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The Closest Connections: Family Relationships in Later Life. Sue Sweeney, MPH, MA Gerontology Department Madonna University Society/Culture. Address universals of human existence Time, space Birth, death Aggression Sex, partnering Parenting, family relationships

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the closest connections family relationships in later life

The Closest Connections: Family Relationships in Later Life

Sue Sweeney, MPH, MA

Gerontology Department

Madonna University

society culture

Address universals of human existence

Time, space

Birth, death


Sex, partnering

Parenting, family relationships

Distribution of resources

Defining in-group/out-groups

society culture1

Social roles, ideals, values/mores, folkways, traditions

World view that acts as a filter of external reality

society culture2

Results from environment, history, experiences, outside influences on the group

family culture
Family Culture
  • Transmission of larger culture on microscopic scale
  • Results from family’s history, experiences, outside influences, place in larger society
family culture1
Family Culture


Nurturance, love, esteem

Independence, autonomy

Respect, belonging

Rivalry, jealousy

Separation, individuation

family culture2
Family Culture
  • Feelings, thinking, expression
  • Group vs individual
  • Generations
  • Use and distribution of power
  • Use and distribution of resources
family culture3
Family Culture
  • Interpersonal relating
  • Gender roles, sexuality
  • Work ethic/leisure
  • Activity/passivity
  • Expression of aggression
family culture4
Family Culture





Open/closed group


filial maturity
Filial Maturity
  • Adult developmental achievement
  • See parent as peer, not idealized
  • No longer retain fantasy of being cared for
  • Accept sexuality of parent(s)
later life family relations
Later Life Family Relations
  • Family culture played out among the challenges of aging & changing rules
    • Empty nest
    • Grandparenthood
    • Retirement
    • Illness/death of parent
    • Dysfunction, disability, dependence of family member
    • Additional responsibilities
    • High stakes decisions
empty nest retirement
Empty Nest/Retirement
  • Renewed focus on couple
  • Redefinition of self
  • Unstructured time
  • Travel, avocations
  • Relocation
  • Taking over grandchildren
  • Raising grandchildren
  • “Stuck” with child care
  • Patriarch/matriarch
parental romances
Parental Romances
  • It’s too soon
  • Replacing dad/mom
  • You’re too old for this
  • You do what?
  • What does he/she really want?
blended families
Blended Families
  • Later remarriage
  • Acceptance of deceased spouse
  • Holidays
    • Traditions
    • Location
  • Inheritance of “steps”
  • Care/end of life decisions
  • Who is leaving whom?
  • Who is favored/burdened with parents’ presence?
  • Downsizing: Who gets what?
  • Violation of family roles/rules?
co residence
  • Whose idea was this?
  • Expected, planned, no choice
  • Resources
  • Power
  • Space allocation
  • Task assignment
  • Care required
  • Reciprocity
abusive neglectful parent spouse
Abusive/Neglectful Parent/Spouse
  • Avoidant/cowed adult child/spouse
  • Non-abusive parent
    • Blamed
    • Failed to protect
  • Resentful eldercare
  • Risk of elder abuse
  • Risk of CG abuse
family caregiving
Family Caregiving
  • Mom/dad takes care of it
  • Sibling involvement
    • Jealousy
    • Resentment
    • Fairness
    • Differential resources
    • Long distance/right here
designated primary caregiver
Designated Primary Caregiver
  • Spouse - expected
  • Oldest (sister or brother)
  • Health professional
  • Unmarried sib
  • Gay sib
  • Unsuccessful, less separated
  • Sib who takes care of others as family role
family of caregiver
Family of Caregiver
  • Resentment
  • Loss of income
  • Loss of attention
  • Loss of family time
  • Loss of privacy
  • Growing up too fast
  • “Dance between guilt & resentment”
caregiver abuse
Caregiver Abuse
  • Excessive demands
  • Inadequate sleep
  • Basic needs not met
  • Loss of self
institutional care
Institutional Care
  • Abandonment
  • Guilt & conflict
  • Adjustment difficulties
  • Uncertain role
  • Continuing needs
  • Less control -> frustration
  • Staff challenges
end of life
End of Life
  • Who notifies, who is notified
  • Keeping vigil
  • Care decisions
  • Funeral decisions
  • Inheritance, disposition of property
practitioner attitude
Practitioner Attitude
  • Suspend conclusions
    • Observation
    • Questions
    • Hypotheses
    • Varying points of view
    • Open formulations
    • A picture that becomes larger and sharper over time
practitioner attitude1
Practitioner Attitude
  • What’s important to each person?
  • What does each expect to happen?
  • What is the optimal outcome, for each?
  • What is next best?
  • What empowers family?
  • Encourage open sharing
practitioner attitude2
Practitioner Attitude
  • “If I had an hour to solve a problem I'd spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.” ― Albert Einstein
practitioner attitude3
Practitioner Attitude
  • No “right” answers
  • What works
  • What does no harm
  • What does least harm
  • Not what’s equitable or just
  • Only see the present result of a whole family history
family education
Family Education
  • Normative events, experiences
  • Course of illness
  • Treatments
  • Alternatives
  • Resources
  • Communication
  • Acknowledge and accept…
  • Lack of internal resources
  • Lack of material resources
  • Lack of social support
  • Lack of role models
  • Cannot compensate for a lifetime of poor choices
  • Cannot compensate for misfortunes of a life
acknowledge the elephant
Acknowledge the Elephant
  • Sibling rivalry
  • Substance abuse
  • Other abuse
  • Exploitation
  • Tragic loss
  • Blame, guilt, shame
  • “It’s common in these circumstances for families to….”
suggest alternatives
Suggest Alternatives
  • Acknowledge family culture
  • Describe changes that invite departure from past pattern
  • Point out cost/consequences of retaining past patterns
  • Model of alternative
  • “I wonder if….”
find middle ground
Find Middle Ground
  • Use cultural/religious/personal values
  • Use what they’ve described as important
  • Ask what model they want their children to have
find middle ground1
Find Middle Ground
  • Ask if they can live with possible outcomes
  • Ask if they’ll have regrets later
  • What would be “right” if it were someone else?
  • Don’t have to like it
  • Hold a family meeting
  • Suggest formal mediation
    • Community Dispute Resolution Program
involve respected authorities
Involve Respected Authorities
  • Religious leaders
  • Cultural/community leaders
  • Trusted professionals
  • Friends of the family
  • Fictive kin
predictive interpretations
Predictive Interpretations
  • Describe possible reactions
  • “Frequently people test the limits by….”
  • Encourage to persevere in spite
  • Helps prepare/plan
substitute decision making
Substitute Decision Making
  • Informed consent
  • Accountability expected
  • Bonding, report to court
  • Harder to back out
mark the transition
Mark the Transition
  • Written agreement
  • Formal documents
  • Web site
  • Ritual or ceremony
  • Family gathering
  • Acknowledge the accomplishment
follow up
Follow Up
  • Reinforce agreements
  • Support and encouragement
  • Start over if not working
case study mr constantine
Case Study – Mr. Constantine
  • What cultural issues may be influencing family dynamics?
  • How is power distributed in the family?
  • What other themes of family culture are pertinent to this case?
case study mr constantine1
Case Study – Mr. Constantine
  • How has Mr. Constantine’s personal history affected this family?
  • What kinds of intervention could be helpful?
  • How would you start a dialogue?
  • Lustbader, W. (1991.) Counting on kindness: The dilemmas of dependency. New York: The Free Press
  • Lustbader, W. & Hooyman, N. (1994). Taking care of aging family members: A practical guide. New York: The Free Press
  • Smith, G. C., Tobin, S. S., Robertson-Tchabo, E. A. & Power, P.W. (1995). Strengthening aging families: Diversity in practice and policy. Thousand Oaks: SAGE Publications, Inc.