CHAPTER 16

LECTURE EXTENSION

Caregiver Problem-Solving Styles and Family Member Adjustment to a Recent-Onset Physical Disability

As discussed in the text, the family structure has become more "top-heavy" as birthrates are decreasing, with more generations alive, but with fewer young members. This means that more than one older family member is likely to need assistance with daily life, with fewer younger adults to provide it. Further, the increasing frequency of chronic disease and disability places new demands on adult children to provide care for aging parents who have incurred permanent disabling conditions. Careving for a chronically ill or disabled parent often imposes significant changes in personal, vocational, and familial roles and functions.

A study by Elliott, Shewchuk, and Richards (1999) explores the relation of caregiver characteristics to the psychological and physical adjustment of family members living with a recent-onset severely disabling condition. They argue that as familial caregivers take on increasing responsibility for providing care and helping disabled family members follow prescribed self-care and medical regimens, there is a need to identify caregiver characteristics that affect patient health outcomes.

The results of the study indicate that caregiver tendencies to solve problems impulsively and carelessly are associated with poorer psychological adjustment of the disabled family member at discharge from a medical rehabilitation program and with health outcomes a year later. The authors theorize that caregivers who are impulsive and careless in their problem-solving approaches probably have difficulty following regimens.

Further findings suggest that quality of family involvement may be an important moderator of patient adjustment. In particular, it appears that patients who experienced a great deal of difficulty coming to terms with their disability during the rehabilitation program may have been aware of their caregivers' tendencies to deal with everyday tasks impulsively and carelessly. Because these ineffective problem-solving behaviors-which are linked to patient outcomes-can be identified early in the rehabilitation process, the authors suggest that the health care delivery system should identify and provide these caregivers with problem-solving interventions that teach them to cope effectively with the demands of caring for a disabled family member.

Elliott, T. R., Shewchuk, R. M., & Richards, J. S. (1999). Caregiver social problem-solving abilities and family member adjustment to recent-onset physical disability. Rehabilitation Psychology, 44, 104-123.

LEARNING ACTIVITY

Defining Friendship

Friendship supports psychological well-being. In many studies of friendship, adults are asked to define friendship. As an out-of-class assignment, students can explore the meaning of friendship in midlife by asking middle-aged adults to define friendship. To facilitate comparison of responses, use a common stem or question such as "A friend is someone . . . " or "What does friendship mean to you?" Have students bring the responses that they collected to class. Discuss the responses, looking for common themes such as trust, shared activities, disclosure, and instrumental support. This activity can be varied by having students seek definitions from young adults, middle-aged adults, and older adults. Definitions of friendship from children and adolescents could also be included. Students should look for similarities and differences in responses across age groups.