The Dynamics of Caregiving: Transitions During a Three-Year Prospective Study

Two decades of research on the effects of family caregiving have documented that this is a stressful role with deleterious consequences for the person providing care (Aneshensel, Pearlin, Mullan, Zarit, & Whitlatch, 1995; Haley, Levine, Brown, Berry, & Hughes, 1987; Lawton, Moss, Kleban, Glicksman, & Rovine, 1991; Pruchno, Peters, & Burant, 1995). Nevertheless, there is evidence of considerable heterogeneity in the effects of caregiving, with some caregivers showing patterns of adaptation while occupying this role, whereas others are characterized by wear-and-tear effects (Townsend, Noelker, Deimling, & Bass, 1989). Whereas most research on caregiving is cross-sectional in design, more recent longitudinal studies have tracked changes in the well-being of caregivers (Aneshensel et al., 1995; Goode, Haley, Roth, & Ford, 1998; Li, Seltzer, & Greenberg, 1999; Schulz & Williamson, 1991; Townsend et al., 1989). Consistent with this new emphasis on prospective investigations has been a reconceptualization of caregiving as a career. Pearlin (1992) noted that the role of caregiver has some features of a career and that, during the period of family caregiving, the demands of the role change (Dwyer, Henretta, Coward, & Barton, 1992). Consequently, the effects on the well-being of the caregiver are not static. The purpose of this article is to examine the prevalence and consequences of transitions into, within, and out of the caregiving career during a 3-year period among wives and daughters who had an elderly husband or parent. Pearlin and Aneshensel (1994) clarified that, unlike most careers, caregiving is unplanned, unexpected, and not entered into by choice. Rather, family members are “drawn into it insidiously” (p. 376), often functioning as caregivers even before they self-define in this role. The ambiguity of the onset of the caregiving role might be more characteristic of spouses than adult child caregivers (Montgomery & Kosloski, 1994), because spousal caregiving grows naturally out of the prior patterns of support and assistance that are exchanged between husband and wife, whereas the character of the exchange of support and resources between parent and adult child is more likely to be altered when caregiving begins (Seltzer & Li, 1996). The structure of the family also influences when a particular family member will enter into the caregiving role. There is good evidence supporting the existence of a hierarchy of caregiving (Cantor & Little, 1985; George, 1988), with spouses being the first-line caregivers and daughters likely to enter the role when the spouse is deceased or unable to function as caregiver (Dwyer et al., 1992). Thus, daughter caregivers tend to care for older care recipients than do wife caregivers (Lawton et al., 1991; Montgomery & Kosloski, 1994). Past studies of the transitions of caregiving have had little to say about the effects of entry into this role because virtually all samples consist of individuals who had become caregivers before the beginning of the study. Research comparing caregivers with non-caregiving peers has shown that caregiving takes An earlier version of this article was presented at the 50th Scientific Meeting of the Gerontological Society of America, Cincinnati, OH, November 15, 1997. Support for the preparation of this article was provided by R01 AG09388. The authors are grateful to Jan S. Greenberg, Leonard I. Pearlin, and two anonymous reviewers for comments on the earlier version of this article and to Barbara Larson and Renee Makuch who coordinated the data collection. Thanks are also due to the Wisconsin Bureau on Aging which provided access to the sample on which this article was based.