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Remarriages add complexity to dementia caregiving

By Kathleen Raven

NEW YORK (Reuters Health) - Negative relations with stepchildren can compound the burdens a wife feels while caring for her husband with Alzheimer's disease or other forms of dementia, a new study suggests.

"We learned from women in the study that those with higher levels of care-related disagreements with stepfamily members felt a significantly greater burden and feelings of depression related to care," said lead author Carey Wexler Sherman of the University of Michigan's Institute for Social Research in Ann Arbor.

Approximately one-third of all American marriages are remarriages for at least one partner, according to the U.S. Census Bureau. Previous research has shown that divorce rates among adults 50 and older doubled between 1990 and 2010.

And currently nearly five percent of the U.S. population, more than 15 million Americans, cares for a dementia patient, according to the Alzheimer's Association, which helped to fund the new research.

For their study, Sherman and her colleagues focused only on wives in later-life remarriages that occurred after child-rearing years, and recruited 61 remarried wife caregivers from across the country.

Between 2008 and 2010, the participants, whose average age was 66, completed questionnaires about their social networks, their levels of depression and their caregiver burdens.

Most participants were white, middle-class and 85 percent of them had been divorced prior to remarriage; the rest were widows. The average length of the women's current marriages was 17 years, though one quarter of them had been remarried for 10 years or less.

Researchers had the women draw a diagram of their social networks and place their acquaintances into three categories, including "social network," "positive network," or "negative network," with little overlap.

The women's own family and friends dominated the social network and positive network categories. And more than half of the participants included one stepfamily member in their "positive" network.

But, at 35 percent, stepchildren comprised the largest proportion of what wives considered a "negative" group related to caretaking.

In two-thirds of the caregivers' social network categories, stepchildren were completely absent. The remarried wives also reported that adult stepchildren and other stepfamily members were more likely to question care-related decisions, offer unwanted advice, interfere or criticize.

The most common complaints from women in the study included stepchildren not being present during the caregiving process or promising to help but never following through. Some participants reported substantial family conflicts with adult stepchildren and other stepfamily members over money, inheritance concerns and medical decisions.

When the researchers looked at what factors affected the caregivers' wellbeing, levels of family disagreement over caregiving issues had the strongest impact on the women's levels of depression and sense of caregiver burden.

"Stepfamilies in older age in general haven't been researched," Merril Silverstein, the Cantor Professor of Aging Studies at Syracuse University in New York, told Reuters Health.

Silverstein invited Sherman's group to publish the study in a special stepfamily section of the Journal of Marriage and Family, but he was not involved in the research.

"Baby boomers are entering old age with complicated family structures - unlike their parents," Merril said.

Generally, couples remarry less often with age and U.S. remarriage rates have declined over the past two decades, but co-habitation and other non-traditional arrangements are less studied, he said.

In 2010, the remarriage rate among men age 65 and older was 12 per 1,000 and among women the same age only 2 per 1,000, according to the National Center for Family & Marriage Research.

"When people remarry later in life, it means they may have relatively few opportunities to bond with adult stepchildren," said Lawrence Ganong, professor of human development and family studies at the University of Missouri in Columbia.

"One of the reasons children take care of their parents is that they feel they've been taken care of and feel obligated to return the favor," Ganong, who was not involved in the study, said.

"We are getting into a new era of older families and couples where unprecedented numbers of divorces and remarriages have happened," he added.

"The first intervention that everyone can do in their own life is discuss with family members how health issues and caregiving will be handled," Sherman said. She and her colleagues are working to develop tailored instructions designed for remarried spouses and stepfamily members.

Most people do not want to sit down and have these conversations because they are difficult, Ganong said.

The Georgia-based Rosalynn Carter Institute for Caregiving offers evidence-based intervention options for dementia caregivers, including cognitive-behavioral therapy, communication training and online workshops.

The authors acknowledge that their study was small and suggest that future research should follow participants for a longer time and include caregivers more representative of the general population's diversity.

Despite her study's results, Sherman thinks this added burden on caregivers can be lightened. "It's important to note … that stepfamilies can do this successfully," she said.

SOURCE: bit.ly/1dEvYrA Journal of Marriage and Family, online September 3, 2013.

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