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Family Systems and Aging
Angela G. Rothrock, PhD
Assistant Professor, Division of Gerontology, Geriatrics and Palliative Care
Associate Director, UAB Geriatrics Education Center and UAB Reynolds
Program
Our Family Structure
• What’s your family structure?
• Where do the members live?
• Have you provided care for a parent?
• Has a family member provided care to you?
Presentation Overview
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What defines “Family”
Family Systems Perspective
Intergenerational Relationships
Family Interaction Patterns
Family Assessment
Culture and the Family
– Living Arrangements
– Caregiving
• Family Conferences
What Defines Family?
• Those who:
– consider themselves economically and
emotionally related to each other by blood,
marriage, or commitment
– are tied together through their common
biological, legal, cultural, and emotional history
and their implied future together
• Varies by size, composition, and closeness
• Most important system that we belong to
• Primary identification
Three Traditional Family Types
• Nuclear
– Married or committed pair
– Dependent children
– Independent household
– Bound to outside kin by voluntary ties of
affection or duty
Three Traditional Family Types
• Extended/Modified Extended
– All relatives connected by blood or marriage
Three Traditional Family Types
• Surrogate Family/Support System
– Any individuals
– Join together to give support and assistance
– Sometime for a specific purpose
– Fictive Kinship - “She’s like a sister to me”
Changing Family Structures
• Considerable change in the 20th/21st centuries
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Patterns of living arrangements
Divorce and remarriage
Decreases in fertility
More women working outside the home
• Older adults embedded in a complex web of ties
• “Beanpole” Families
(Bengston, Rosenthal & Burton, 1990)
Family Systems Perspective
• Family is an interdependent, emotional unit
– Change or stress that affects one, affects all
– Interaction patterns are repeating and hard to
reorganize
– Losses occur regarding
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Control
Continuity
Defined roles
Significant relationships
Sense of purpose
Family Systems Perspective
• Joint responsibility for problems
• Unresolved issues will resurface
• Crucial that families adapt to changing
circumstances
– Ex. Physical or cognitive decline of a member
Family Life Cycle Theory
• First presented in 1957, Evelyn Duvall
• Based on census data, post WWII
• Widely utilized
• Largely driven by the age of the oldest child
• 8 stages reflecting
– Size of the family
– Age of members
– Types of challenges faced
Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134.
Family Life Cycle Theory
• Families progress through eight stages:
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Getting married
Childbearing
Preschool years
School-age years
Adolescent/Teenage years
Launching
Middle-aged parents
Aging family members
Family Life Cycle Theory
• Tasks must be completed before moving to the
following stage
• Criticized for heavy reliance upon traditional/
idealized culture-specific assumptions regarding:
– what constitutes a family
– the experiences families will have
– when these will occur
• Does not address intergenerational family
issues
Family Life Cycle Theory
• Developmental task and needs of
generations are no longer complementary
• Multiple iterations, now more focused on
transitions of the family or its individuals
– Emphasis on family dynamics
– Successful transitioning may help to prevent
disease and emotional or stress-related
disorders.
Intergenerational Relationships
• 50% of older adults have daily contact with
their children
• Intergenerational relationships between
parents and adult children:
– are frequently characterized by ambivalence
• 2 “sets of parents”
• Feelings regarding “role reversals”
• Competing priorities/goals
– Carstensen’s Socioemotional Selectivity Theory
Socioemotional Selectivity Theory
• Social contact/Relationships are motivated
by either:
– Pursuit of knowledge
– Desire to regulate emotion
Knowledge Acquisition
Emotion Regulation
Infancy
Carstensen, L.L (1987. 1991. 1992)
Late Life
Intergenerational Relationships
• Implications for health and well-being
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Family habits (eating, exercising)
Encouragement
Stress/burden (increase or decrease)
Feelings of well-being
Contributions
Intergenerational Relationships
• Bengston’s Theory of Intergenerational
Solidarity (Bengston & Roberts, 1991)
• Generations relate to each other in terms of:
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Living arrangement (structural)
Shared values (normative)
Norms (consensual)
Contact (associational)
Closeness (affectual)
Instrumental Support (functional)
• Financial, caregiving, etc
Continuum of Social Family Norms
• Dependence to independence
– Filial Maturity
• Adult children learn to accept and meet parents’
dependency
• Involves being depended on and being dependable
• They are emotionally ready to relinquish earlier roles
• Obligation to volunteerism
– Filial obligation, felt by children
– Parents don’t want to be a burden
5 Family Interaction Patterns
(Blazer, 1998)
• Compatible vs. Conflictual
– Always in agreement or always arguing
– Resurfacing of old conflicts
• Cohesive vs. Fragmented
– Present as a unit or as individual members
5 Family Interaction Patterns
(Blazer, 1998)
• Productive vs. Non-Productive
– Mobilize to create changes needed or powerless
to act
• Fragile vs. Stable
– Family stability or disruption in relationships
• Rigid vs. Flexible
– Exchange and share roles and respond
readily to crisis
Family Assessment
• The Family APGAR (FAPGAR) (Smilkstein, 1978)
• Brief screening questionnaire
– 5 closed-ended questions
– Fitting for multiple family structures
FAPGAR
5 Components of Family Function
• A - Adaptation
• P - Partnership
• G - Growth
• A - Affection
• R - Resolve
FAPGAR Results
• Reflect a patient’s view of the functional state
of their family
• Focus on family unit as part of medical
care/treatment
• Useful for multiple cultures
Culture and the Family
• Familial cultural norms are specialized in
three ways
– Specific to particular role relationships
– Systematically related to social class, race,
ethnicity, religion, or region
– Vary across individual families (traditions)
• Research has focused on cultural differences
in living arrangements and caregiving
Culture and Living Arrangements
• Affects the exchange of help and support
• Western countries and Japan (Sundstrom, 1993)
– Decline in the proportion of older people living with
adult children since 1950
– In US, decreased from 33% to 15%
– In Sweden, decreased from 27% to 5% (most
extreme change)
• Intimacy at a distance
– Pattern of proximity but in separate households
Culture and Living Arrangements
• Korean families (Won & Lee, 1999)
– 75% of those age 60+ live with their children
– More likely to live with sons
– More likely to live with married children
• Developing Countries (Hashimoto, 1991)
– Brazil, Egpyt, India, South Korea, Singapore,
Thailand, Zimbabwe
– Older adults maintain co-residence with children
– Lowest in Egypt and Brazil
Family Caregiving
• ~80% of informal care of frail elders is
provided by family caregivers
– Usually a single, primary caregiver
– 1/3 are adult children
• Sandwich generation
Family Caregiving
• Gender and history of relationships are key to
determining: (Matthews, 2002)
– Which child provides care
– How caregiving is shared among relatives
• Sibling conflict
– How the older adult participates
• Some cultures don’t involve the elder in decisions
Culture and Family Caregiving
• Distinct cultural differences
• PBS series – Life, Part 2
– Ethnicity, Race and Aging episode
– http://www.pbs.org/lifepart2/watch/season2/ethnicity-race-aging
Family Conferences
• Family Conferences
– Involve healthcare professionals and family
members
– Interdisciplinary team approach
– Presentation of loved ones diagnoses, concerns
– Improved quality of care
– Considerations of various perspectives
– Discussion of advanced care planning, resources
– Engage multiple family caregivers
– Sort out tasks and schedules
Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992) ,The Family Conference in Geriatrics,Canadian
Family Physician, p585-588
References
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Bengtson, V.; Rosenthal, C. J.; and Burton, L. (1990). "Families and Aging: Diversity and Heterogeneity." In
Handbook of Aging and the Social Sciences, 3rd edition, ed. R. H. Binstock and K. George. New York: Academic Press.
Bengtson, V. L., & Roberts, R. E. L. (1991). Intergenerational solidarity in aging families: An example of formal theory
construction. Journal of Marriage and the Family, 53, 856-870.
Blazer D (1998). Emotional problems in later life: Intervention strategies for professional caregivers. New York:
Springer
Carstensen, L.L. (1987). Age-related changes in social activity. In L.L. Carstensen & B.A. Edelstein (Eds.), Handbook
of Clinical Gerontology (pp.222-237). New York: Pergamon Press.
Carstensen, L.L. (1991). Selectivity theory: Social activity in life-span context. Annual Review of Gerontology and
Geriatrics, 11, 195-217.
Carstensen, L.L. (1992). Social and emotional patterns in adulthood: Support for socioemotional selectivity
theory. Psychology and Aging, 7, 331-338.
Duvall, E. M. (1988). Family development's first forty years. Family Relations, 37, 127-134.
Hashimoto, A. (1991). "Living Arrangements of the Aged in Seven Developing Countries: A Preliminary Analysis."
Journal of Cross-Cultural Gerontology 6:359–81.
Matthews S (2002). S isters and Brothers/Daughters and Sons: Meeting the Needs of Old Parents. Bloomington:
Unlimited Publishing; 2002.
Molloy DW, Cranney A, Krajewski A, Orange JB, & Davidson W (1992) ,The Family Conference in Geriatrics, Canadian
Family Physician, p585-588
Smilkstein, G. (1978). The Family APGAR: A proposal for family function test and its use by physicians. Journal of
Family Practice, 6(6), 1231-1239.
Sundstrom, G. (1993). "Care by Families: An Overview of Trends." In Caring for Frail Elderly People. Paris:
Organization of Economic Co-operation and Development.
Won, Y., and Lee, G. (1999). "Living Arrangements of Older Parents in Korea."
Journal of Comparative Family Studies 30:315–28.