Grandparenting, health, and well-being: a systematic literature review

Whether grandparenting is associated with improved health or well-being among older adults is a salient question in present-day aging societies. This systematic review compiles studies that consider the health or well-being outcomes of grandparenting, concerning (1) custodial grandparent families, where grandparents are raising grandchildren without parental presence; (2) three-generation households, where grandparents are living with adult children and grandchildren; and (3) non-coresiding grandparents, who are involved in the lives of their grandchildren. Review was based on literature searches conducted in September 2019 via Web of Science, PubMed, PsycINFO, and Ebsco. We screened 3868 abstracts across four databases, and by following the PRISMA guidelines, we identified 92 relevant articles (117 studies) that were published between 1978 and 2019. In 68% of cases, custodial grandparenting was associated with decreased health or well-being of grandparents. The few studies considering the health or well-being of grandparents living in three-generation households provided mixed findings (39% positive; 39% negative). Finally, in 69% of cases, involvement of non-coresiding grandparents was associated with improved grandparental outcomes; however, there was only limited support for the prediction that involved grandparenting being causally associated with grandparental health or well-being. Despite this, after different robustness checks (counting all nonsignificant results, taking into account the representativeness of the data and causal methodology), the main finding remains the same: the most negative results are found among custodial grandparents and three-generation households and most positive results among non-coresiding grandparents.

Material Hardship Among Custodial Grandparents and Grandchildren's Physical and Mental Health in COVID-19

COVID-19 has increased economic hardship for many families, including custodial grandparent-headed families. We aim to examine latent classes of material hardship among custodial grandparent-headed families, to assess predictors associated with identified classes, and to investigate associations with grandchildren’s physical and mental health outcomes during COVID-19. Data was collected from a cross-sectional survey in June 2020. The sample comprised of 362 grandparents. Latent class analysis and logistic regression were conducted. Three latent classes of material hardship were identified: Class 1 (n = 232; 64.1%) low overall hardship with high medical hardship, class 2 (n = 52; 14.4%) moderate overall hardship with high utility hardship, and class 3 (n = 78; 21.5%) severe overall hardship. Factors, such as race, household income, labor force status, financial assistance status, and trigger events to raise grandchildren, were associated with class membership. Class 2 (OR = 0.19, p < 0.05) compared to Class 1 was significantly associated with grandchildren’s physical health. Our findings suggest that material hardship is heterogeneous among custodial grandparents during COVID-19, and children in households experiencing utility hardship have a higher risk for poorer physical health outcomes. Results highlight the needs to meet grandparents’ material needs and call for future research to examine the mechanism that explains the link between material hardship and grandchildren’s outcomes.

The Importance of Social Support Networks on Mental Health Status of Custodial Grandparents

This symposium presents a collection of papers that examine the concept of social support and its effect on custodial grandparents’ (CG) mental health state. Each paper explores a different perspective about grandparents’ access to and/or use of social support networks and mental health outcomes; several papers view social support within the context of the COVID-19 pandemic. Nadorff and colleagues explore social support by middle-generation family members and its effects on grandparents’ stress and depressive symptoms. Musil and colleagues report on psychosocial and social support predictors of self-appraised healthcare and financial security by CG during the Covid-19 pandemic. Whitley and Kelley describe current social networks relied upon by a preliminary sample of CG while managing the daily stresses and strains associated with COVID-19 and its restrictive mandates. The final two papers report the use of specialized technology and support services delivered to homebound CG during the COVID-19 pandemic. Lee and colleagues describe a telemental health model using Solution-Focused Brief Therapy to serve socially isolated grandparents experiencing mental health distress as during the pandemic. Mendoza and Park report on program challenges and outcomes of implementing a support service for grandparents living under COVID-19 restrictions. The highlights of the papers will be discussed by Yanfeng Xu and give attention to the ways scholars and practitioners can build upon these works to maximize the mental health outcomes of CG, while managing to live in socially restrictive and challenging environments.

Acceptance Commitment Therapy Intervention for Custodial Grandfamilies: A Virtual Implementation

Custodial grandfamilies often face challenges, such as psychological distress, parenting burden, and grandchildren showing internalizing and externalizing behaviors. Given their circumstances, effective training and education is critical to provide a supportive family environment for both custodial grandparents and custodial grandchildren. The aim of this study was to develop, pilot and evaluate a psychosocial intervention for custodial grandfamilies. The program, interACT, was implemented virtually due to restrictions related to COVID-19. It is an intervention for custodial grandparents (CGPs) and custodial grandchildren (CGC) to improve psychological wellbeing and life skills. Participant eligibility was determined by grandfamilies having Iowa residency and legal guardianship or custody of an 8-12 year old grandchild. The program utilizes the Acceptance and Commitment Therapy (ACT) framework, focusing on psychological flexibility, acceptance, and psychosocial resilience for CGPs and CGC. The program used techniques such as mindfulness, self-compassion, and decision-making skills. During the pilot program stage, participants were divided into CGPs and CGC groups, and completed self-paced weekly 45 minute long modules through a program website. To enhance online session experience, Extension staff facilitated hour-long Zoom calls to discuss module contents and foster peer connection for both groups. Findings will be available at the conclusion of the pilot program. We expect to find increased psychological well-being and improved life skills for both groups right after the implementation of the ACT. Findings and limitations will be discussed with practical implication for program implementation via virtual delivery for the current custodial families. Future studies could extend current curriculum to other populations.

Living With COVID-19: Descriptions of Custodial Grandparents' Mental Health Stress and Social Support Networks

Research suggests custodial grandparents (CG) with chronic health conditions, limited economic resources, and restricted social connections are at risk for adverse mental health outcomes. The growing uncertainty surrounding COVID-19 seems to accentuate these findings. This paper presents preliminary descriptions of mental stress by a small sample of CG (n=26) surveyed after the onset of COVID-19. They described the social groups comprising their networks, and the methods used to engage with them. A majority of the sample (96.2%) reported experiencing mental stress since the onset of the virus; based on Brief Symptom Inventory results, five CG scored in the clinical range for stress. Food access, fear of getting sick, and grandchildren’s school requirements are leading sources of stress. Despite such challenges, CG report varying levels of social engagement with their support networks. The reported descriptions give preliminary insight how CG can maximize their social networks to build/sustain positive mental health well-being.

Is Age Just a Number? Influence of Caregiver Age on Injuries of Children Raised by Grandparents

Unintentional injuries are the most common cause of death for children in the United States. One factor linked to their occurrence is parenting style (i.e., a collection of factors such as physical health, mental health, and possible cohort differences in parenting role expectations). Differences in parenting behaviors may be evident in grandparents caring for their grandchildren, due to cohort differences and age-related declines in cognitive and physiological processes. This may impact their abilities to monitor, supervise, and respond to children. Further, Hayslip & Kaminski report custodial grandparents are less likely than parents to understand and respond to the psychological and emotional needs of children but are more likely to enforce discipline. This study sought to explore the ways in which parenting styles are associated with unintentional injury behaviors in children (via caregiver age) for grandchildren raised by grandparents. Participants were grandparents raising their grandchildren, recruited via Qualtrics Panel Service (N = 323). Conditional process analyses were conducted using Model 1 of SPSS PROCESSv3.5. Age moderated the relation between consistency of discipline and child unintentional injury (F (1, 231) = 12.67, p <.001) as well as level of supervision and child unintentional injury (F (1,146) = 6.23, p = .01). Age did not moderate the relation between positive parenting and unintentional injuries. These results imply that children being raised by older grandparents were especially at risk for increased injuries when their grandparents used less consistent discipline or lower rates of supervision. Pathways are suggested for age-specific psychoeducation interventions for custodial grandparents.

Predictors of Custodial Grandparents’ Perceived Barriers to the Use of Services

Getting timely access to help, information, and a variety of services is paramount among the challenges of raising a grandchild, and grandparents face a variety of internal and external barriers in getting such help. The present pilot exploratory study focused on caregiving-related and personal resource variables best predicting grandparent caregivers’ perceptions of barriers to receiving services. Fifty-two grandparents (M age = 59.1) raising their grandchildren completed measures assessing caregiver strain, social support, resilience, self-care, psychosocial adequacy, health, depression, and grandchild relationship quality. They also completed measures of the extent to which they faced personal and caregiving-related difficulties giving rise to the need for services (e.g. health, grandchild well-being, support from others) as well as the extent to which they had experienced barriers to service (health/financial limitations, isolation, transportation, respite care, lack of knowledge of services) in the past 3 months. Correlations (p < .05) suggested that psychosocial adequacy (r = -.32), depression (r = .27), caregiver strain (r = .42) and difficulties (r = .48) were all related to greater perceived barriers. Regression analyses (F7, 40 = 2.81, p < .02) indicated that caregiver strain (Beta = .33, p < .05) and difficulties giving rise to the need for services (Beta = .32, p < .04) emerged as most salient in predicting barriers. These findings underscore the fact that personal, caregiving-related, and interpersonal factors exacerbate the barriers associated with grandparents’ accessing needed services and reinforce such factors’ impact on grandparents as targets for overcoming impediments to accessing services among them.

Disability & Sleep Quality of Custodial Grandparents During Fall 2020 of the COVID-19 Pandemic

Disability of custodial grandparents, grandparents who are the primary caretakers of their grandchildren often in parent absent households, are not frequently examined. One in four adults in the U.S. lives with a disability with the highest percentage of disabilities reported in the South. Quality sleep is integral for overall wellbeing and is altered with age. Sleep complaints of older adults are associated with multiple adverse health outcomes such as dementia, stroke and obesity. The objective of this study was to examine the relationship between disability and sleep quality amongst custodial grandparents during the COVID-19, Fall 2019 in Georgia. Thirty-four custodial grandparents were recruited from the Georgia Division of Aging Kinship Care Support Groups, ages 42 to 78, with most identifying as African American. Disability status and the Pittsburgh Sleep Quality Index were measured. Results showed a significant negative relationship for custodial grandparents’ disability status and sleep quality (χ2= 9.167, p=0.027; Γ=-0.683, p=0.002), sleep disturbance (χ2= 12.150, p=0.002; Γ=-0.897, p<.001), and use of sleeping medication (χ2= 9.645, p=0.022; Γ=-0.785, p<.001). Custodial grandparents with a disability had worse sleep quality, more sleep disturbances, and took more sleeping medication compared to custodial grandparents without a disability. Results have implications for kinship care providers and medical practitioners when engaging with custodial grandparents about their health, disability and impacts on their sleep quality.

Examining Different Types of Sleep Among Custodial Grandparents During COVID-19

Sleep is associated with healthy living. With increased age, sleep is harder to initiate and maintain. Currently, over two million grandparents have become primary caregivers to their grandchildren and are at risk for poor sleep outcomes. Research shows that grandparent caregivers are at risk for depression due to poor sleep quality. Thus, this study aimed to identify the sleep quality of custodial grandparents to gain a better understanding of sleep patterns during COVID-19 in 2020. Thirty-four custodial grandparents were recruited from the Georgia Division of Aging Kinship Care Support Groups from September through October 2020. Participants were between 42 to 78 years old with a mean age of 57. Participants completed the Pittsburgh Sleep Quality Index. Stata statistical software was used to analyze the relationship between the sleep quality subscales. Results showed a significant positive relationship for custodial grandparents between sleep quality and daytime dysfunction (χ2=25.993, p=0.002; Γ=0.495, p=0.039) as well as sleep quality and sleep disturbance (χ2=11.129, p=0.084; Γ=0.751, p<0.001). There is a significant positive relationship between daytime dysfunction and sleep duration (χ2=14.984, p=0.091; Γ=0.681, p<.001), where grandparents with daytime dysfunction have longer sleep duration. Findings suggest grandparents with poor sleep quality are more likely to experience daytime dysfunction and have more sleep disturbances in the COVID-19 environment. Our study will benefit researchers and practitioners caring for custodial grandparents and contribute to future research focused on custodial grandparents and sleep quality.