Expectations for Families to Care for Older Adults in the United States: Rapid Scoping Review 2011–2023

Journal of Family Theory & Review · 2026-01-22 · 1 citations

ABSTRACT As the population ages and families become increasingly diverse, more work is needed to understand expectations for families to care for older adults. In this review, we discuss the theoretical frameworks and conceptualizations used to study care expectations, summarize overarching findings about theories of care expectations and corresponding measurement, and propose future directions for research. We examined studies published between January 2011 and December 2023 that focused on the United States. There was little theoretical agreement across studies, with intergenerational solidarity's concept of familism being most prevalent. Terminology and conceptualization of care expectations varied. Most survey items or scales used broad definitions of care and/or family, focused solely on adult children, or had only one item available. Future research should include the development of family theories and more nuanced measures of expectations, specifically by caregiver role/relationship, for specific tasks, and/or the health conditions of older adults receiving care.

The Sociological Stakes of Attitudes Toward the Families and Care of Older Adults With Dementia

Sociological Forum · 2026-03-31

This forum essay calls for greater sociological attention to the theoretical and empirical study of attitudes about the families and care of older adults living with Alzheimer's disease and related dementias (ADRD; dementia). Investigating these attitudes can help expand our understanding not only of the social experience of older adults with dementia, but also of family members and caregivers, as dementia is often highly stigmatized, memory loss changes relationships, and relationship dynamics influence care provision and inequalities. Attitudes and norms function at multiple levels - individual, family, and societal - and have large-scale consequences for social systems and inequality in an aging and increasingly diverse United States, where a growing number of older adults have dementia and family caregiving is normative. We briefly highlight demographic trends and interdisciplinary developments that underscore the urgency of and advantages to addressing these attitudes in sociology specifically. We conclude with a call to action and recommendations for scholars seeking to pursue related research within four relevant subfields within sociology: families, aging in the life course, stratification (race, gender, class), and medical sociology.

Beliefs about levels of care responsibility for older adults in need: Differences by relationship and the presence of dementia

Alzheimer s & Dementia Behavior & Socioeconomics of Aging · 2026-01-20

INTRODUCTION: Social norms prescribe family responsibility for care of older adults. However, it is unclear how beliefs about levels of responsibility may vary. METHODS: Using the 2024 RAND American Life Panel (ALP), we test whether beliefs vary by type of relationship, including for lifelong friends, whether the older adult has dementia, and by respondent's caregiver status. RESULTS: Level of caregiving responsibility assigned is highest for spouses/partners, but biological children, stepchildren, and lifelong friends are believed to have some level of responsibility. Beliefs are relatively unchanged by impairment, except levels are higher for the family unit when the older adult has dementia. Caregivers and non-caregivers have similar beliefs with a few exceptions. DISCUSSION: An older adult's social network members are perceived to have some caregiving responsibility, with greater levels of responsibility for nuclear family. The results lend support to the application of hierarchical compensatory theory to beliefs about care responsibility.

Older Adults’ Close Friendships and Feelings of Lacking Companionship and Isolation

Innovation in Aging · 2025-12-01

Abstract Having close friendships (henceforth, “friends”) in later life and their characteristics (e.g., contact, support) may impact an older adult’s feelings of companionship and isolation. We used data from the 2024 National Poll on Healthy Aging with adults ages 50 and older (N = 3,181). Logistic regression analyses indicated that the perception of not having enough friends mediates the relationship between having any friends and experiencing feelings of companionship or isolation, even after adjusting for covariates. In fully adjusted models among older adults with friends (N = 2,877), having fewer friends, less than weekly contact, and feeling that you do not have enough friends or the right amount of contact with them were each associated with being more likely to feel a lack of companionship or to feel isolated. These findings highlight the importance of satisfaction with friendships and their quality, in addition to the number of friends one has in later life.

Relationship Types and Care Received: Differences by Dementia Status

Innovation in Aging · 2025-12-01

Abstract Families and unpaid caregivers continue to provide the majority of assistance to older Americans, including to older adults living with dementia. However, diversity in the family structures of older adults may alter the help they receive and from whom. Using the 2022 National Health and Aging Trends (NHATS) study, I find older adults with and without dementia are equally likely to report having any children or siblings. Although older adults with dementia are more likely to be unpartnered, rates of care by a partner are the same once accounting for partnership status. Older adults with dementia are significantly more likely than those without dementia to receive care from children and grandchildren, but rates of care received are similar for siblings in both groups. These findings have implications for understanding the broader care networks of older adults beyond the traditional focus on a spouse and adult children.

Family Structure and Unmet Care Needs Among Older Adults With and Without Dementia in the United States

The Gerontologist · 2025-02-07 · 3 citations

BACKGROUND AND OBJECTIVES: Family members provide the bulk of assistance to older adults with care needs, but implications of family structure for unmet care needs-and differences when dementia is present-are less clear. RESEARCH DESIGN AND METHODS: We use samples of older adults with care needs from the 2015 National Health and Aging Trends Study (NHATS) and the 2017 Panel Study of Income Dynamics (PSID). We examine 2 measures that indicate whether needs are being met for self-care and mobility activities: having unassisted difficulty with at least one activity (NHATS, PSID) and experiencing any adverse consequences related to a lack of help (NHATS). In NHATS we also combine these to identify individuals with met (no unassisted difficulty; no consequences), self-met (unassisted difficulty only), under-met (any consequence only), and unmet needs (unassisted difficulty, any consequence). RESULTS: Adverse consequences were reported more often among those with dementia (43%) relative to those without (24%); in contrast, unassisted difficulty was reported by fewer older adults with dementia (68%, 70%) than without dementia (85%, 87%). Having more family members was positively associated (OR = 1.039) and having a spouse or partner was inversely associated (OR = 0.700) with experiencing adverse consequences. Having stepchildren was associated with lower odds of having unassisted difficulty (OR = 0.228, 0.531), but greater odds of unmet (relative to met) needs (RRR = 1.610). Most family associations were not moderated by dementia. DISCUSSION AND IMPLICATIONS: Adverse consequences, unassisted difficulty, and unmet need are distinct concepts, and produce different estimates and distinctive relationships with dementia and family structure.

Life Course Family Dynamics and Transfers From Children to Biological Parents

Journal of Marriage and the Family · 2025-10-06

Objective: Time in childhood spent living apart from a biological parent or with a repartnered parent is theorized to disrupt norms of intergenerational solidarity and reduce transfers from adult children to parents. Parents' partnership status when children are grown is also expected to influence children's transfers. We estimate the probability of a past-year child-to-parent transfer as a function of childhood family structure and parents' current partnership status. Background: Changes in family structure across the life course are common and can have lasting effects on parent-child relationships. Prior research has focused on static measures of childhood family structure or focused only on parents' later-life partnerships. Method: We use dynamic measures of biological parents' partnership status and coresidence with children from birth to age 17 and parent's current partnership status to estimate the probability that a child transferred time or money to that parent in the last year (N=8,840 parent-child dyads). Data are from the 1968-2013 US Panel Study of Income Dynamics (PSID), including the 2013 Rosters and Transfers module. Results: Adult children are most likely to make transfers to a parent who is currently partnered with their other biological parent and more likely to support a currently unpartnered or repartnered mother than a father in the same status. Time in childhood spent living with a parent positively predicts adult children's transfers to that parent. Conclusion: Past and current family arrangements each contribute to adult children's likelihood of providing time or money to parents, especially for fathers.

Dementia and Sandwiched Caregiving: Effects on Caregiver and Older Adult Psychological Well-Being

Innovation in Aging · 2025-12-01

Abstract The population of sandwiched caregivers—those supporting both an older adult and a minor child—is increasing yet understudied particularly regarding dementia care. Existing research on this group often focuses on adult children, neglecting other caregivers (e.g., neighbors or grandchildren). This study examines psychological well-being in sandwiched versus non-sandwiched caregivers and their older adult care recipients by dementia status [person living with dementia (PLWD) versus non-PLWD]. Data from 1,514 caregivers and 1,109 older adults were analyzed using the 2022 National Health and Aging Trends Study and National Study of Caregiving. Among caregivers, 253 had a child under 18: 99 cared for PLWD and 154 for non-PLWD. Non-sandwiched caregivers (n = 1,261) included 524 caring for PLWD and 737 non-PLWD. Multivariate linear regression models assessed both caregiver and older adult well-being, adjusting for demographic and care-related covariates. Models were weighted and adjusted for NHATS/NSOC’s complex survey design. For caregiver well-being, sandwiched caregivers had significantly higher well-being (B = 1.85, p<.01) relative to non-sandwiched. However, care-recipient dementia status was not significantly associated with caregiver well-being. The interaction between dementia status and being sandwiched was significant (B=-2.18, p<.01), indicating a reduced well-being advantage for sandwiched caregivers of PLWD. Among older adults, PLWD had significantly lower well-being than non-PLWD (B=-7.36, p<.001). These findings suggest that caregivers with children may experience protective benefits if their older adult care-recipient does not have dementia, whereas dementia negatively impacts well-being among both members of the caregiving dyad. Future research should focus on tailored strategies to improve dyadic well-being in these complex caregiving situations.

Balancing Acts: Exploring Well‐Being in Sandwiched and Non‐Sandwiched Caregivers

Alzheimer s & Dementia · 2025-12-01

BACKGROUND: The population caring for both an older adult and a minor child, known as "sandwiched" caregivers, is growing due to demographic shifts. Most research on the sandwiched caregivers exclusively focuses on adult children, overlooking others like neighbors or grandchildren. Moreover, little is known about sandwiched caregivers of persons living with dementia. This study compares well-being of sandwiched and non-sandwiched caregivers of individuals with and without dementia, with a focus on the role of additional help from family and friends and restriction in social activities. METHOD: Data from 1,728 caregivers of 1,156 older adults were analyzed from the 2022 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). Four groups were compared: Sandwiched, Dementia (S+D); Sandwiched, No Dementia (S-D); Non-Sandwiched, Dementia (NS+D); Non-Sandwiched, No Dementia (NS-D). Linear regressions predicted caregiver well-being, adjusting for demographic and care-related variables, with social participation restriction and family/friend help as moderators. Analyses are weighted and adjusted for NHATS/NSOC's complex survey design. RESULTS: A majority of S+D caregivers were biological, step, or in-law children of the person with dementia (72%), followed by other relatives (21%), and unpaid caregivers like friends or neighbors (7%). Sandwiched caregivers are more likely to receive additional help, be employed, and belong to racial-ethnic minority groups relative to non-sandwiched caregivers (ps< .001). In terms of well-being, compared to S+D caregivers, S-D caregivers had significantly higher well-being (B = 2.91, p < .001), as did NS+D caregivers (B = 1.66, p = .021), but not NS-D caregivers (B = 1.03, p = 163). Linear regression interaction effects revealed differential impacts of social restriction on well-being across caregiver groups, such that S-D caregivers (B = -1.73, p < .001) and NS+D (B = -1.01, p = .013) report significantly worse well-being associated with increased participation restriction compared to S+D. Additional support from family and friends did not significantly moderate the relationship between caregiver groups and well-being. CONCLUSION: This research underscores vulnerability in well-being among sandwiched caregivers, especially those involved in dementia care. While sandwiched caregivers often have additional care support, those caring for non-dementia care recipients are particularly sensitive to restrictions in social activities due to caregiving. Interventions are needed to address the wellbeing needs of sandwiched caregivers.

A Perspective on Making “Invisible” Care Visible Through Time Use Data

Journal of Aging & Social Policy · 2025-07-24 · 1 citations

With an aging population and projected increases in the number of older adults in need of care, especially those with chronic and progressive disease like dementia, family care is at the forefront of pressing social issues in the U.S. and worldwide. Time use data, including 24-hour time diaries (TD), daily diaries (DD), and ecological momentary assessments (EMA), may be especially helpful for shedding light on the often "invisible" care being given by American families caring for older adults. This review presents U.S. datasets that have TD, DD, or EMA available and proposes areas of future research including charting care and the impact on well-being, as well as expanding data collections.