), 699–711. https://doi.org/10.1080/13607863.2012.678482

24.

Fingerman

K. L.

Charles

S. T.

(2010). It takes two to tango: Why older people have the best relationships. Current Directions in Psychological Science, 19(3), 172–176. https://doi.org/10.1177/0963721410370297

25.

Fingerman

K. L.

Miller

Charles

(2008). Saving the best for last: How adults treat social partners of different ages. Psychology and Aging, 23(2), 399–409. https://doi.org/10.1037/0882-7974.23.2.399

26.

Freedman

V. A.

Skehan

M. E.

Wolff

J. L.

Kasper

J. D.

(2019). National study of caregiving I-III user guide. Johns Hopkins Bloomberg School of Public Health. https://www.nhats.org

27.

Galvin

J. E.

Tolea

M. I.

Chrisphonte

(2020). The positive and negative appraisals of caregiving (PANAC) scale: A new measure to examine the caregiving experience in Alzheimer’s disease and related dementias. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 6(1), e12104. https://doi.org/10.1002/trc2.12104

28.

Gaugler

J. E.

Kane

R. L.

Kane

R. A.

Newcomer

(2005). Unmet care needs and key outcomes in dementia. Journal of the American Geriatrics Society, 53(12), 2098–2105. https://doi.org/10.1111/j.1532-5415.2005.00495.x

29.

Gérain

Zech

(2019). Informal caregiver burnout? Development of a theoretical framework to understand the impact of caregiving. Frontiers in Psychology, 10, 1748. https://doi.org/10.3389/fpsyg.2019.01748

30.

Gilligan

Suitor

J. J.

Feld

Pillemer

(2015). Do positive feelings hurt? Disaggregating positive and negative components of intergenerational ambivalence. Journal of Marriage and Family, 77(1), 261–276. https://doi.org/10.1111/jomf.12146

31.

Goode

K. T.

Haley

W. E.

Roth

D. L.

Ford

G. R.

(1998). Predicting longitudinal changes in caregiver physical and mental health: A stress process model. Health Psychology, 17(2), 190–198. https://doi.org/10.1037/0278-6133.17.2.190

32.

Greenglass

Fiksenbaum

Eaton

(2006). The relationship between coping, social support, functional disability and depression in the elderly. Anxiety, Stress, and Coping, 19(1), 15-31. https://doi.org/10.1080/14659890500436430

33.

Guay

Dubois

M.-F.

Corrada

Lapointe-Garant

M.-P.

Kawas

(2014). Exponential increases in the prevalence of disability in the oldest old: A Canadian national survey. Gerontology, 60(5), 395–401. https://doi.org/10.1159/000358059

34.

Hooker

S. A.

Grigsby

M. E.

Riegel

Bekelman

D. B.

(2015). The impact of relationship quality on health-related outcomes in heart failure patients and informal family caregivers: An integrative review. Journal of Cardiovascular Nursing, 30(4S), S52–S63. https://doi.org/10.1097/JCN.0000000000000270

35.

Hooley

P. J. D.

Butler

Howlett

J. G.

(2005). The relationship of quality of life, depression, and caregiver burden in outpatients with congestive heart failure. Congestive Heart Failure, 11(6), 303–310. https://doi.org/10.1111/j.1527-5299.2005.03620.x

36.

Huo

Fuentecilla

J. L.

Birditt

K. S.

Fingerman

K. L.

(2019). Older adults’ empathy and daily support exchanges. Journal of Social and Personal Relationships, 36(11-12), 3814-3834. https://doi.org/10.1177/0265407519837372

37.

Huo

Fuentecilla

J. L.

Birditt

K. S.

Fingerman

K. L.

(2020). Empathy and close social ties in late life. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 75(8), 1648–1657. https://doi.org/10.1093/geronb/gbz044

38.

Idler

E. L.

Kasl

S. V.

(1995). Self-ratings of health: Do they also predict change in functional ability? The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 50(6), S344–S353. https://doi.org/10.1093/geronb/50B.6.S344

39.

Kiecolt-Glaser

J. K.

Wilson

S. J.

(2017). Lovesick: How couples’ relationships influence health. Annual Review of Clinical Psychology, 13(1), 421–443. https://doi.org/10.1146/annurev-clinpsy-032816-045111

40.

Knight

E. L.

Jiang

Rodriguez-Stanley

Almeida

D. M.

Engeland

C. G.

Zilioli

(2021). Perceived stress is linked to heightened biomarkers of inflammation via diurnal cortisol in a national sample of adults. Brain, Behavior, and Immunity, 93, 206-213. https://doi.org/10.1016/j.bbi.2021.01.015

41.

Lloyd

Patterson

Muers

(2016). The positive aspects of caregiving in dementia: A critical review of the qualitative literature. Dementia, 15(6), 1534–1561. http://doi.org/10.1177/1471301214564792

42.

Lum

H. D.

Hooker

Bekelman

D. B.

(2014). Caregiving in heart failure: Relationship quality is associated with caregiver benefit finding and caregiver burden. Heart and Lung, 43(4), 306–310. https://doi.org/10.1016/j.hrtlng.2014.05.002

43.

Luong

Charles

S. T.

Fingerman

K. L.

(2011). Better with age: Social relationships across adulthood. Journal of Social and Personal Relationships, 28(1), 9–23. https://doi.org/10.1177/0265407510391362

44.

Lwi

S. J.

Ford

B. Q.

Casey

J. J.

Miller

B. L.

Levenson

R. W.

(2017). Poor caregiver mental health predicts mortality of patients with neurodegenerative disease. Proceedings of the National Academy of Sciences, 114(28), 7319–7324. https://doi.org/10.1073/pnas.1701597114

45.

Mattson

R. E.

Paldino

Johnson

M. D.

(2007). The increased construct validity and clinical utility of assessing relationship quality using separate positive and negative dimensions. Psychological Assessment, 19(1), 146–151. https://doi.org/10.1037/1040-3590.19.1.146

46.

Miller

L. M.

Charles

S. T.

Fingerman

K. L.

(2009). Perceptions of social transgressions in adulthood: Does age make a difference? The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 64(5), 551–559. https://doi.org/10.1093/geronb/gbp062

47.

Monin

J. K.

Jorgensen

T. D.

Vroomen

J. L.

(2020). Self-reports and caregivers’ proxy reports of unmet needs of persons with dementia: Implications for both partners’ health-related quality of life. The American Journal of Geriatric Psychiatry, 28(3), 363–367. https://doi.org/10.1016/j.jagp.2019.10.006

48.

Monin

J. K.

Levy

B. R.

Kane

H. S.

(2017). To love is to suffer: Older adults’ daily emotional contagion to perceived spousal suffering. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 72(3), 383–387. https://doi.org/10.1093/geronb/gbv070

49.

Moon

Rote

Beaty

J. A.

(2017). Caregiving setting and baby boomer caregiver stress processes: Findings from the national study of caregiving (NSOC). Geriatric Nursing, 38(1), 57–62. https://doi.org/10.1016/j.gerinurse.2016.07.006

50.

Okoro

C. A.

Hollis

N. D.

Cyrus

A. C.

Griffin-Blake

(2018). Prevalence of disabilities and health care access by disability status and type among adults—United States, 2016. Morbidity and Mortality Weekly Report, 67(32), 882-887. https://doi.org/10.15585/mmwr.mm6732a3

51.

Pearlin

L. I.

Mullan

J. T.

Semple

S. J.

Skaff

M. M.

(1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594. https://doi.org/10.1093/geront/30.5.583

52.

Polenick

C. A.

Min

Kales

H. C.

(2020). Medical comorbidities of dementia: Links to caregivers’ emotional difficulties and gains. Journal of the American Geriatrics Society, 68(3), 609–613. https://doi.org/10.1111/jgs.16244

53.

Pristavec

(2019). The caregiving dyad: Do caregivers’ appraisals of caregiving matter for care recipients’ health? Archives of Gerontology and Geriatrics, 82, 50-60. https://doi.org/10.1016/j.archger.2019.01.020

54.

Quinn

Clare

Woods

(2009). The impact of the quality of relationship on the experiences and wellbeing of caregivers of people with dementia: A systematic review. Aging & Mental Health, 13(2), 143–154. https://doi.org/10.1080/13607860802459799

55.

Quinn

Clare

Woods

R. T.

(2012). What predicts whether caregivers of people with dementia find meaning in their role? International Journal of Geriatric Psychiatry, 27(11), 1195–1202. https://doi.org/10.1002/gps.3773

56.

Rausch

Caljouw

M. A.

Van der Ploeg

E. S.

(2017). Keeping the person with dementia and the informal caregiver together: A systematic review of psychosocial interventions. International Psychogeriatrics, 29(4), 583–593. https://doi.org/10.1017/S1041610216002106

57.

Rippon

Quinn

Martyr

Morris

Nelis

S. M.

Jones

I. R.

Victor

C. R.

Clare

(2020). The impact of relationship quality on life satisfaction and well-being in dementia caregiving dyads: Findings from the IDEAL study. Aging & Mental Health, 24(9), 1411–1420. https://doi.org/10.1080/13607863.2019.1617238

58.

Rook

K. S.

(2015). Social networks in later life: Weighing positive and negative effects on health and well-being. Current Directions in Psychological Science, 24(1), 45–51. https://doi.org/10.1177/0963721414551364

59.

Rovine

M. J.

Liu

(2012). Structural equation modeling approaches to longitudinal data. In Newsom

J. T.

Jones

R. N.

Hofer

S. M.

(Eds), Longitudinal data analysis: A practical guide for researchers in aging, health, and social sciences (pp. 243–270). Routledge/Taylor & Francis Group.

60.

Skolarus

L. E.

Freedman

V. A.

Feng

Burke

J. F.

(2017). African American stroke survivors: More caregiving time, but less caregiving burden. Circulation: Cardiovascular Quality and Outcomes, 10(2), e003160. https://doi.org/10.1161/CIRCOUTCOMES.116.003160

61.

Sullivan-Singh

S. J.

Stanton

A. L.

Low

C. A.

(2015). Living with limited time: Socioemotional selectivity theory in the context of health adversity. Journal of Personality and Social Psychology, 108(6), 900–916. https://doi.org/10.1037/a0039047

62.

Tough

Brinkhof

M. W.

Siegrist

Fekete

(2017). Subjective caregiver burden and caregiver satisfaction: The role of partner relationship quality and reciprocity. Archives of Physical Medicine and Rehabilitation, 98(10), 2042–2051. https://doi.org/10.1016/j.apmr.2017.02.009

63.

Tough

Siegrist

Fekete

(2017). Social relationships, mental health and wellbeing in physical disability: A systematic review. BMC Public Health, 17(1), 414. https://doi.org/10.1186/s12889-017-4308-6

64.

van der Roest

H. G.

Meiland

F. J.

Maroccini

Comijs

H. C.

Jonker

Dröes

R.-M.

(2007). Subjective needs of people with dementia: A review of the literature. International Psychogeriatrics, 19(3), 559–592. https://doi.org/10.1017/S1041610206004716

65.

Verhofstadt

L. L.

Devoldre

Buysse

Stevens

Hinnekens

Ickes

Davis

(2016). The role of cognitive and affective empathy in spouses’ support interactions: An observational study. Plos One, 11(2), e0149944. https://doi.org/10.1371/journal.pone.0149944

66.

Wadham

Simpson

Rust

Murray

(2016). Couples’ shared experiences of dementia: A meta-synthesis of the impact upon relationships and couplehood. Aging & Mental Health, 20(5), 463–473. https://doi.org/10.1080/13607863.2015.1023769

67.

Wang

Kim

Birditt

K. S.

Zarit

S. H.

Fingerman

K. L.

(2020). Middle-aged children’s coping strategies with tensions in the aging parent-child tie. The International Journal of Aging and Human Development, 90(3), 234–254. https://doi.org/10.1177/0091415018822079

68.

Wolff

J. L.

Spillman

B. C.

Freedman

V. A.

Kasper

J. D.

(2016). A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Internal Medicine, 176(3), 372–379. https://doi.org/10.1001/jamainternmed.2015.7664

69.

L.-W.

Chen

W.-L.

Peng

T.-C.

Chiang

S.-T.

Yang

H.-F.

Sun

Y.-S.

Chan

J. Y.-H.

Kao

T.-W.

(2016). All-cause mortality risk in elderly individuals with disabilities: A retrospective observational study. BMJ Open, 6(9), e011164. https://doi.org/10.1136/bmjopen-2016-011164

70.

D. S. F.

Cheng

S.-T.

Wang

(2018). Unravelling positive aspects of caregiving in dementia: An integrative review of research literature. International Journal of Nursing Studies, 79, 1-26. https://doi.org/10.1016/j.ijnurstu.2017.10.008

71.

Zarit

S. H.

Kim

Femia

E. E.

Almeida

D. M.

Klein

L. C.

(2014). The effects of adult day services on family caregivers’ daily stress, affect, and health: Outcomes from the Daily Stress and Health (DaSH) study. The Gerontologist, 54(4), 570–579. https://doi.org/10.1093/geront/gnt045

72.

Zarit

S. H.

Polenick

C. A.

DePasquale

Liu

Bangerter

L. R.

(2019). Family support and caregiving in middle and late life. In Fiese

B. H.

Celano

M. E.

Deater-Deckard

Jouriles

E. N.

Whisman

M. A.

(Eds), APA handbook of contemporary family psychology: Applications and broad impact of family psychology (pp. 103–119). American Psychological Association. https://doi.org/10.1037/0000100-007

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.14 MB

Lasting impact of relationships on caregiving difficulties,burden,and rewards

Abstract

Keywords

Introduction

Positive and negative relationship qualities

Relationship qualities and caregiving appraisals

Caring for persons of different ages and disabilities

Materials and methods

Data and sample

Measures

Relationship qualities

Caregivers’ appraisals of caregiving

Care recipient age and physical disability

Covariates

Analysis

Results

Post-hoc tests

Discussion

Relationship qualities and caregiving appraisals

Caring for persons of different ages and disabilities

Limitations and conclusion

Supplemental Material

Supplemental Material - Lasting impact of relationships on caregiving difficulties, burden, and rewards

Footnotes

Author contributions

Declaration of conflicting interests

Funding

ORCID iDs

Open research statement

Supplemental Material

References

Supplementary Material