This study examined the effects of stability and change in grandchild caregiving in a sample of women who were recruited based on their caregiving status to grandchildren, and it offers some new insights into grandmother caregiving patterns. First, most grandmothers (78%) in our sample remained in a stable caregiving role across the 24-month time frame, but more than one in five grandmothers transitioned out of their initial caregiving role; 70% of these changes represented a reduction in caregiving responsibility, and nearly half of all changes were from multigenerational home situations to homes without an adult child and grandchildren. These findings illuminate the impermanent nature of some caregiving situations, especially for grandmothers in multigenerational homes. Much research has focused on grandmothers becoming primary caregivers, but far less (Hughes et al., 2007
; Szinovacz & Davey, 2006
) has examined the common phenomena of families moving into and out of grandparents’ homes. These sometimes temporary transitions to and from multigenerational homes typically occur to support adult children who are managing life events, such as health, financial, and relationship issues, rather than because of the grandmothers’ need for assistance and hence may affect various aspects of her health and well-being.
A unique contribution of this study was the ability to evaluate the impact of such transitions in caregiving responsibility, in addition to examining between-group differences at baseline and over time. We found significant differences between grandmother caregiving groups in all study variables, except resourcefulness and mental health. Grandmothers raising grandchildren reported the most stress, strain, concerns about family functioning, and depressive symptoms but felt the least reward and support and had the worst physical health, whereas noncaregiving to grandchildren was associated with better mental and physical health. Although grandmothers raising grandchildren scored worse than the other grandmothers on most measures, we found no evidence that their health deteriorated more than that of grandmothers in other groups, which would be more consistent with an adaptation perspective supported by the broader literature on caregiving to older adults (Lawton et al., 2000
; Townsend et al., 1989
The results provide partial support for our hypotheses that taking on more caregiving burden (e.g., from a noncaregiving role to primary or multigenerational caregiving) adds to psychological distress. Increasing grandchild caregiving responsibility did affect perceived stress, intrafamily strain, and perceptions of worse family functioning, which would coincide with greater difficulties in family life. Qualitative work on transitions (Standing et al., 2007
) highlights changes in grandmother caregiving or household composition as times of mixed feelings for grandmothers. When young families or grandchildren move into grandmothers’ homes, the grandmothers not only may be relieved to be able to help but also may feel angst about the difficult family events preceding the transition. Grandmothers report frustration from changes in their own lives as they share their time, energy, and financial resources with the young family or grandchildren. On the other end of the continuum, grandmothers facing transitions to noncaregiver roles report ambivalence when young families or grandchildren move out of their homes. In spite of relief following the resolution of health or financial problems or a safe return from military deployment, many grandmothers report a sense of loss when a grandchild leaves and continue to worry about the child's welfare. Thus, these caregiving transitions, whether the grandmother is accepting or relinquishing care responsibilities, can be difficult and emotionally stressful, even when there is a reduction in responsibility.
Although switching or transitioning to a heavier caregiving role appears to adversely affect appraised stress and strain, such transitions did not affect mental health or depressive symptoms, unlike the caregivers to older adults studied by Burton and colleagues (2003)
or Seltzer and Li (2000)
. The few secondary analyses that have examined the impact of grandchildren moving into or out of grandparents’ homes, with or without their parent(s), have reported effects that are similar to ours (Hughes et al., 2007
; Szinovacz & Davey, 2006
); particularly when controlling for demographic factors and/or prior depressive symptoms, the effects of caregiving on depressive symptoms were not strong or sustained (Blustein et al., 2004
; Szinovacz et al., 2006
Both self-rated and overall physical health became worse over 24-month time, which is not unexpected in a cohort with a mean age of 57 years at baseline (Giarrusso, Feng, Wang, & Silverstein, 1996
). Although we expected that caregiving changes would affect emotional health, we did not predict that transitions to greater caregiving would be associated with worse self-rated and overall physical health. Our findings that caregiving changes result in decreases in self-rated health are consistent with those of other studies in which transitions to heavy caregiving
(Burton et al., 2003
) or primary caregiving responsibility (Hughes et al., 2007
) coincide with worse self-rated health. The findings about increased physical health limitations when taking on greater care responsibilities suggest that caregiving transitions are a point of vulnerability and that health care and social service providers need to consider evaluating both emotional well-being and physical health during these periods. Transitions might be ideal times for providing supportive counseling and engaging families in anticipatory planning.
The lack of significant differences in resourcefulness based on caregiving status speaks to the global nature of this problem-solving/coping ability. Resourcefulness has been associated with better mental health, more positive affect, and fewer depressive thoughts as well as better self-rated health and physical functioning (Zauszniewski, Bekhet, Lai, McDonald, & Musil, 2007; Zauszniewski, Eggenschwiler, Preechawong, Roberts, & Morris, 2006
). Studies are underway to test ways to improve resourcefulness, and resourcefulness training may be a fruitful approach for grandmothers across all caregiving groups to improve quality of life, especially for those who have elevated depressive symptoms.
Role reward was greatest for older and White grandmothers; however, grandmothers raising their grandchildren reported the least reward in their role as a grandmothers—even so, they still evaluated their experience as somewhat more rewarding than not. For many grandmother caregivers, the “unexpected career of caregiving” (Pearlin & Aneshensel, 1994) for their grandchildren or the “off timing” of this family role transition (Burton, 1996
) may account for less rewarding experiences in the grandmother role.
We oversampled grandmothers raising grandchildren and grandmothers in multigenerational homes; thus, the sample does not proportionally represent grandmothers who provide care to grandchildren in the population at large. Because this was a quota sample of grandmothers by caregiving group rather than a demographically representative sample, we cannot make generalizations about the frequency of caregiving changes (Blustein et al., 2004
; Hughes et al., 2007
; Szinovacz et al., 1999
). However, the number of grandmothers in each group allowed us to make necessary comparisons, whereas others (Hughes et al., 2007
) suggested that the small percentage of primary and multigenerational caregivers in their nationally representative sample may have limited the detection of effects of such caregiving. Efforts to quantitatively evaluate if specific reasons for transitions or meanings that a grandmother derives from her caregiving experience affect outcomes would add to our understanding of these often dynamic family situations. An additional limitation of this study is that changes in caregiving status and their effects are based on the report of the grandmother only; however, we are currently collecting follow-up data from the grandmother and grandchild perspectives. Triangulation of these perspectives will provide further insights into the effects of caregiving transitions on grandmothers, grandchildren, and families.
Recommendations for Research, Practice, and Policy
This study, rooted in the Resiliency Model (McCubbin et al., 1996
), examined the effects of grandmother caregiving and caregiving transitions on elements of the model. Additional work examining relationships within the model will further strengthen the applicability of the model to grandparent caregiving. The findings of this study can inform health professionals/practitioners working with grandmothers and their families, especially during stable caregiving for grandmothers raising grandchildren or when women increase grandchild caregiving responsibility. In light of the current era of economic insecurity as well as the numbers of the baby boom cohort moving into the grandparent stage of their lives, continued research about intergenerational caregiving and caregiving transitions is important in describing the phenomena and finding ways to support these various family structures. The health needs of grandmothers and their families are increasing as the population ages and unemployment and poverty indicators rise. Policies directed toward assisting grandparent-headed households can benefit families with members in all stages of the life course, instead of perpetuating the generational divide.
The current study sheds light on the importance of caregiving patterns of grandmothers and the effects of continuity or change in the caregiving roles over time. The findings from this study contribute to gerontological and intergenerational research on grandmothers and their families, with an emphasis on how changes in caregiving responsibility and the passage of time affect mental and physical health, support, and perceptions of family functioning.