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Seismic Population Changes Await Us

In developed countries like the United States and Canada, a demographic agequake is taking place.

By 2040, less than two decades away, all members of the large baby boomer generation (born between 1946 and 1964) will have celebrated their 75th birthdays or beyond.

This aging population will result in the explosive and unprecedented growth of persons in their 70s and 80s. All the plusses and minuses of countries that are top-heavy with an older population will come fully into focus.

Noteworthy, to be sure!

But strongly correlated with this population growth is another trend line that should be on our radar screen. As boomers age into their later years, they face a heightened risk of physical and cognitive health problems and activity limitations. These impairments threaten their ability to stay safely and securely in their current dwellings.

But despite stressful circumstances, older people make their positions clear. They strive to preserve the status quo by aging in place or staying put in their current homes and apartments. They are wary about moving into an adult child's home. And transitioning to a senior care facility is their last resort.

They Need Help, but from Whom?

Instead of moving, these older persons cope with threats to their independence by inviting the helping hands of others into their homes. However, only a very small percentage primarily depend on assistance from paid home care or custodial workers. The older person is far more likely to call on one or more family members for support.

But not all their relatives are equally involved. Gender matters.

Women turn out to be the preeminent caregivers. Most are the wives (or partners), daughters, and daughters-in-law of those cared for. Men do more than in the past, but they spend less time providing care than women and assist less with the most challenging self-care and hands-on tasks.

This article highlights the demanding caregiving activities of these female caregivers. It draws attention to how they take on these responsibilities not just once but as many as three times during their adult lives. I refer to this ongoing involvement as the older woman's lifecycle of caregiving.

It is an appropriate time to address these issues. The United Nations has declared October 1st the International Day of Older Persons, and this year's focus is on the resilience and contributions of older women.

The Lifecycle of Caregiving Faced by Older Women

Caregiving Stage One—The parents or parents-in-law need help

The first caregiving engagement typically happens when women are in their 40s or 50s. One or both of their parents (or in-laws) are having trouble conducting their everyday activities and keeping up their housing accommodations.

This initial involvement may last only for weeks or months. They help a mother or father recuperate from an illness, operation, or accident. They expect a relatively speedy recovery, and the care needed is well delineated with a foreseeable endpoint.

Alternatively, a parent's progressively more serious condition requires a long-term care relationship lasting over several years. The worsening of a dementia diagnosis (such as Alzheimer's) or an advanced or uncurable disease such as cancer leads to deteriorating mental or physical abilities, sharply reduced activities, increasingly demanding health issues, and end-of-life care.

The female caregiver finds herself in unfamiliar territory. Her job description is broad and fluid. She performs the duties of a janitor, chauffeur, home care worker, financial advisor, social worker, occupational therapist, and nurse.

Her most demanding tasks involve assisting with an older person's self-care tasks, such as bathing, eating, dressing, and getting around. But even jobs, such as medication management and the operation of medical equipment, can be arduous.

She always wears three hats: provider, advocate, and emotional confidant.

Not surprisingly, the caregivers are always seeking answers:

Who should I call for help?
Do I have the most effective and reliable solution?
Is the care option affordable or covered by government programs or private health insurance?

And then there are those other tough questions:

Should I encourage my mother or father to remain in their current places and get them all the help to make this happen?
Should I invite them to live in my house?
Should I urge them to move to a senior care development?

Even if a parent relocates to a supportive care setting, the woman's caregiving responsibilities seldom end—only the job site changes. U.S. studies confirm that family members continue helping even after this transition.

The Covid-19 epidemic made this very clear. When these facilities banned family visitors—eliminating their assistance—their older occupants experienced elevated rates of depression and more behavioral problems.

Caregiving Stage Two—The Spouse or Partner Needs Help

Women in their 70s and 80s often find themselves in a second caregiving relationship. This time they assist their typically older husbands or partners with their health problems and physical limitations. As men live longer and their unmet needs increase, they require such help.

Being both a wife and a caregiver is not necessarily a happy combination of responsibilities. A wife may feel uncomfortable ordering her lifelong partner to behave in specific ways—however conducive to his health and functioning.

On the positive side, older women may be savvier because of their earlier caregiving experiences with their parents. But compared to their younger days, they may have less physical vigor and endurance or lack the same emotional fortitude. They may perform less effectively as caregivers.

If help from adult children or paid staff cannot supplement her efforts, she becomes overburdened. She finds herself in the unenviable position of considering a long-term care facility as a solution. But even then, she is still the proactive watchdog of her husband's care.

Caregiving Stage 3—The older woman needs assistance but finds herself alone

Typically, in her late 70s and 80s, the tireless woman caregiver must deal with new assistance demands for the third time in her life. However, it is now personal. She confronts her own impairments and declines.

More ominously, she often copes alone. Wives often outlive their husbands because they marry older men and because men die earlier than women.

Not only are older women "aging solo," but they also spend more of their later years with activity limitations and health problems. They are especially at risk of having a dementia diagnosis. They are disadvantaged for another reason. These one-woman households often experience financial troubles because they lack a spouse's or partner's income stream.

Older female boomers go it alone for other reasons. They had very high divorce rates. Not only can't they depend on a spouse, but they can't be sure that their adult children will be reliable caregivers.

But even if their spouses are still living, older women often cannot count on their assistance. Since these men are also in their late 70s and 80s, they lack the capabilities or stamina to be effective caregivers.

These drawbacks help explain why the oldest occupants of long-term facilities—in their 80s and 90s—are far more likely to be unmarried (single, divorced, or widowed) women. Even as they strive to be fiercely independent, they have little choice but to vacate their familiar homes and apartments.

More optimistically, the rhythms of the caregiving lifecycle come full circle.

Older women turn to their adult children for help. But they have no guarantees. Their kids have their own problems—income insecurity, work demands, and possibly still raising their children. Being geographically separated from their older parents also restricts their involvement.

Other daughters are reluctant to help their older parents. They have a history of discordant relationships with those who raised them—sometimes because of past neglect and abuse experiences.

There are other reasons for pessimism.

Compared with previous generations, these female baby boomers are more likely to be childless or, at best, count on fewer children for help. Those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, or sometimes questioning) older persons are especially unlikely to have children. Instead, they rely on support from their contemporaries or younger friends.

Caregiving Can Be a Rewarding Experience for Older Women

Some older people will be lucky enough to enjoy old age without experiencing severe health or impairment problems and will not have to call on their families.

But for the majority, after they turn age 65, they can anticipate needing long-term services and support at some point. The caregiving role of older women is not going away anytime soon.

The good news is that women find it a rewarding experience. It is a chance to give back to their parents or demonstrate marital bonds. Moreover, the overwhelmingness of their tasks makes them feel stronger, more confident about their abilities, and emotionally closer to their family members. And they are more assured that their loved ones are well cared for.

Caregivers Suffer Negative Consequences

Yet make no mistake. Caregiving takes a substantial physical and mental toll. Women are always on call, unprepared to help, and anxious about making mistakes.

They often rate their health as poorer and experience loss of sleep, exhaustion, anxiety, and physical injuries (from lifting or transferring their older family member). Required financial outlays may be especially burdensome. Stress levels will be exceptionally high if they are still raising their own children.

Women in the labor force are notably vulnerable.

They may have to stop or reduce their work hours to be effective caregivers. They lose wages and job advancement opportunities. Or their work performance suffers. The onerous demands on their time can weaken their social relationships and create marital conflicts.

Relief Available

We are getting more enlightened. Nonprofit and government-based programs are more available to help caregivers of older persons in Canada and the United States. These are valuable resources for those seeking information, education, guidance, and emotional support.

Encouragingly, more employers now offer caregiving support services as an employee benefit.

Besides these organized efforts, our dedicated women caregivers will always benefit from increased understanding and support from members of their social circles.

There may also be light at the end of the tunnel.

Introducing gerontechnology devices into older persons' homes promises to reduce family caregiving responsibilities. We can hope, too, that private home care services will become more available and affordable than they are today.

And perhaps in the not-too-distant future, we will routinely rely on human-like robots to take care of our older parents and spouses.

It will indeed be a brave new world.

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About the Author

Stephen M. Golant, Ph.D., is a leading national speaker, author, and researcher on the housing, mobility, transportation, and long-term care needs of older adult populations. He is a Fellow of the Gerontological Society of America, a Fulbright Senior Scholar award recipient, and a Professor at the University of Florida. Golant’s latest book is Aging in The Right Place, published by Health Professions Press. You can contact him at golant@ufl.edu

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