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The present study examines the association of providing assistance to older parents amidst everyday circumstances and short-term psychological consequences for adult children providing assistance.
We explore this association using 824 daily diary interviews of 119 adult children providing assistance in the National Study of Daily Experiences by using a left-censored random effects tobit regression model that accounts for the clustered data and floor effects in reported psychological distress.
Psychological distress was higher on days adult children provided assistance to their parent (b=0.88, p<0.05) even after controlling for situational variables such as time spent on daily paid work, leisure activities and assistance provided to individuals other than parents. Demographic and psychosocial variables such as having resident children (b=2.14, p<0.01), education (b=−0.54, p<0.05) and neuroticism (b=2.08, p<0.05) also predicted daily psychological distress.
Even after controlling for within-person (daily situational variables) and between-person factors (background characteristics), the act of providing assistance itself has immediate associations with daily mood for helpers, particularly for those with fewer resources and greater demands on time. Feasibility and success of programs that provide respite and relief services to older adults and their children should be assessed in light of daily living.
Variations in assistance between adult children and their older parents has emerged as an important topic in social gerontology (e.g., Davey, Janke, & Savla, 2005; Pillemer & Suitor, 2006). Whereas studies of continuous care to chronically ill family members can contribute to our general understanding of care-related stress and its psychological consequences on the younger generations providing assistance, most of these studies are specific to certain types of care experiences (e.g. for Alzheimer’s patients, stroke patients) and focus on intense caregiving. This focus has provided an important, but limited perspective on the range of possible outcomes (Ory, Hoffman, Yee, Tennstedt, & Schulz, 1999). There is growing recognition that family member are involved in a range of activities: from infrequent to daily provision and from casual routine assistance to very intensive care for family members that could still affect the daily lives of people providing assistance (e.g., Szinovacz & Davey, 2007). Furthermore, a preponderance of the literature has relied on retrospective accounts of assistance that are often collected over a relatively long period of time, covering weeks, months and years. As a result, they are likely to be confounded by other events that happen during the time period. This study examines the more immediate impact of routine assistance against the context of daily living and its cumulative effects over time for adult children providing assistance.
Understanding of daily stressors and their immediate and cumulative influence over time has benefited from developments in daily diary designs in which repeated measures are collected from individuals during their daily lives (Almeida, 2005; Bolger, Davis & Rafaeli, 2003). In this design, individuals report regarding a number of everyday events, behaviors, symptoms and emotional states to capture the ongoing experiences in the natural context of daily living (Larson & Almeida, 1999). Unlike traditional designs that require respondents to recall experiences over long time frames, this design alleviates memory distortions, especially those related to current emotional state, and improve accuracy of recall. But the most valuable feature of diary methods is that they allow assessment of within-person processes and permits us to shift our focus from mean levels of stressors and well-being in a group of individuals to charting the day-to-day fluctuations in stress and well-being within an individual itself (Reis & Gamble, 2000). Since individuals serve as their own control, we can now examine how daily provision of assistance to a parent is associated with changes in their own well-being from one day to the next. For example, it has been suggested that competing roles may increase psychological distress among caregivers (e.g. Murphy, et al., 1997). Most of these studies have used a between-person design, comparing one caregiver to another. These studies could be confounded by within-person differences such as amount of time spent on competing roles or experiencing poor health or physical ailment on a day when assistance is provided. In contrast, in the present study, we are able to test whether psychological distress is higher on days when an adult child provides assistance than on days they do not. Similarly, between-person designs have found that higher education may buffer helpers from psychological distress. Our within-person design, however, allows us to determine the buffering effect of education on a day when assistance is provided versus one when it is not, as well as compare helpers on other potentially important background characteristics.
Providing routine assistance to an older parent has been found to have salient psychological consequences such as increased distress and burden for the adult child providing help (e.g. Aneshensel, Pearlin, Mullan, Zarit & Whitlach, 1995; Antonucci, Akiyama & Lansford, 1998; Marks, 1998; Walen & Lachman, 2000). Many researchers believe that this distress and burden is partly due to the impingement of the helping role on other everyday roles and experiences which makes up the structural underpinning of stress spillover or proliferation (Pearlin, 1989; Pearlin, Aneshensel & LeBlanc, 1997). According to the stress process model (Aneshensel, Pearlin, Mullan, Zarit & Whitlatch, 1995) individuals bear multiple social roles, for instance, they may simultaneously be breadwinners, parents, employee or employer, member of voluntary organization, and so forth. Each of these roles imposes time commitments, responsibilities and obligations. Many of these roles have been a part of the daily plan of an individual for a long time and have been accommodated into the flow of daily living. The helping role emerges after these primary roles have already been acclimatized (Pearlin, Mullan, Semple & Skaff, 1990). Initially, the demands of providing routine assistance to a parent may be minimal and sporadic; however, they can continue to grow over time making reordering of priorities and reallocating energies increasingly difficult. It is this feature of the helping role that contributes to the stress proliferation wherein the new role imposes demands on ones time and energy and requires restructuring and juggling of the primary roles in daily life making it particularly challenging and eventually undermining the health and well-being of individuals providing routine assistance to parents (Pearlin, 1989).
Extant research supporting this theory have found that whether providing help is situation specific and occasional or repetitive and chronic, it is still powerful enough to disrupt an array of roles, activities and relationships that are only proximally related to the helping role. Using longitudinal data, McKinlay, Crawford and Tennstedt (1995), found that providing assistance exerted the greatest toll on an individual’s personal life, followed by family life and employment. Providing assistance was found to be particularly stressful for those who have multiple responsibilities and for those who spent less time on themselves. Murphy and her colleagues (Murphy, Schofield, Nankervis, Bloch, Herrman & Singh, 1997) found that role overload was highest for women helpers with multiple roles of parent or worker. At the same time resentment in the helping role was highest for those women who had fewer roles apart from providing help, who had to quit work to fulfill their role, and those without a partner. More recently Stephens and her colleagues (2001) examined role conflict experienced by 278 helping women who simultaneously played the role of a mother, wife and employee. Their results suggest that part of the stress that these women experienced was due to conflicts between the helping role and the other roles they were playing.
Although we expect to find evidence of stress proliferation in the everyday lives of all helpers, we believe that the nature and extent of exposure and reactivity to stress will vary with the background and situational characteristics of the person involved. For instance, the social and economic characteristics of helpers as well as the possession of resources from which they can draw from are important covariates to consider. We consider several important ones in this paper.
Adult children’s age is an important predictor of the provision of routine assistance. Older adult children have been found to give more support than younger adult children (Ikkink, van Tilburg & Knipscheer, 1999; Wong, Capoferro & Soldo, 1999) and might have fewer conflicting demands. Although the effect of adult children’s gender on routine exchanges is not as well understood (Pinquart & Sörensen, 2006), it is quite clear that women, in particular daughters, spend more time providing assistance to their older parents than adult sons (Campbell & Martin-Matthews, 2003).
Household structure also plays an important role in the determination of exchanges between the generations and vulnerability to stressors. An adult child’s marital status is an important aspect of intergenerational exchanges, wherein unmarried daughters are more likely to engage in an exchange of household assistance than married siblings for whom the opportunity cost of providing assistance is higher (Couch, Daly & Wolf, 1999). Moreover, the presence of minor children in married-couple households leads to increased time spent in domestic work, reduced time in the labor market, decreased monetary transfers to parents, and increased role overload (Ikkink, van Tilburg, & Knipscheer, 1999). Economic theories also suggest that educational or financial status of adult children facilitates the provision of assistance to older parents. For instance, empirical studies (Couch, Daly & Wolf, 1999; Johnson, 2008) have found that siblings with little education or earning lower wages provide hands-on assistance to older parents whereas their higher-earning counterparts provide financial resources or use paid services. We therefore expect that adult children with lower education may be more distressed on days when assistance is provided.
Finally, several researchers have asserted that personal dispositions interact with stressful situations in determining individuals’ own appraisals of a stressor (Ben-Porath & Tellegen, 1990; Costa et al., 1996). Studies of personality traits have shown that neuroticism predicts increased exposure and lowered adjustment to interpersonal daily stressors (Bolger & Zuckerman, 1995; Mroczek & Almeida, 2004). Perceived mastery and control, on the other hand, are known to buffer the emotional effects of chronic daily stressors (Lachman & Weaver, 1998; Pearlin & Schooler, 1978; Yates, Tennstedt & Chang, 1999). We therefore expect adult children with higher mastery and lower scores on the neuroticism trait will experience less significant psychological distress on days when assistance is provided to parents. Whereas some of the factors listed above increases ones vulnerability to stressors, others may serve as protective factors.
Daily diary designs provide a unique opportunity to simultaneously study the within-person and between-person differences by examining psychological distress in helpers on days when assistance is provided versus days when it is not (within-person), as well as by comparing helpers as a function of their background and contextual factors (between-person). Given that the proliferation of stressors on primary role-related activities is a key determinant of stress and well-being among individuals providing assistance, in the present study we hypothesize that psychological distress will be higher on days helpers encountered more daily situational factors (spent more time on activities, encountered stressors, provided help to other family members) in addition to providing assistance to a parent. We also hypothesize that women, younger individuals, African-Americans, unmarried individuals, those with young children, as well as individuals with lower education, higher neuroticism and lower mastery would be more susceptible to psychological distress.
Using a representative sample of the population, we identified adult children that engage in a full range of assistance in order to address two main questions. First, how are the daily role-related experiences affected by the type of day, i.e. helping versus non-helping day? Second, after controlling for daily role-related experiences and responsibilities and person-level variables, is psychological distress higher on days when assistance is provided than days when it is not?
We use data from participants in the National Study of Daily Experiences (NSDE). The NSDE is a randomly selected sub-sample of the National Survey of Midlife Development in the United States (MIDUS) survey carried out under the John D. and Catherine T. MacArthur Foundation Network for Successful Midlife Development (for detailed descriptions of the MIDUS project see Brim, Ryff, & Kessler, 2004). Out of the 1,242 MIDUS participants contacted, 1,031 (562 women, 469 men) participated in the NSDE daily diary study, yielding a response rate of 83%. Over the course of eight consecutive evenings, participants completed short telephone interviews about their daily experiences. The initiation of interviews was staggered across days of the week to control for the possible confounding between day of study and day of week. Participants completed an average of seven of the eight interviews resulting in a total of 7,221 daily interviews. Participants received $20 for their participation (for more details on the study see Almeida, Wethington, & Kessler, 2002). Out of the 1,031 NSDE participants, we identified 119 individuals who reported providing either instrumental or emotional assistance to their parent on at least one of the eight days of the diary interview. The 119 individuals completed an average of 6.9 days of interviews out of the 8 days, resulting in 824 daily interviews.
Daily psychological distress was operationalized using an inventory of ten emotions from the “Non-Specific Psychological Distress Scale” (Mroczek & Kolarz, 1998; Kessler et al., 2002) that were asked on each of the eight days of telephone interviews. Participants rated these mood related questions on a five point scale (0 = none of the time; 4 = all of the time). The inventory included emotions such as sadness, hopelessness, anxiety, and restlessness. The scale was developed using item response models and factor analysis, yielding a single factor structure representing current psychological distress (for complete information on psychometric properties of the scale and validation, refer to Kessler et al., 2002; Mroczek & Kolarz, 1998). Cronbach’s alpha ranged from .70 to .89 across the eight days of administration.
Psychological distress in this sample had a positively skewed distribution (M = 1.97, SD = 3.51, Skewness = 3.55) since the scores clustered towards the lower end of the scale. This low rating of psychological distress has been seen in other studies of more serious caregivers as well (Schulz, Newson, Mittelmark, Burton, Hirsch & Jackson, 1997). To adjust for the skewness, we attempted to transform this variable to a more symmetric distribution by adding a constant of unity to the score before taking the natural logarithm of psychological distress (MLogged Psychological Distress = 0.67, SD = 0.83). We used the logged psychological distress score for descriptive and univariate analyses and relied on random effects tobit regression with left-side censoring for the multivariate model.
Using a broad definition of helping, we assess providing routine assistance to a parent as help provided with emotional or instrumental tasks on each of the eight days of the study. Two questions were asked regarding assistance to people living outside the house, in particular a parent. The first question was: “Did you provide any unpaid assistance or instrumental assistance to someone outside the house?” (e.g., help with shopping etc.). If participants agreed, then they were asked to name each of those to whom they provided assistance on that day. Parents were included in this list. Likewise, the second question was about providing emotional support (e.g., giving advice, comforting them). Providing either emotional or instrumental support or both on a given day to a parent was coded as 1 if yes, and 0 if no. Providing emotional or instrumental support to someone else other than a parent was also used as a control variable and was coded similar to the previous variable, namely 1 if provided support and 0 if provided no support on a given day. In this way, we could distinguish assistance provided to parents from assistance provided to others.
Three time use variables measured competing everyday situational demands. These variables were related to time spent on tasks and activities on each day other than providing assistance to a parent. The first variable, routine chores, assessed the amount of time the participant spent on routine chores in the house, such as yard work. The second variable reflected the amount of time spent on activities related to business, paid work or school, which included time traveling and thinking about the work. The third variable considered the use of time on activities related to leisure, such as relaxing, taking a nap, or engaging in physical exercises or leisure activities. Time spent on these activities was coded in hours and minutes.
From the MIDUS survey, which was collected approximately a year before the NSDE diary interviews, variables that acted as reasonably stable background characteristics were included as between-person covariates in these analyses. Demographic variables such as gender (0 = male, 1=female), African American race (0 = no, 1 = yes) and education (1 = less than high school; 2 = high school; 3 = college; 4 = college and higher) were included in this study. Apart from these individual characteristics, family related variables such as marital status (1 = married, 0 = not married) and if the participant had any children under 18 years (0 implying no children) were utilized. Based on the age reported during the NSDE diary interview, this variable was coded into categories (1 = 25 to 35 years (24.37%); 2 = 36 to 45 years (30.25%); 3 = 46 to 55 years (26.89%); 4 = 56 to 64 years (15.97%); 5 = 65 to 74 years (2.52%)). Finally, we included trait neuroticism and personal mastery as two personal characteristics variables. The neuroticism items include the following four adjectives: moody, worrying, nervous, and calm (Lachman & Weaver, 1997). Participants indicated how well each of the four items described them on a four-point scale from 1 (a lot) to 4 (not at all). All but the last item were reverse-coded and the mean across the items was taken such that a higher value indicated higher levels of neuroticism. Scores ranged from 1 to 4. Cronbach’s alpha for this sample was 0.76.
Personal mastery scale consists of two items from Pearlin & Schooler’s (1978) and two items from Lachman & Weaver (1998). See Lachman & Weaver (1998) for more information on this scale. Respondents were asked to rate on a 7-point scale (1 = strongly agree; 7 = strongly disagree) how strongly they agreed with the following questions: a) I can do just about anything I really set my mind to; b) When I really want to do something, I usually find a way to succeed at it; c) Whether or not I am able to get what I want is in my own hands; and d) What happens to me in the future depends mostly on me. Responses were recoded so higher scores indicated greater personal mastery. The scale was constructed by calculating the mean across each set of items. Scores ranged from 1 to 7. Cronbach’s alpha for this sample was 0.63. Descriptive statistics for the total sample are provided in Table 1.
Table 1 presents the descriptive statistics for the participants of the study. The average age of participants was 45 years (SD = 11.41, Range = 25 to 74 years), 67% of them were female, 65% of them were married, 38% of them had resident children under the age of 18 years, majority of the sample was Caucasian (94%), with high school education or higher (M = 2.90, SD = 0.93). These participants were on average moderately high on neuroticism (M = 2.24, S.D. = 0.74, Range = 1 to 4) and on mastery (M=5.91, S.D. = 0.92, Range = 1 to 7).
On average, participants provided assistance on 28% of the study days (approximately 2 out of 8 days). Sixty-six participants (55%) provided routine assistance to their parents on only one of the days compared to 53 of them (45%) who provided assistance on more than one day of the study (not shown in Table 1). On average, each day participants spent approximately two hours on routine chores (M = 2.19, S.D. = 2.25), four and a half hour on work related activities (M = 4.26, S.D. = 4.60) and approximately eleven hours on leisure activities, sleep and exercise (M = 10.68, S.D. = 3.92). These participants also provided assistance to other family members, friends and work colleagues on 4% of the study days. Out of the 119 participants, only 27 (22.69%) of them provided assistance to other family members on parent care days. Thirty-nine participants (32.77%) provided instrumental support to a parent, 60 participants (50.42%) provided emotional support, and 20 participants (16.81%) provided both, instrumental and emotional support to a parent.
In order to examine if engaging in the helping role has an immediate association with psychological distress and other role-related experiences, we next considered time use data and role-related experiences to test whether days when assistance was provided to parents were different from days when it was not using paired t-tests. Participants reported significantly higher psychological distress (t = −2.01, p<0.05) on days when assistance was provided (Mlog = 0.76) than on days when it was not (Mlog = 0.66). With regard to everyday living activities, on average participants spent the same amount of time on routine chores and leisure activities, however they spent significantly less amount of time (t = 2.54, p<0.01) on work-related activities on days when assistance was provided (M = 3.67) than on days when it was not (M = 4.61). Participants also reported a significantly greater number of stressors on days when assistance was provided (t = −3.00, p<0.01). On average, they experienced stressors on 57% of days when assistance was provided, compared with 43% of the days when it was not (t = −2.90, p<0.01). Out of all stressors, network stressors, events that occurred in the lives of close family members and friends, occurred more on days when assistance was provided (experienced on 17% of helping days) than on days when it was not (experienced on 7% of non-helping days).
To take into account the clustering of subjects on eight days of the study and in order to adjust for floor effects in reported negative affect, in the next set of analysis we used a left-censored random effects tobit regression model to predict daily psychological distress. One of the main reasons for using daily diary designs is that we expected there would be as much within-person variations (i.e., helping days are different from non-helping days) as between-person variations (i.e., participants differ from each other) in psychological distress among participants. To examine this, our analysis began with the standard unconditional model which estimates the average psychological distress and tests whether there is significant variation in daily psychological distress. As was expected we found as much intraindividual variability as interindividual variability. The intraclass correlation coefficient (rho) of 0.49, suggests that approximately half of the total variation in daily psychological distress is within-person and the other half of the variation is between-person. Model 1 in Table 3 indicates that on average psychological distress is higher on days when assistance is provided than days when it is not (p < 0.05). A series of models were next estimated, beginning with a model with everyday situational factors (within-person predictors) followed by background characteristics (between-person predictors) predicting daily psychological distress.
Model 2 in Table 3 presents the results of including the everyday situational factors measured on 8 days of the study. Results indicate that on days that participants devoted more time to paid work (b=0.12, p<0.05) and on leisure activities and sleep (b=0.18, p < 0.01), they reported higher psychological distress as compared to days when they spent less time on these activities. Spending time on routine household chores was not related to psychological distress. Additionally, psychological distress was found to be higher on days when the participant provided assistance to another family member other than the parent (b = 2.70, p < 0.01). Even after controlling for the amount of time spent on paid work and leisure activities and sleep and engaging in other helping tasks, providing assistance to a parent was associated with the experience of greater psychological distress (b=0.87, p<0.05).
Model 3 in Table 3 presents the results of including situational (within-person) as well as the background factors (between-person), such as age of adult child, gender, marital status, race, parental status, education, and personality factors such as neuroticism and mastery. Examination of the between-person variables show that having less education (b = −0.54, p<0.01), being single (b = −0.96, p=0.07) and having young children (b=2.14, p<0.01), increases the chances of experiencing psychological distress across all days. Conversely, having lower neuroticism (b = 2.08, p <0.001) and higher mastery (b = −0.53, p<0.06) act as a protective factor against psychological distress. Age and gender of the adult child as well as race did not predict daily psychological distress among participants. Finally, even after controlling for the situational factors as well as the background characteristics, providing assistance to a parent continued to be associated with greater psychological distress on the day help was given, compared to days when it was not (b = 0.88, p < 0.05). Several interactions between everyday situational factors and background characteristics of the adult children were explored; however, perhaps due to the limited sample size we did not find any in the present study.
Previous research has examined assistance between generations primarily using retrospective accounts of assistance provided over long time spans. These methods do not capture the everyday hassles and disturbances that are associated with the act of providing daily assistance to a parent. In the present paper, we take a micro-level approach to examine the association of providing routine assistance amidst everyday circumstances and the psychological consequences for the adult child over shorter time spans.
In order to address our first research question, we begin by examining how daily role related experiences are affected on days when assistance is provided compared with when it is not. Past studies that have examined the relationship between work roles and helping roles have found that helpers often have to give up or cut down on personal roles (employee or parental role) to provide assistance (Murphy, et al., 1997; Stephens, et al., 2001). Consistent with this idea we find that our sample of helpers were reasonably involved in routine daily chores and work related activities, but on days when assistance was provided they spent less time on work related activities. Notably, we also found that helpers reported more stressors on days when assistance was provided than on days when it was not. Many of the stressors revolved around participants’ social networks. This is an interesting finding since network stressors are events that occur in the lives of others. Perhaps helpers’ expression of care and compassion further exposes them to the stressors of friends and family.
To address our second research question, we use a multivariate analysis approach to examine psychological distress on days when assistance was provided versus days when it was not taking into account the daily role-related experiences and responsibilities and background characteristics. Our results clearly show that even at the micro-level, the enactment of the role of providing routine assistance to a parent is in itself stressful. Consistent with our first hypothesis and in line with previous research that suggests that conflicting demands of helping and other personal roles (e.g. employee, parent) is an important factor that accounts for the negative effects on wellbeing of the helper, we find that any increase in the amount of time spent on work on a given day increases psychological distress on days when assistance is provided. A surprising finding was that time spent on leisure and sleep was also related to higher psychological distress on days when assistance was provided. Since leisure and sleep are also planned activities which may cause role conflict and overload on days when assistance is provided it is not surprising to find that distress was higher on those days. Further research is required to examine the implications of these findings. Some researchers have suggested that if these factors are held constant, providing assistance might lead to positive appraisals of the helping role (Marks, 1998). Our findings do not support this. Even after controlling for the amount of time spent on activities such as household chores, work, as well as providing help to others, providing assistance to a parent was still found to be significantly related to higher daily psychological distress.
Consistent with our second hypothesis we find clear evidence that being single, non-white and having lower education is associated with higher daily psychological distress (Couch, Daly & Wolf, 1999; Pinquart & Sörensen, 2006). Moreover, we also find evidence that personal characteristics such as low neuroticism and high mastery buffer the effects of care enactment on psychological distress. However, we did not find any effects for age, gender and race in our study. This could be because of the relative homogeneity of this sample, since the study was not specifically designed to study assistance provided by adult children. The age range within a sample of adult children would also be more restricted than a sample that also included assistance provided by spouses. It is also possible that differences between sons and daughters are less pronounced than those found between husbands and wives (e.g., Aneshensel et al., 1995; Miller, 1990; Zarit, Todd, & Zarit, 1986; Zarit & Whitlatch, 1992), or across a wider continuum of assistance (Davey & Szinovacz, 2007). Likewise, the small proportion of non-whites in the sample made it difficult to find any race effects and also restricts the generalizability of the results.
The present study is among the first systematic studies that have examined the daily impact of providing routine assistance to a parent living outside the house; however, there are several limitations that need to be acknowledged. First of all, the present data were not collected with the intention of understanding routine assistance to parents. We therefore had to rely on global measures of assistance instead of specific dimensions of care such as number of hours of assistance to a parent. Since measures of intensity of providing care were not available, we are not able to clarify whether it is the act of providing care or the intensity of providing care that is more important for predicting psychological distress. Future research should examine the daily intensity of help provision and its consequences on indicators of distress. Additionally, variables that are important predictors of intergenerational exchanges such as parent’s health status and proximity to the parent were not known and so could not be included. Providing assistance to a parent who lives in closer proximity might be physically draining and exhausting, however being far away from a parent might not give adult children immunity from feeling overwhelmed on days the parent requires care. The lack of information about parent’s health status and proximity to parents did not allow us to assess the variability in everyday distress due to these factors. Finally, several interactions between providing daily assistance, daily exposure to stressors and resilience variables were tested, but due to the low power of the study, these could not be estimated and remain to be explored in future diary studies.
Despite these limitations, the current study clearly suggests the possible link between assisting a parent and the downward trajectory of health and well-being that has been found in caregiving. The accumulation of small and large daily stressors may build up and spill over into other areas of life, eventually undermining psychological resources and well-being. Our results also imply that individuals who experience greater role conflict and demand on their time as well as those with the fewest resources experience most distress on days when assistance is provided to parents. These results also suggest new strategies for supporting people assisting parents and other older relatives. Rather than designing respite and support programs in a non-specific way, programs could specifically target the everyday care events that are stressful. By building on an understanding of the daily events that people find stressful, this approach could make daily life easier for older adults and the individuals who support them and prevent the depletion of care resources. By focusing on stressors in this way, support programs may be more effective in relieving caregiver burden, while also giving financial and other support for those with the fewest resources.
This research was supported in part by the National Institute of Mental Health Training grant, # T32 MH18904 to the first author and MacArthur Foundation Research Network on Successful Midlife Development and National Institute on Aging Grant, AG19239 awarded to the second author.
Author ContributionsSavla conceptualized the paper, analyzed the data and wrote the paper. Almeida designed the research, performed the data collection and assisted in writing the paper. Davey and Zarit assisted with the conceptualization, analysis and interpretation of the paper and contributed to writing the paper.
Jyoti Savla, Department of Human Development & Center for Gerontology, Virginia Polytechnic Institute & State University.
David M. Almeida, Department of Human Development and Family Studies, The Pennsylvania State University.
Adam Davey, College of Health Professions, Temple University.
Steven H. Zarit, Department of Human Development and Family Studies, The Pennsylvania State University.