grandparents raising children
Helping Older Adults Understand A New Role
BY SALLY PETERS
In 1997, 2.4 million American families were headed by grandparents who were raising one or more of their grandchildren--an increase of 19% since 1990. According to the Administration on Aging (AoA), these older people raising grandchildren face a number of challenges, such as their own failing health, a lack of support and respite services and a lack of affordable housing and health care.
Unfortunately, many of these grandparent caregivers quietly accept their new role and ignore their own health needs in the interest of attending to their grandchildren's needs, says Larry Rosen, PA-C, who practices at Noble Community Medical Group in Los Angeles. "They are less attentive to their own needs because they simply do not have the time," he says. When a young child is introduced unexpectedly into their lives, grandparents may deplete their physical, emotional and financial resources to meet the needs of their young wards. As a result, their own needs are not met, and the consequences can be unhealthy. "It's a very, very difficult lifestyle for these people," Rosen says.
Grandparent caregivers are at increased risk for stress, depression and exhaustion brought on by their new roles. Adults of this age may have chronic illnesses such as hypertension or
diabetes and already may be experiencing stress as a result of these problems. Often grandparents are challenged by a dual role, to be parents to a grandchild as well as their own child. Here's what you can do to help.
A Million Grandmas
Slightly more than half of the families headed by grandparents featured both grandparents. But 1 million had only a grandmother as head of the household, and 150,000 had only a grandfather in the lead role, according to the U.S. Census Bureau. Grandparent-headed families represent all ages and socioeconomic groups.
Grandparents typically find themselves raising young children because of the absence of biological parents. This absence can result from substance abuse, child abuse or neglect, abandonment, teen pregnancy, death, divorce, unemployment, incarceration or AIDS, according to the American Association of Retired Persons (AARP).
Poverty is a concern in many households where grandparents are raising young children. According to the AARP, the family income in 39% of grandparent-grandchild families is below $20,000 annually. About 41% of those families have incomes between $20,000 and $40,000. Many grandparents still need to work to support themselves. While more than 37% of grandparent caregivers are retired, 35% still work full time, and 16% work part time.
Nutrition--for the child and the grandparent alike--may be an issue. "Attention to nutrition and exercise is put on the back burner," Rosen says. Children in these households may not be eating adequately because their grandparent caregivers are unable to provide nutritious meals. Healthy nutrition may be overlooked when older adults allow the children's nutrient needs to take precedence over their own. Grandparent caregivers also may be at risk for abusing alcohol, tobacco or stimulants such as caffeine in an effort to cope.
Many grandparent caregivers may have illnesses associated with older adulthood such as hypertension or type 2 diabetes, says Donna Behlar McArthur, PhD, a lecturer at the University of Arizona College of Nursing. "Stress is related to many chronic illnesses, and the added stress of parenting a young child may further compromise the grandparents' physical and emotional health," Dr. McArthur says. If a grandparent is physically or mentally ill, introducing a young child into the home adds another stress, she says. "It's just overwhelming."
Despite their love of their grandchildren and a sense of gratification in contributing to a better life for them, grandparent caregivers can experience emotional stress and generalized fatigue from the burden of their new roles, Dr. McArthur says. They may report symptoms such as sleep disturbances. The older adult may experience anxiety from trying to keep up with the child's school, social and physical activity schedules, she says. "Seeing a client over time, you identify subtle changes," she says. "Being alert to signs of depression and anxiety are very important."
If you have developed a trusting relationship with your older patients, they will be more comfortable in discussing current stressors in their lives. If you are concerned about how your adult patient is handling a new role of grandparent caregiver, Dr. McArthur suggests initiating a conversation by asking a leading question such as, "Many grandparents describe feeling overwhelmed by caring for their grandchildren. Do you ever feel this way?" Interventions to help the grandparent gain a sense of self-esteem and confidence in the face of increased responsibility and loss of independence may be appropriate.
When assessing older patients, particularly those with chronic diseases (physical and mental), you must look for signs and symptoms of depression. Negative health behaviors (e.g. alcohol abuse and increased tobacco use) may indicate problems with coping. Treatment approaches for depression may include referrals to mental health professionals and medication. Exercise caution when introducing an antidepressant into the medication regime of a patient who is already taking a number of drugs. If an antidepressant is indicated, Dr. McArthur recommends taking advantage of this "teachable moment" to review all of the patient's medications. In fact, medication reviews should be done at every visit, she says. It is possible that a patient's current medications could be contributing to the depression.
Depression in grandparent caregivers may be evaluated by using the criteria for depression outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). According to the DSM IV, depression is present when five or more specific symptoms have been present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms must be depressed mood or loss of interest or pleasure. Most of the criteria must be observed nearly every day for a diagnosis of depression to be appropriate. The criteria include:
* Depressed mood most of the day, as indicated by subjective report or observation by others.
* Diminished interest or pleasure in all, or almost all, activities most of the day.
* Significant weight loss when not dieting, weight gain or decrease or increase in appetite.
* Insomnia or hypersomnia.
* Psychomotor agitation or retardation.
* Fatigue or loss of energy.
* Feelings of worthlessness or excessive or inappropriate guilt.
* Diminished ability to think or concentrate, indecisiveness.
* Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Another factor to consider is that compliance in taking medications for other disorders often falls by the wayside when people are depressed, Rosen says. He has seen more than one patient with diabetes who has been negligent in taking their medications because they were getting children off to school.
The PA's Role
To provide grandparent-headed families with the support and resources they need to function, be aware of resources for grandparent caregivers, from community agencies, support groups, schools and churches to national organizations. Compile a list of resources in your community to hand out to grandparent caregivers. You can find links to grandparenting resources on the AoA Web page (http://www.aoa.dhhs.gov) and the AARP Web page (http://www.aarp.org).
Consider bringing the children's parents (if they are accessible) into office visits with grandparents to discuss issues of raising young children, Rosen says. Often, parents may not be aware that older adults are under stress if they don't speak up.
Sally Peters is an assistant editor.