Offspring Caregivers’ Mental Health Affected By Intergenerational Disagreements On Preferred Living Arrangement For The Elderly

BackgroundIn China, for thousands of years, family has played a significant role in elder care. Family members, especially elders’ offspring, have the obligation to provide elder care, traditionally by co-residing with their elderly parents.In the1960s, the Chinese government encouraged "Two-child policy" in urban areas. Now, those parents, if still living, are about80years old and most of them need assistance in daily life. However, their offspring lack siblings to share the caregiving burden. At the same time, they have to deal with stress from work and life. Meanwhile, with the improvement of living standards, the elderly live in urban have more demands for material and spiritual support than before. The disparity between the demands of the elderly parents and what their offspring can provide has become more severe. Therefore, the traditional way of elder care has gradually cannot meet the demands of urban elderly.The declined birth rate, changes in the family structure, weakening of absolute parental authority are affecting the offspring caregivers in their behaviors in elder care. The offspring caregivers are starting to prefer non-traditional care, such as independent living. More and more offspring caregivers hope to care their parents by hire a maid or send their parents to institutions. However, the majority of elders still preferred the traditional way. They don’t like to take care by stranger and refuse to go to institutions. According to the strain theory, the intergenerational disagreement on the way of elder care could cause psychological stress of offspring caregivers. At present, the intergenerational disagreement in preferred living arrangements is increasingly obvious. Is it will harm to offspring caregivers’ mental health? Most studies conducted in Western populations showed that, compared with non-caregivers, caregivers had higher level of depressive symptoms. In China, since the end of last century, studies on family caregiving have been carried out in China, but the subjects were limited to the family caregivers whose parents were suffering from stroke, Alzheimer, cancer, or other serious diseases. So far, there is no research focus on the effect of intergenerational disagreement of elder care on offspring caregivers’ mental health.Objectives1Investigate elderly parents’ actual living arrangements, elderly parents’ preferred living arrangements and offspring caregivers’preferred living arrangements for their parents.2Analyze the different of preferred living arrangements between elderly parents and offspring caregivers.3Explore the effect of intergenerational disagreement of elder care on offspring caregivers’ mental health.MethodsThis was a cross-sectional descriptive study. The participants were recruited from five communities by convenience sample in this study. The participants must meet the following inclusion criteria:aged40years or above; living in urban area of Jinan; their parents or parents-in-law living in the urban area of Jinan; no disease that might affect physically or mentally the validity of the interview. The Self-rating Depression Scale (SDS) was used to measure participants’ depressive symptoms. The Self-rating Anxiety Scale (SAS) was used to measure participants’anxiety symptoms.The SPSS20.0was used for statistic analysis. Describe participants’ characteristics, depressive symptoms, anxiety symptoms and the intergenerational ideas of preferred living arrangements. Analyze the different of preferred living arrangements between elderly parents and offspring caregivers. Multiple factor analysis was conducted using generalized linear models (GLM), to analyze the effect of intergenerational disagreement of elder care on offspring caregivers’ mental health. In order to explore the participants with highest SDS score or SAS score, the study divided participants into server groups, then GLM models were used to adjust confounding factor and analyze the effect of the intergenerational disagreements on depressive symptoms among participants with different characteristics.Results1Participants’ depressive symptoms and anxiety symptomsThe total of participants was870. The mean of SDS score was (43.6±9.7), rang from25to75participants have depressive symptoms, accounted for25.5percent of all participants. The mean of SAS score was (37.2±8.1), rang from25to77participants have anxiety symptoms, accounted for8.9percent.2The preferred living arrangements between elderly parents and offspring caregiverIn elderly parents’ preferred living arrangements, the proportion of "co-reside with children, no paid help" was highest as60.9%. In offspring caregivers’preferred living arrangements for their parents, the proportion of "co-reside with children, no paid help" was highest as47.4%which lower than elderly. However, the proportion of "co-reside with children, paid help" and "non-co-reside with children, paid help" were higher than elderly.3The intergenerational disagreements of preferred living arrangementsThe proportion of disagreements of preferred living arrangements between elderly and offspring caregivers was36.7%. There were14.8%elders lived in their offspring’s preferred way,13.8%elders lived in their preferred way. In co-reside concordance, the proportion of elders lived in their offspring’s preferred way to non-co-reside, but they preferred co-reside was highest as11.0%. In paid help concordance, the proportion of elders lived in their preferred way to no paid help, but they offspring preferred paid help was highest as11.4%.4The effect of intergenerational disagreement of preferred living arrangements on offspring caregivers’SDS scoreWhen intergenerational ideas of preferred living arrangements were different, the differences of offspring caregivers’SDS score were statistically significant (P<0.05). The intergenerational disagreements had greatly impact on offspring caregivers’ depressive symptoms when elderly physical functional status was relatively independent and relatively dependent. Especially, if the elderly were relatively independent and offspring caregivers had to co-reside with their parents against their willingness, the max mean difference on the depression measures was up to10.35(P<0.05) and11.16(P<0.05), in comparison with both parties were willing to co-reside. In the case of offspring caregivers hiring a maid to take care of the elderly against the willingness of the elderly, the max mean difference on depression was up to7.38(P<0.05) and13.01(P<0.05), in comparison with the situation in which both parties agreed with hiring a maid.5The effect of intergenerational disagreement of preferred living arrangements on offspring caregivers’SAS scoreWhen intergenerational ideas of preferred living arrangements were different, the differences of offspring caregivers’SAS score were statistically significant (P<0.05). The intergenerational disagreements had greatly impact on offspring caregivers’ anxiety symptoms when elderly physical functional status was relatively independent and relatively dependent. Especially, if the elderly were relatively independent and offspring caregivers had to co-reside with their parents against their willingness, the max mean difference on the depression measures was up to9.53(P<0.05) and12.88(P<0.05), in comparison with both parties were willing to co-reside. In the case of offspring caregivers hiring a maid to take care of the elderly against the willingness of the elderly, the max mean difference on depression was up to4.77(P<0.05) and 3.95(.P<0.05), in comparison with the situation in which both parties agreed with hiring a maid.Conclusions1The ideas of preferred living arrangements between elderly and offspring are different. The elderly preferred to co-reside with offspring. The offspring caregivers are starting to prefer hair a maid as paid help.2In the following two situations:(1) The adult children prefer independent living, but they have to live with their elderly parents, and (2) adult children hire a maid against their elderly parents’ willingness, the effects on offspring caregivers’ metal health is the most.3When elderly was relatively independent and relatively dependent, the effect of intergenerational ideas of preferred living arrangements on offspring caregivers’ metal health is most.