Informal family-based care of dependent adults places a significant burden on caregivers. The impact of caregiving on subjective wellbeing, preventive behaviours, lifestyle and employment is well documented, and there is good evidence for increases in risk factors for serious illness, although evidence on actual incidence of major illness varies between studies. The individual-based focus of much research on this topic has tended to obscure the social and cultural forces underlying the fact that the majority of family caregivers are women, and to ignore the gender inequities which are perpetuated by an assumption that family caregiving is naturally the work of women. This article reviews evidence on the burden of caregiving, and argues for psychological research which addresses issues of public policy rather than the individual woman and her personal ability to cope.
Abel, E. K. (1987). Love is not enough: Family care for the frail elderly. Washington, DC: American Public Health Association.
2.
Abel, E. K. (1991). Who cares for the elderly? Public policy and the experiences of adult daughters. Philadelphia, PA: Temple University Press.
3.
Allen, K. R., & Walker, A. J. (1992). A feminist analysis of interviews with elderly mothers and their daughters. In J. F. Gilgun, K. Daly & G. Handel (Eds.), Qualitative methods in family research (pp. 198–214). Newbury Park, CA: Sage.
4.
Angel, R. J., Angel, J. L., & Himes, C. L. (1992). Minority group status, health transitions, and community living arrangements among the elderly. Research on Aging, 14, 496–521.
5.
Apter, T. (1993). Professional progress: Why women still don't have wives. Basingstoke, UK: Macmillan.
6.
Aronson, J. (1992). Women's sense of responsibility for the care of old people: ‘But who else is going to do it?’Gender and Society, 6, 8–29.
7.
Barkley, M. L. (1993). Balancing work and family: The experience of new parents. Australian Journal of Marriage and the Family, 14, 143–150.
8.
Barusch, A. S., & Spaid, W. M. (1996). Spouse caregivers and the caregiving experience: Does cognitive impairment make a difference?Journal of Gerontological Social Work, 25, 93–105.
9.
Bass, D. M., Noelker, L. S., & Rechlin, L. R. (1996). The moderating influence of service use on negative caregiving consequences. Journals of Gerontology, 51B, S121–S131.
10.
Biglan, A. (1993). Recapturing Skinner's legacy to behavior therapy. Behavior Therapist, 16, 3–5.
11.
Biglan, A., Glasgow, R. E., & Singer, G. (1990). The need for a science of larger social units: A contextual approach. Behavior Therapy, 21, 195–215.
12.
Brackley, M. H. (1994). The plight of American family caregivers: Implications for nursing. Perspectives in Psychiatric Care, 30(4), 14–20.
13.
Brody, E. M., Litvin, S. J., Hoffman, C., & Kleban, M. H. (1992). Differential effects of daughters' marital status on their parent care experiences. Gerontologist, 32, 58–67.
14.
Burton, L. C., Newsom, J. T., Schulz, R., Hirsch, C. H., & German, P. S. (1997). Preventive health behaviors among spousal caregivers. Preventive Medicine, 26, 162–169.
15.
Canadian Study of Health and Aging. (1994). Patterns of caring for people with dementia in Canada. Canadian Journal on Aging, 13, 470–487.
16.
Caradoc-Davies, T. H., & Harvey, J. M. (1995). Do ‘social relief’ admissions have any effect on patients or their care-givers?Disability and Rehabilitation, 17, 247–251.
17.
Chang, C. F., & White-Means, S. I. (1991). The men who care: An analysis of male primary caregivers who care for frail elderly at home. Journal of Applied Gerontology, 10, 343–358.
18.
Choi, N. G. (1994). Patterns and determinants of social service utilization: Comparison of the childless elderly and elderly parents living with or apart from their children. Gerontologist, 34, 353–362.
19.
Clarke, C. J., & Neidert, L. J. (1992). Living arrangements of the elderly: An examination of differences according to ancestry and generation. Gerontologist, 32, 796–804.
20.
Clulow, C. (1995). Who cares? Implications of caring responsibilities for couples and families. Sexual and Marital Therapy, 10, 63–68.
21.
Cohen, C. A., Gold, D. P., Shulman, K. I., & Zucchero, C. A. (1994). Positive aspects in caregiving: An overlooked variable in research. Canadian Journal on Aging, 11, 378–391.
22.
Collins, C., & Ogle, K. (1994). Patterns of predeath service use by dementia patients with a family caregiver. Journal of the American Geriatrics Society, 42, 719–722.
23.
Cott, N. (1977). The bonds of womanhood: Women's sphere in New England, 1780–1835. New Haven, CT: Yale University Press.
24.
Crimmins, E. M., & Ingegneri, D. G. (1990). Interaction and living arrangements of older parents and their children: Past trends, present determinants, future implications. Research on Aging, 12, 3–35.
25.
Dalley, G. (1988). Ideologies of caring: Rethinking community and collectivism. London: Macmillan.
26.
Domingo, L. J., & Asis, M. M. B. (1995). Living arrangements and the flow of support between generations in the Philippines. Journal of Cross-Cultural Gerontology, 10, 21–51.
27.
Doress-Worters, P. B. (1994). Adding elder care to women's multiple roles: A critical review of the caregiver stress and multiple roles literatures. Sex Roles, 31, 597–616.
28.
Draper, B. M., Poulos, C. J., Cole, A. M., Poulos, R. G., & Ehrlich, F. (1992). A comparison of caregivers for elderly stroke and dementia victims. Journal of the American Geriatrics Society, 40, 896–901.
29.
Dwyer, J. W., & Coward, R. T. (1991). A multivariate comparison of the involvement of adult sons versus daughters in the care of impaired parents. Journals of Gerontology, 46, S259–S269.
30.
Ehrlich, F., Bowring, G., Draper, B., Poulos, C., & Salgado, R. (1992). Caring for carers: A national problem. Medical Journal of Australia, 156, 590–592.
31.
England, M. (1995). Crisis and the filial caregiving situation of African American adult offspring. Issues in Mental Health Nursing, 16, 143–163.
32.
Fakhoury, W., McCarthy, M., & Addington-Hall, J. (1996). Determinants of informal caregivers' satisfaction with services for dying cancer patients. Social Science and Medicine, 42, 721–731.
33.
Falloon, I. R. H., Graham-Hole, V., & Woodroffe, R. (1993). Stress and health of informal carers of people with chronic mental disorders. Journal of Mental Health, 2, 165–173.
34.
Feinberg, L. F., & Kelly, K. A. (1995). A well-deserved break: Respite programs offered by California's statewide system of caregiver resource centers. Gerontologist, 35, 701–705.
35.
Finch, J., & Groves, D. (Eds.). (1983). A labour of love: Women, work and caring. London: Routledge & Kegan Paul.
36.
Fisher, M. (1994). Man-made care: Community care and older male carers. British Journal of Social Work, 24, 659–680.
37.
Fuller-Jonap, F., & Haley, W. E. (1995). Mental and physical health of male caregivers of a spouse with Alzheimer's disease. Journal of Aging and Health, 7, 99–118.
38.
Gallagher-Thompson, D., & DeVries, H. M. (1994). ‘Coping with frustration’ classes: Development and preliminary outcomes with women who care for relatives with dementia. Gerontologist, 34, 548–552.
39.
Gallagher-Thompson, D., & Steffen, A. M. (1994). Comparative effects of cognitive–behavioral and brief psychodynamic psychotherapies for depressed family caregivers. Journal of Consulting and Clinical Psychology, 62, 543–549.
40.
Gelfand, D. E., & McCallum, J. (1994). Immigration, the family, and female caregivers in Australia. Journal of Gerontological Social Work, 22(3–4), 41–59.
41.
George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: A multidimensional examination of family caregivers of demented adults. Gerontologist, 26, 253–259.
42.
Glaser, R., & Kiecolt-Glaser, J. K. (1997). Chronic stress modulates the virus-specific immune response to latent herpes simplex virus type 1. Annals of Behavioral Medicine, 19, 78–82.
43.
Gold, D. P., Reis, M. F., Markiewicz, D., & Andres, D. (1995). When home caregiving ends: A longitudinal study of outcomes for caregivers of relatives with dementia. Journal of the American Geriatrics Society, 43, 10–16.
44.
Gonyea, J. G. (1995). Middle age. In D. Levinson (Ed.), Encyclopedia of marriage and the family. New York: Macmillan.
45.
Gonyea, J. G., & Googins, B. K. (1992). Linking the worlds of work and family: Beyond the productivity trap. Human Resource Management, 31, 209–226.
46.
Harris, P. B., & Long, S. O. (1993). Daughter-inlaw's burden: An exploratory study of caregiving in Japan. Journal of Cross-Cultural Gerontology, 8, 97–118.
47.
Hashimoto, A. (1991). Living arrangements of the aged in seven developing countries: A preliminary analysis. Journal of Cross-Cultural Gerontology, 6, 359–381.
48.
Henderson, K. A. (1990). The meaning of leisure for women: An integrative review of the research. Journal of Leisure Research, 22, 228–243.
49.
Hennessy, C. H., & John, R. (1996). American Indian family caregivers' perceptions of burden and needed support services. Journal of Applied Gerontology, 15, 275–293.
50.
Hollingsworth, E. (1994). Falling through the cracks: Care of the chronically mentally ill in the United States. In J. Hollingsworth & E. Hollingsworth (Eds.), Care of the chronically and severely ill (pp. 145–172). New York: Aldine de Gruyter.
51.
Hooyman, N. R., & Gonyea, J. (1995). Feminist perspectives on family care: Policies for gender justice. Thousand Oaks, CA: Sage.
52.
Hu, T., Huang, L., & Cartwright, W. W. (1986). Evaluation of the costs of caring for the senile demented elderly: A pilot study. Gerontologist, 26, 158–163.
53.
Jutras, S., & Lavoie, J.-P. (1995). Living with an impaired elderly person: The informal caregiver's physical and mental health. Journal of Aging and Health, 7, 46–73.
54.
Jutras, S., & Veilleux, F. (1991). Informal caregiving: Correlates of perceived burden. Canadian Journal on Aging, 10, 40–55.
55.
Kaye, L. W., & Applegate, J. S. (1990). Men as caregivers to the elderly: Understanding and aiding unrecognised family support. Lexington, MA: Lexington Books.
56.
Keddy, B., Cable, B., Quinn, S., & Melanson, J. (1993). Interrupted work histories: Retired women telling their stories. Health Care for Women International, 14, 437–446.
57.
Kiecolt-Glaser, J. K., & Glaser, R. (1994). Caregivers, mental health, and immune function. In E. Light, G.Niederehe & B. D. Lebowitz (Eds.), Stress effects on family caregivers of Alzheimer's patients: Research and interventions (pp. 64–75). New York: Springer.
58.
King, A. C., Oka, R. K., & Young, D. R. (1994). Ambulatory blood pressure and heart rate responses to the stress of work and caregiving in older women. Journals of Gerontology, 49, M239–M245.
59.
Knodel, J., Saengtienchai, C., & Sittitrai, W. (1995). Living arrangements of the elderly in Thailand: Views of the populace. Journal of Cross-Cultural Gerontology, 10, 79–111.
60.
LeBlanc, A. J., Aneshensel, C. S., & Wight, R. G. (1995). Psychotherapy use and depression among AIDS caregivers. Journal of Community Psychology, 23, 127–142.
61.
Lee, C. (1994). Health care, psychology, and a healthy society. Australian Psychologist, 29, 15–17.
62.
Lee, C. (1998). Alternatives to cognition. Mahwah, NJ: Lawrence Erlbaum Associates.
63.
Lee, M.-L., Lin, H. S., & Chang, M. C. (1995). Living arrangements of the elderly in Taiwan: Qualitative evidence. Journal of Cross-Cultural Gerontology, 10, 53–78.
64.
Leutz, W. N., Capitman, J. A., MacAdam, M., & Abrahams, R. (1992). Care for frail elders: Developing community solutions. Westport, CT: Auburn House.
65.
Magni, E., Zanetti, O., Bianchetti, A., Binetti, G., & Trabucchi, M. (1995). Evaluation of an Italian educational programme for dementia caregivers: Results of a small-scale pilot study. International Journal of Geriatric Psychiatry, 10, 569–573.
66.
Max, W., Webber, P., & Fox, P. (1995). Alzheimer's disease: The unpaid burden of caring. Journal of Aging and Health, 7, 179–199.
67.
McKinlay, J. B., Crawford, S. L., & Tennstedt, S. L. (1995). The everyday impacts of providing informal care to dependent elders and their consequences for the care recipients. Journal of Aging and Health, 7, 497–528.
68.
McNaughton, M. E., Patterson, T. L., Smith, T. L., & Grant, I. (1995). The relationship among stress, depression, locus of control, irrational beliefs, social support, and health in Alzheimer's disease caregivers. Journal of Nervous and Mental Disease, 183, 78–85.
69.
Mehta, K., Osman, M. M., & Lee, A. E. Y. (1995). Living arrangements of the elderly in Singapore: Cultural norms in transition. Journal of Cross-Cultural Gerontology, 10, 113–143.
70.
Miller, B., McFall, S., & Montgomery, A. (1991). The impact of elder health, caregiver involvement, and global stress on two dimensions of caregiver burden. Journal of Gerontology, 46, S9–S19.
71.
Miller, B., & Montgomery, A. (1990). Family caregivers and limitations in social activities. Research on Aging, 12, 72–93.
72.
Moen, P., Robison, J., & Dempster-McClain, D. (1995). Caregiving and women's well-being: A life course approach. Journal of Health and Social Behavior, 36, 259–273.
73.
Monahan, D. J., & Hooker, K. (1995). Health of spouse caregivers of dementia patients: The role of personality and social support. Social Work, 40, 305–314.
74.
Morris, E. K. (1991). The contextualism that is behaviour analysis: An alternative to cognitive psychology. In A. Still & A. Costall (Eds.), Against cognitivism: Alternative foundations for cognitive psychology (pp. 124–149). New York: Harvester Wheatsheaf.
75.
Morris, R. G., Woods, R. T., Davies, K. S., & Morris, L. W. (1991). Gender differences in carers of dementia sufferers. British Journal of Psychiatry, 158(Suppl. 10), 69–74.
76.
Motenko, A. K. (1989). The frustrations, gratifications, and well-being of dementia caregivers. Gerontologist, 19, 166–172.
77.
Mui, A. C. (1995a). Caring for frail elderly parents: A comparison of adult sons and daughters. Gerontologist, 35, 86–93.
78.
Mui, A. C. (1995b). Perceived health and functional status among spouse caregivers of frail older persons. Journal of Aging and Health, 7, 283–300.
79.
O'Connor, D. W., Pollitt, P. A., Roth, M., Brook, C. P. B., & Reiss, B. B. (1990). Problems reported by relatives in a community study of dementia. British Journal of Psychiatry, 156, 835–841.
80.
Orbell, S. (1996). Informal care in social context: A social psychological analysis of participation, impact and intervention in care of the elderly. Psychology and Health, 11, 155–178.
81.
Osterbusch, S., Keigher, S., Miller, B., & Linsk, N. (1987). Community care policies and gender justice. International Journal of Health Services, 17, 217–232.
82.
Peak, T., Toseland, R. W., & Banks, S. M. (1995). The impact of a spouse-caregiver support group on care recipient health care costs. Journal of Aging and Health, 7, 427–449.
83.
Penrod, J. D., Kane, R. A., Kane, R. L., & Finch, M. D. (1995). Who cares? The size, scope, and composition of the caregiver support system. Gerontologist, 35, 489–508.
84.
Pohl, J. M., Given, C. W., Collins, C. E., & Given, B. A. (1994). Social vulnerability and reactions to caregiving in daughters and daughters-in-law caring for disabled aging parents. Health Care for Women International, 15, 385–395.
85.
Pruchno, R. A., & Potashnik, S. L. (1989). Caregiving spouses: Physical and mental health in perspective. Journal of the American Geriatrics Society, 37, 697–705.
86.
Purdy, J. K., & Arguello, D. (1992). Hispanic familism in caretaking of older adults: Is it functional?Journal of Gerontological Social Work, 19, 29–43.
87.
Scharlach, A. E. (1995). Elder care and the changing workforce. In L. R. Murphy, J. J. Hurrell, S. L. Sauter & G. P. Keita (Eds.), Job stress interventions (pp. 295–307). Washington, DC: American Psychological Association.
88.
Scharlach, A. E., Midanik, L. T., Runkle, M. C., & Soghikian, K. (1997). Health practices of adults with elder care responsibilities. Preventive Medicine, 26, 155–161.
89.
Schiller, N. G. (1993). The invisible women: Caregiving and the construction of AIDS health services. Culture, Medicine and Psychiatry, 17, 487–512.
90.
Schofield, H. L., Herrman, H. E., Bloch, S., Howe, A., & Singh, B. (1997). A profile of Australian family caregivers: Diversity of roles and circumstances. Australian and New Zealand Journal of Public Health, 21, 59–66.
91.
Schulz, R., Newsom, J., Mittelmark, M., Burton, L., Hirsch, C., & Jackson, S. (1997). Health effects of caregiving: The caregiver health effects study: An ancillary study of the cardiovascular health study. Annals of Behavioral Medicine, 19, 110–116.
92.
Schulz, R., Visintainer, P., & Williamson, G. M. (1990). Psychiatric and physical morbidity effects of caregiving. Journals of Gerontology, 45, P181–P191.
93.
Seeman, T. E. (1994). Successful aging: Reconceptualizing the aging process from a more positive perspective. In B. Vellas, J. L. Albarede & P. J. Garry (Eds.), Facts and research in gerontology 1994: Epidemiology and aging (pp. 61–73). New York: Springer.
94.
Shaw, W. S., Patterson, T. S., Semple, S. J., Ho, S., Irwin, M. R., Hauger, R. L., & Grant, I. (1997). Longitudinal analysis of multiple indicators of health decline among spousal caregivers. Annals of Behavioral Medicine, 19, 101–109.
95.
Snyder, B., & Keefe, K. (1985). The unmet needs of family caregivers for frail and disabled adults. Social Work in Health Care, 10(3), 1–14.
96.
Sommers, T., & Shields, L. (1987). Women take care: The consequences of caregiving in today's society. Gainesville, FL: Triad.
97.
Stone, R., Cafferata, G., & Sangl, J. (1987). Caregivers of the frail elderly: A national profile. Gerontologist, 27, 616–626.
98.
Strawbridge, W. J., & Wallhagen, M. I. (1991). Impact of family conflict on adult child caregivers. Gerontologist, 31, 770–777.
99.
Taylor, R., Ford, G., & Dunbar, M. (1995). The effects of caring on health: A community-based longitudinal study. Social Science and Medicine, 40, 1407–1415.
100.
Tokyo Metropolitan Government. (1995). Living conditions of the elderly. Tokyo: Author.
101.
Traustadottir, R. (1991). Mothers who care: Gender, disability and family life. Journal of Family Issues, 12, 211–218.
102.
US Bureau of the Census. (1991). Statistical abstracts of the United States: I (111th ed.). Washington, DC: US Government Printing Office.
103.
Wagner, D. L., & Neal, M. B. (1994). Caregiving and work: Consequences, correlates, and workplace responses. Educational Gerontology, 20, 645–663.
104.
Walker, A. (1992). Conceptual perspectives on gender and family caregiving. In J. Dwyer & R. Coward (Eds.), Gender, families and elder care (pp. 34–49). Newbury Park, CA: Sage.
105.
Walker, R. J. & Pomeroy, E. C. (1996). Depression or grief? The experience of caregivers of people with dementia. Health and Social Work, 21, 247–254.
106.
Wells, Y. D., & Kendig, H. L. (1996). Changes in carers' capacity and motivation to provide care. Journal of Family Studies, 2, 15–28.
107.
Wenger, G. C. (1994). Dementia sufferers living at home. International Journal of Geriatric Psychiatry, 9, 721–733.
108.
White-Means, S. I. (1993). Informal home care for frail Black elderly. Journal of Applied Gerontology, 12, 18–33.
109.
Yu, L. C., Yu, Y., & Mansfield, P. K. (1990). Gender and changes in support of parents in China: Implications for the one-child policy. Gender and Society, 4, 83–89.
