Please enable JavaScript.

Coggle requires JavaScript to display documents.

W9 Informal Caregiving in SG - Coggle Diagram

- - - - Eg. lost wages, desired lifestyles, personal freedom, aspirations
      - Statistics
        
        USA
        
        Mudrazija, 2019
        
        Opportunity costs of informal caregiving (foregone costs)
        
        US$67 billion in 2013
        
        Factors
        
        growth of disabled older population
        
        increased share of better-educated caregivers
        
        Projected to double to US$132 to 147 billion in 2050
        
        Avg opp cost increase
        
        Per caregiver :arrow_right: 8% - 20%
        
        Per US citizen :arrow_right: 54% - 72%
        
        Chari, Engbert, Ray, & Mehrotra (2010)
        
        Methodology
        
        Imputation for non working individuals via selection corrected regression methodology
        
        Wage is used as the measure of an individual’s value of time (opportunity cost)
        
        Results
        
        Total opportunity cost :arrow_right: $522 billion per annum
        
        Costs of replacement with
        
        Paid unskilled labour :arrow_right: US$221 billion
        
        Paid skilled labour :arrow_right: US$642 billion
        
        Singapore
        
        lack of data on economic value of caregiving
        
        12500 residents cited family caregiving as main reason for leaving job and not looking for one from 2015 to 2017
        
        most were married women 40 and above
      - Factors
        
        :arrow_up: in older disabled
        
        :arrow_up: educated caregivers
    - - Statistics
        
        Financial costs in USA
        (AARP Caregiving in the U.S. 2020 Report)
        
        53 million family caregivers that provided 23.7 hours of care weekly
        
        estimated economic value of unpaid contributions: $US470 billion
        
        almost half of family caregivers spend above US$5000 on out-of-pocket caregiving expenses
        
        more pronounced in young caregivers or caregivers w prolonged/multiple caregiving roles
      - mental, emotional, social and financial costs borne by unpaid informal caregivers
  - - - Institutionalisation
        
        caregivers who institutionalised relatives with dementia had same levels of depression & anxiety as high as when they were in-home caregivers
        
        harder for :womens:
      - Bereavement
        
        Teno et al., 2004
        
        family members of loved ones who received home hospice services (eg. nursing home, acute hospital)
        
        :arrow_up: satisfaction & :arrow_down: unmet needs
        
        Bodnar & Kiecolt Glaser, 1994
        
        caregivers after bereavement showed :arrow_up: rate of depression and anxiety up to 3 years later
    - - opportunity to give back to someone who was once their caregiver
      - chance of model "caring" to children who would hopefully provide care to them in turn
- - - - dynamic shared across a network of family members
      - reflects family history of care exchanges throughout the lifespan
  - - - Characteristics
        
        acknowledges person can take on both caregiver role and care recipient (from different person)
        
        Eg. :older_woman: cares for spouse :older_man: with diabetes and receives care from son :man::skin-tone-2: for osteoarthritis
        
        may exist across nonconsecutive generations (eg. grandparent to child)
        
        may involve even more complex
        patterns where multiple family members exchange and support one another together
      - Developmentally Normative
        
        Parents :family: :arrow_right: chronically ill child/teen
        
        Spouse :arrow_right: chronically ill spouse
        
        Adult child :arrow_right: chronically ill parent
      - Distribution Factors
        
        :womens: tend to support ADL needs more
        
        :arrow_up: sensitivity to bodily needs
        
        distributing care roles based on skills, experiences, resources, time
        
        cultural and familial expectations of family members responsible for care
        
        tensions among siblings when parent health declines and favouritism is perceived
        
        expected for favoured sibling to care for parent
        
        geographical proximity of family members
        
        practical considerations
        
        health status of CG & CR
      - potential bidirectional flow between caregiver and care recipient
    - - indication that care provision requires collaboration & teamwork across multiple family members
        
        Eg. one schedules appointments while another prepares meals
    - - Balanced
        
        Parent (CG) to Child (CR)
        
        creates expectation of level of care received from child later in life
        
        provides substantial amount of care for child
        
        Child (CG) to Parent/Grandparent (CR)
        
        child that experienced supportive rs with parent/grandparent may have :arrow_up: desire to provide care for that person later in life
        
        Fluctuations
        
        Eg. Guy with type 1 diabetes shifts from parents to romantic partner as primary caregiver
        
        due to changing developmental capacities and milestones of each generation
      - Unbalanced
        
        leads to distress and strained relationship
        
        exchange dynamic does not match one's values or beliefs about their level of obligation to provide care
        
        Examples
        
        Parents with children diagnosed with cognitive/developmental disability
        
        remain primary caregivers even as they age
        
        experience :arrow_down: quality of life and :arrow_up: stress than parents of healthy children
        
        siblings may become primary caregivers for both disabled siblings and ageing parents
      - family members expect to receive support similar to support they provided in the past
  - - - across time and within families throughout lifespan
    - - Cultural
        
        Perspectives
        
        Collectivism
        
        prevalent in Asian culture
        
        Familism
        
        prevalent in AA or Hispanic cultures
        
        Components
        
        filial piety & obligation
        
        perceived support
        
        family as source of rules and guidance
        
        "needs of family :arrow_up: than needs of individual"
        
        multidimensional with some positive and negative aspects
        
        Eg. Familism
        
        perceived support => :arrow_up: positive outcomes
        
        filial obligation => :arrow_up: emotional distress
        
        Gender
        
        :womens: responsible for family care while :mens: responsible for financial needs
        
        :womens: => ADLS (personal care & specialised medical care)
        
        Spouses in old age
        
        provide equal amounts of care in all areas
        
        guided by expectations of marital relationship than traditional gender role expectations
        
        more shared between genders as sick spouse no longer able to fulfil gender role expectations
        
        :mens: => IADLs (financial support & care arrangements)
        
        broader cultural factors that socialise families to expectations regarding family care exchanges
      - Familial
        
        quality of family relationships where care exchanges occur
        
        Physical closeness
        
        long-distance caregivers provide
        
        :arrow_down: hands-on support
        
        :arrow_up: emotional and instrumental support (eg. financial assistance & care coordination)
        
        assumes cohesion warmth and closeness between CGs and CRs
        
        typically vary in degree of closeness
        
        Relationship quality
        
        warm and accepting parents & romantic partners
        
        associated with supportive and collaborative exchanges
        
        :arrow_up: illness outcomes over range of chronic illnesses
        
        :arrow_up: adult CG-CR relationship quality
        
        Daughters
        
        despite :arrow_down: in functioning leading to :arrow_up: demands of care provision
        
        maintained commitment and mothers remained engaged as care recipients
        
        report rewards from caregiving even with conflict
        
        Spousal CGs & CRs with :arrow_up: marital quality
        
        benefit from :arrow_up: exchanges of emotional support to one another
        
        Divorce and remarriage
        
        stepchildren :arrow_down: engaged with stepparents than biological parents
        
        noncustodial parenthood shown to threaten parent-child relationship across life course
        
        stepfamily network :arrow_up: being seen as important & potentially supportive one
        
        stepchildren frequently listed as part of positive and negative support networks of late-life remarried people
      - Individual
        
        individual characteristics of CG and CR
        
        Caregiver
        
        Protective factors
        
        Good mental health
        
        protects against CG stress
        
        :arrow_up: resources for higher quality of caregiving
        
        :arrow_up: depressive symptoms lead to
        :arrow_down: involvement in child's illness management & :arrow_down: illness outcomes
        
        Personal mastery
        
        associated with :arrow_up: CG wellbeing & affect
        
        Agreeableness
        
        moderate relationship between stress and life satisfaction in informal CGs
        
        negative effect of caregiving significantly :arrow_down: in CGs with :arrow_up: agreeableness
        
        :arrow_up: self-efficacy
        
        :arrow_up: efffective dyadic coping in spouses with cancer
        
        :arrow_up: caregiver well-being
        
        Aggravating
        
        Diagnosis in CR
        
        associated with depressive symptoms which impair ability to provide care effectively
        
        CGs of lung cancer patients
        
        :arrow_up: anxiety & depression
        
        1 more item...
        
        Care Receiver
        
        Nature of condition
        
        In children
        
        cancer, cerebral palsy, AIDS, spinal bifida associated with :arrow_down: CG wellbeing
        
        :arrow_down: life expectancy & impairments in cognitive & physical functioning
        
        In :older_man::skin-tone-3:
        
        AD and related dementias
        
        :arrow_up: CG burden
        
        diseases vary in
        
        Timeline (sudden VS gradual)
        
        Expected duration and/or consequences (high daily managment, cognitive/communication deficits)
        
        Time course (prog. declining/relapsing)
        
        Receptivity
        
        In children
        
        behavioural problems associated w :arrow_up: parenting stress
        
        In adults
        
        extent to which CG exhibits resistance above typical level
        
        Personalities of CRs
        
        :arrow_up: physical health when
        
        CRs are easygoing (:arrow_down: neuroticism & :arrow_up: agreeableness)
        
        CRs are well-intentioned (:arrow_up: agreeableness & :arrow_down: conscientiousness)
        
        :arrow_down: physical health when
        
        CRs are :arrow_down: agreeable
  - - - modern demographic trends to delay childbirth to later ages
      - :arrow_down: family sizes & trend to remain childless
        
        :arrow_down: number of potential CGs in family
    - - additional challenges juggling educational, occupational, family CG roles
      - may be delayed in achieving normative milestones of early adulthood
    - - shape expectations for care exchanges later in life
- - - - to an indivudual w chronic illness or disability
  - - - high variability across course of caregiving due to
        
        timing of entry into caregiving role
        
        transitions in care experienced over time
        
        Step-up care
        
        eg. hospital :arrow_right: specialist
        
        Step-down care
        
        eg. specialist :arrow_right: community hospital
        
        duration of role in relation to overall life course of caregiver
        
        diversity of family structures, norms, values, relationships
    - - caregiving over time
      - existence of 4 typical phases in caregiving trajectories
        
        may not be linear
        
        see article for examples
      - existence of broad domains of activity characterising family caregiving