Health Effects and Impact of Grandparents
Grandparents Raising Grandchildren
According
to the 2000 Census Supplementary Survey, an estimated 6 million or 8.4% of
children in the US live with nonparental relatives, a 173% increase since 1970
and a 78% increase since 1990 (US Bureau of the Census, 2001).
Of the 6 million
children living with nonparental relatives, 75% are being raised by
grandparents. Although this phenomenon impacts all racial and economic groups,
the most significant rises have been among African Americans and low-income
families.
The
most common antecedents to children being raised by grandparents-while often
interrelated-include child abuse and neglect, substance abuse, mental illness,
incarceration, homicide, and HIV/AIDS among parents (Dowdell, 1995; Kelley,
Yorker, Whitley, & Sipe, 2001).
While some children have been removed from
the care of their birth parents by the child protection system and placed with
foster parents, many more are with grandparents through informal arrangements
among family members (Yorker et al., 1998).
While caregiver burden among those providing
for elderly parents or spouses has been studied extensively over the past few
decades, only recently has it been examined among older adults raising
grandchildren and great-grandchildren.
With the dramatic rise in the number of
grandparents raising grandchildren in households that do not include either
birth parent, research on this population has only recently evolved.
Researchers studying this phenomenon represent a number of disciplines
including nurses, sociologists, gerontologists, and psychologists. Nurse
researchers have made important contributions to empirical knowledge related
to the impact of the caregiving role on grandparents raising grandchildren.
Consequences of Grand Parents Raising
Recent
research indicates that raising grandchildren was associated with negative consequences
for the well being of grandparents.
For instance, numerous studies indicate
that grandparents raising grandchildren are at an increased risk for physical
health problems, with some health problems serious enough to jeopardize their
ability to provide care for their grandchildren (Dowdell, 1995; Whitley, White,
Kelley, & Yorker, 1999).
Based on a nationally representative sample,
researchers found that grandmothers raising grandchildren were more likely than
non-care-giving grandmothers to report their health as fair or very poor
(Fuller-Thomson & Minkler , 2000). These grandmothers were also more likely
to report physical limitations when performing daily living activities.
Similarly, Dowdell found that 45% of the custodial grandmothers identified themselves
as having a physical health problem or illness that seriously affected their
general health, with single grandmothers more likely than married grandmothers
to report health pro problems.
In a prospective cohort study as part of the
Nurses’ Health Study, researchers found that providing high levels of care to
grandchildren increases the risk of coronary heart disease (Lee, S., Colditz,
Berkman, & Kawachi , 2003).
Custodial Grandparents
In a
study involving 102 custodial grandmothers, almost half self-reported their
health as only fair or poor (Whitley et al., 1999). Health assessments by
registered nurses indicated that 25% of the participants were diabetic, 54%
were hypertensive, and 80% met the criteria for obesity, which is associated
with cardiovascular problems.
Participants scored significantly worse in the
areas of physical functioning, bodily pain, social functioning, role
functioning, and general health than national norms on a standardized
self-report measure of health.
Researchers
consistently have found that assuming full-time parenting responsibilities for
grandchildren was associated with increased rates of psychological distress,
including depression, in grandparents ( Burnette , 1998; Emick & Hayslip ,
1999; Force, Botsford, Pisano, & Holbert , 2000; Fuller-Thomson, Minkler ,
& Driver, 1997; Kelley, Whitley, Sipe, & Yorker, 2000; Szinovacz ,
DeViney , & Atkinson, 1999).
In a study of African-American women raising
grandchildren, Minkler and Roe (1993) found that 37% of grandmothers raising
grandchildren reported their psychological health had worsened since assuming
full time caregiving responsibilities, with the majority (72%) reporting
feeling “depressed” in the week prior to data collection.
In another
study, researchers found that nearly 30% of grandparents raising grandchildren
had psychological distress scores in the clinical range, which is indicative of
a need for mental health intervention (Kelley, Whitley, et al.).
Focus of Grand Parents Children Raising
Grandparents
raising children with special needs or behavioral problems experience even
higher rates of psychological distress. In one study, researchers found that
grandparents raising special-needs children reported poorer mental health
well-being than those raising children without special needs (Brown, DR, &
Boyce-Mathis, 2000).
Other studies have found that grandparents raising
grandchildren viewed as difficult or as having behavioral problems experienced
more negative effects than grandparents’ raising children viewed as normal (
Hayslip , Emick , Henderson, & Elias, 2002; Pruchno & McKenney,
2002).
While many of the studies discussed above involve relatively small and
homogeneous populations, researchers analyzing data from the National Survey of
Families and Households reported similar findings. For instance, when
researchers compared custodial grandparents to noncustodial grandparents, they
found that custodial grandparents were almost twice as likely to be categorized
as depressed (Fuller-Thomson et al., 1997).
Even after controlling for
depression that preexisted the onset of caregiving, custodial grandmothers had
higher rates of depression. Minkler and Fuller-Thomson (2001) also found that
custodial grandmothers were more likely than noncustodial grandmothers to have
significant levels of depressive symptomatology.
How Grand Parent Caregiver Affected During Care Taking
A
number of factors have been identified as contributors to increased
psychological distress, including depression, in grandparent caregivers. Some
of the most well-documented correlates included poor physical health, social
isolation, and financial difficulties.
For example, in one study, researchers
found that family resources, participants’ physical health, and to a lesser
extent social support predicted levels of psychological distress in
grandparents raising grandchildren (Kelley et al., 2000).
Other factors contributing
to mental health status that have been. Identified by researchers include
circumstances involved with the onset of assuming full-time parenting
responsibilities (eg, abandonment by, addiction in, incarceration or death of
their adult child), changes in role demands, conflict with the children’s
parents, behavior problems of grandchildren, and legal issues ( Caliandro &
Hughes, 1998; Dowdell, 1995; Emick & Hayslip , 1999; Yorker et al., 1998).
By
assuming full-time parenting responsibilities, grandparents are often faced
with in-creased financial pressures at or near a time in their lives when
income is dramatically decreased. This decrease in income is most often related
to retirement and living on fixed incomes or from having to leave full-time
employment because of the demands of full-time parenting, especially when the
grandchildren have special needs.
While some families may be entitled to
Temporary Assistance to Needy Families (TANF) cash benefits, the monthly
payments are typically nominal and insufficient for adequately housing,
clothing, and feeding children. Furthermore, a lack of resources has been found
to contribute to increased psychological stress in grandparents raising
grandchildren (Kelley et al., 2000).
Findings
from several studies portray grandparent caregivers as socially isolated from
peers due to demands of raising children at a point in their lives when they
would otherwise have few childcare responsibilities (Fuller-Thomson &
Minkler , 2000; Hay slip, Shore, Henderson, & Lambert , 1998; Musil ,
1998).
The social isolation typically reported by grandparents raising
grandchildren is important given that social support is a mediator of
psychological distress in grandparents raising grandchildren (Kelley et al.,
2000).
Further
research on the well-being of custodial grandparents is needed. Longitudinal
studies would contribute to knowledge of the long-term impact of this type of
caregiving.
Experimental studies will be necessary to determine which
intervention strategies are most effective in improving the physical and mental
health of this population. An increase in policy-relevant research is needed to
address the health care, financial, and housing needs of grandparents raising
grandchildren.