Intergenerational Antecedents of Care to Older Adults Approaching the End of Life With and Without Dementia

摘要 根据社会交换的框架，我们假设，随着父母需求的增加，对儿童的早期投资稍后将以工具性照顾的形式得到回报。我们将考察死亡时间作为替代或补充方法，以使用关于功能和认知障碍的代理和自我报告来评估老年人与其成年子女护理职业相关的脆弱性。测试的模型将为有关儿童如何充当条件资源的理论提供信息--当父母的需求触发时，对父母的早期投资做出反应--改善了对家庭生命周期中代际关系的描述。这项研究的目标是：(1)将宝贵的时间、金钱和情感资源的早期转移与成年子女向脆弱的老年父母提供的护理的变化率联系起来；(2)测试一种新的方法方法--“倒计时模型”--它使用死亡时间代表一种全球形式的脆弱性，从而触发向老年父母提供护理；以及(3)确定与其他原因相比，对老年父母的护理是否与阿尔茨海默氏症和其他痴呆症相关原因的死亡时间更密切相关。倒计时模型使用死亡时间作为替代的、客观派生的生物脆弱性衡量标准，以代表年迈父母对护理的需求。我们对这一模型的应用提供了一种独特的理论和方法的结合，它增强了对家庭中数十年来展开的长期代际交流动态的理解，并代表了父母利用关于他们死亡的时间和(痴呆症和非痴呆症)原因的知识逐渐变得脆弱。该项目的数据来自世代纵向研究(LSOG)，这是一项由多个小组和多代人组成的研究，收集了1971至2016年间三代家庭的数据。聚焦于1971年平均年龄为19岁的中间一代，我们考察了1985至2016年间这些孩子向年长父母提供照顾的轨迹，作为加速父母脆弱性的函数，以及他们与1971年父母在他们身上进行的早期投资(共享活动)、金钱(财务支持)和情感(亲密)的互动。使用之前从2016年国家死亡指数中收集的关于父母的死亡信息-结合更新到2019年的NDI搜索-我们测试了死亡时间作为日益增长的认知和身体脆弱的代表的效用，这会刺激孩子提供越来越多的护理。鉴于家庭作为晚年长期护理的可靠来源的不确定性越来越大，这项研究是及时的。

ABSTRACT Based on the framework of social exchange, we hypothesize that early investments made in children will later be reciprocated in the form of instrumental care as parental needs increase. We will examine time-to-death as either an alternative or complementary approach to the use of proxy and self-reports about functional and cognitive impairment to assess vulnerability in older adults in relation to the care-careers of their adult children. The models tested will inform theory about how children serve as conditional resources—responding to their parents’ early investments when triggered by parental need—rendering an improved depiction of intergenerational relationships over the family life cycle. The goals of the research are to: (1) link early transfers of valued resources of time, money, and emotion to rates of change in the amount of care adult children provide to their vulnerable older parents; (2) test a novel methodological approach—the “countdown model”—that uses time-to-death to represent a global form of vulnerability that triggers the delivery of care to older parents; and (3) identify whether care to older parents is more strongly associated with time-to-death from Alzheimer's disease and other dementia-related causes compared to other causes. The countdown model uses time-to-death as an alternative, objectively derived metric of biological vulnerability to represent the need for care by aging parents. Our application of this model provides a unique marriage of theory and method that enhances understanding of long-term intergenerational exchange dynamics that unfold over many decades in families, and represents progressive vulnerability of parents using knowledge about the timing and (dementia and non-dementia) causes of their death. Data for this project are derived from the Longitudinal Study of Generations (LSOG), a multi-panel and multi- generational study that has collected data on three-generation families from 1971 to 2016. Focusing on the middle-generation, which averaged 19 years of age in 1971, we examine trajectories of care provided by these children to older mothers and fathers between 1985 and 2016 as a function of accelerating parental vulnerabilities, and their interaction with early investments of time (shared activities), money (financial support), and emotion (intimacy) made in them by their parents in 1971. Using previously collected mortality information about parents from the National Death Index in 2016—combined with an updated NDI search to 2019—we test the utility of time-to-death as a representation of growing cognitive and physical frailty that stimulates children to provide increasing amounts of care. This research is timely in light of growing uncertainty about the family as a reliable source of extended care in later life.