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Psychiatry Investig > Volume 17(4); 2020 > Article
Kim, Lee, and Chung: Perceived Health Status of and Moderating Factors in Elderly People Caring for Their Grandchildren

Abstract

Objective

Situations in which elderly people are the primary caregivers for their grandchildren are becoming more common. This study aimed to investigate moderating factors of and the association between grandchild care and the grandparents’ perceived health. Financial support in return for grandchild care was also investigated as a moderating factor.

Methods

Participants included 357 elderly people over the age of 60 years. The assessment to evaluate the perceived health status and social support was performed via a questionnaire. It included questions regarding the care of grandchildren and demographic variables, as well as the Medical Outcome Survey (MOS) 36-item short-form health survey (SF-36), and the MOS Social Support Survey (MOS-SSS).

Results

The subscale scores of SF-36 and MOS-SSS did not differ significantly for grandchild-care status. However, the subscale scores of SF-36 were significantly higher in groups that received regular financial support from adult children in return for grandchild care than in groups that did not.

Conclusion

Our data suggest that regular financial support in return for grandchild care may be a moderating factor in the association between grandchild care and the perceived health status of elderly people. These findings have important social implications and warrant future study to reveal the psychological mechanism of these associations and enhance the health of elderly individuals.

INTRODUCTION

As the life expectancy of humans and the employment of mothers both increase worldwide, more grandparents find themselves caring for their grandchildren. Despite significant variations in the prevalence of grandchild care in different countries with varying maternal employment regimes, a study performed in 10 European countries reported that 58% of grandmothers and 49% of grandfathers cared for their grandchildren under the age of 16 in the past year [1]. In the United States, the prevalence of grandparent-and-grandchild co-residence increased from 3.2% in 1970 to 5.5% in 2003 [2]. In addition, 24% of preschoolers in the United States were regularly cared for by a grandparent [3]. A Taiwanese study also reported that the percentage of elders providing care for grandchildren dramatically increased from 9% in 1993 to 21% in 2007 [4]. In Korea, the percentage of children cared for by a grandparent was reported to be as high as 37.2% in 2016 [5]. The rate of grandchild care is reported to be higher in cases of employed mothers (53%) than in cases of unemployed mothers (43%) in USA [3]. This is also the case in Korea; the rate of grandchild care is 53.7% in cases of employed mothers and only 25.8% in cases of unemployed mothers [5]. Further, the younger the child was, the more support was required from the grandparents; 70.7% of children younger than 1 year required grandparent care [5].
Raising a child is physically and emotionally challenging, but it also provides emotional rewards. As such, research regarding the relationship between grandchild care and the health of the grandparent is inconclusive [6]. Multiple studies reported positive associations between grandchild care and the health and wellbeing of grandparents [6-10]. For instance, Di Gessa et al. [7] reported that both intensive and non-intensive experiences with caring for grandchildren provided some health benefits to the grandparents. Ku et al. [8] also reported that long-term multigenerational caregivers were more likely to report better self-rated health, higher life satisfaction, and fewer depressive symptoms when compared with non-caregivers. Older veterans with a diagnosis of posttraumatic stress disorder (PTSD) reported reduced symptoms after caring for their grandchildren [10].
On the contrary, other studies showed a negative association between grandchild care and the health of the grandparents [11-14]. Grandparents caring for grandchildren were more likely to experience depressive and isolated feelings [12]. Custodial grandparents in particular were vulnerable to unfavorable health outcomes such as limited activities of daily living (ADLs) or depressive and isolated feelings [11,13].
However, multiple studies reported that the relationship between grandchild care and the health of grandparents is not a positive/negative linear relationship. Rather, there are various moderating factors involved, such as the intensity of caring, the amount of social support, the relationships among family, and the characteristics of the grandparents themselves [15-18].
Coall and Hertwig [16] reported that the relationship between a grandparent’s wellbeing and the intensity of care has an inverted u-shape, and very-low and very-high intensity of care can have a negative effect on both a grandparent’s wellbeing and the development of grandchildren. Chen and Liu [17] also reported that high intensity care of younger grandchildren accelerated health declines, whereas lighter levels of care had a protective effect.
Social support is another main factor involved in the health of grandparents caring for their grandchildren. In a longitudinal study, Hayslip et al. [19] reported that social support moderated the effects of parental stress on depression. Musil et al. [20] also reported that social support moderated the effects of strain and family-life stresses on depressive symptoms in grandparents.
The characters of grandchildren, such as abnormal emotional or hyperactive symptoms, also contribute to higher levels of anxiety and depression in grandparents caring for grandchildren [21]. In addition, stressors such as depression and anxiety of grandparents may arise from certain grandparent characteristics, such as being female, in poverty, or of ethnic minority [22].
Financial support from grown-up children is a common phenomenon in Asian culture, as it contributes to the fulfillment of the virtue of filial piety [23,24]. Financial support in return for grandchild care is common in Korea, but not as common in Western countries [25]. Cong and Silverstein [23] reported financial support from grown-up children reduced depression of grandparent. The psychological benefits were the most pronounced when financial support was accompanied by full-time grandchild care. However, studies examining the effect of financial support by grown-up children on grandchild care are limited. Our study investigated the association between and moderating factors of grandchild care and perceived grandparent health. Financial support in return for grandchild care was also investigated as a moderating factor.

METHODS

Participants

Study data were collected from the Suseong Mental Health Care Program for the Elderly, which was performed in Daegu, the fourth largest city in South Korea with a population of 2.5 million, during 2011. The participants included 357 elderly people over the age of 60; the number of male participants was 149 (41.7%). The age of the participants ranged from 60 to 93, with an average age of 72.12. All participants gave written informed consent after being provided with a complete explanation of the project. They were then questioned by the trained interviewer. The study protocol was approved by the Institutional Review Board for Human Subjects of a university hospital in Cheonan, South Korea (2018-12-004).

Assessment

The assessment was performed via a questionnaire on demographic variables and other relevant information about grandchild care. Questions inquired about the grandparent’s experience with grandchild care, financial support from children, motivation and reason for grandchild care and intensity of grandchild care, the probability of continued grandchild care, the kind of support needed, and benefits from grandchild care.
The questionnaire also included the Medical Outcome Survey (MOS) 36-item short-form health survey (SF-36) and the MOS Social Support Survey (MOS-SSS). The SF-36 is a multi-item scale that assesses eight health concepts: 1) limitations in physical functioning; 2) limitations in social functioning; 3) limitations to usual roles due to physical problems; 4) limitations to usual roles due to emotional problems; 5) general mental health; 6) vitality; 7) bodily pain; and 8) general health perceptions [26]. The MOS-SSS is a scale for the assessment of perceived social support that consists of 19 items and subscales for emotional/informational support, tangible support, positive social interaction, and affection support [27]. The scores for subscales of the SF-36 and the MOS-SSS were converted to a range from 0 to 100 using the formula (raw sum - possible minimum score)÷(possible maximum score - possible minimum score) ×100.

Statistical analysis

Demographic variables and items related to grandchild care were analyzed using frequency analysis, chi-squared tests, and analysis of variances (ANOVA). The participants were categorized into three groups: 1) those who were currently caring for their grandchildren (Current group), 2) those who had cared for their grandchildren previously but not currently (Past group), and 3) those who had never cared for their grandchildren (None group). The ANOVA was used to test for any statistically significant differences between these three groups on subscales of the SF-36 and the MOS-SSS.
The grandparents who had experienced grandchild care were further categorized into two groups: 1) those who received regular financial support in return for grandchild care (Pay group) and 2) those who did not receive regular financial support in return for grandchild care (the No pay group). The SF-36 and the MOS-SSS scores between the Pay group and No pay group were compared using three models. Model 1 used multivariate analysis of variance (MANOVA) without considering any covariates. Model 2 used a multivariate analysis of covariance (MANCOVA) with age, sex, educational level, household income level, marital status, and employment status as covariates. Model 3 included the intensity of grandchild care in addition to model 2.
To examine the association between financial support group (pay group) and the SF-36 subscales, a generalized linear model (GLM) was used, with the covariates of age, sex, educational level, household income level, marital status, employment status, and financial support (model 1). Model 2 included the intensity of grandchild care in addition to model 1. To determine whether there was a correlation between the amount of financial support received and scores on the SF-36 and the MOS-SSS, Pearson’s correlation coefficient was used. All data were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical software, version 25.0 (IBM Corp., Armonk, NY, USA).

RESULTS

Demographic characteristics

The demographic characteristics of participants are shown in Table 1. The age, education, and income levels were not significantly different among the None, the Current, and the Past groups. Elderly females experienced significantly more grandchild care than elderly males, and grandparents who cared for grandchildren were less likely to work.

Characteristics related to grandchild care

Characteristics related to grandchild care are shown in Table 2. Among participants who had experienced grandchild care, 48.7% received regular financial support from their grown-up children in return for the care, amounting to approximately 490,000 KRW (approximately 450 USD) per month in average. Results showed that 52.6% of grandparents started caring for their grandchildren on their own will, and 73.8% of grandparents cared for their grandchildren full-time on weekdays. Employment of both parents of the grandchildren was the biggest reason for grandchild care (84.5%). When asked whether they were willing to continue grandchild care, 35.8% responded “No”.

Perceived health status and social support

The perceived health statuses and social support of the None, the Current, and the Past groups are shown in Table 3. None of the groups’ subscales of perceived health status and social support differed significantly.
The perceived health statuses and social support of the Pay group and the No pay group are shown in Table 4. Scores on some subscales of the SF-36, including role limitation by physical problem, role limitation by emotional problem, social function, bodily pain, total mental health, and total physical health, were significantly lower in the No pay group than in the Pay group in model 1. In model 2, role limitation by physical problem, role limitation by emotional problem subscales, and social function on the SF-36 were significantly different between the two groups. None of the subscales on the SF-36 were significantly different between the groups in model 3. Although not shown in Table 4, there was no main effect of intensity of grandchild care on any of the subscales on the SF-36 when included as a covariate in model 3.
Also, none of the subscales on the MOS-SSS were significantly different between the two groups in all models.

Associations between regular financial support and scores on the SF-36 and the MOS-SSS subscales

GLM analysis with the covariates of age, sex, education level, household income level, marital status, employment status, and regular financial support from grown-up children in model 1 found that regular financial support was positively associated with scores on the physical role, emotional role, and total mental health subscales of the SF-36 (Table 5). However, this association disappeared when intensity of grandchild care was included as a covariate in model 2 (Table 5, Supplementary Table 1 in the online-only Data Supplement). The amount of financial support received was not significantly correlated with the scores on any of the subscales on the SF-36 or the MOS-SSS (Supplementary Table 2 in the online-only Data Supplement).

DISCUSSION

Our study investigated the factors related to grandchild care and the perceived health status of grandparents. Among all participants, about 36.1% of elderly individuals were found to have experienced grandchild care. This is comparable with the previous study that reported the prevalence of 37.2% in South Korea [5]. However, there was one study where the prevalence of grandchild care by grandparents had been compared between two countries, Chinese (57.6%) and Korea (5.6%) and the number was much lower than in this study.24 The worldwide provision of grandchild care is reportedly increasing despite the wide range in cultures and social systems (i.e., about 50% in Europe and 24% in the United States) [1,3].
Although 71.9% of grandparents had started caring for their grandchild part-time or full-time on their own will, about 35.8% of grandparents reported they did not want to continue caring for their grandchildren in the future. This finding implicates that caring for grandchild might be burden for grandparents to keep up with. This burden might be caused by the long periods of time required for grandchild care. Most of the grandparents (93.7%) spent their time regularly on grandchild caring, longer than daytime on weekdays. Furthermore, 59.7% of the grandparents always cared for their grandchild. These are large burdens compared to the results reported in Western countries. For example, a European study reported that only 32.4% of grandparents caring for a grandchild provided intensive care, which had been defined as “looking after at least one grandchild almost daily or for at least 15 hours a week.”6 In this study, grandparents also responded that “caring support for grandchildren” was the most needed form of by their own grown-up children (63.0%). However, despite the burden of parenting, grandparents also did report benefits from caring for their grandchildren (76.7%). This is consistent with the findings of previous studies, which reported positive associations between grandchild care and the wellbeing of grandparents [7,8,10].
The fact that there were no significant differences in scores on any of the SF-36 subscales in the None, the Past, and the Current groups suggests that taking care of grandchildren itself did not have significant effect on the perceived health status of grandparents and that there might be other relevant factors. The fact that there were no significant differences in the scores for any of the MOS-SSS subscales in three groups also suggests that raising grandchildren itself did not have direct impact on perceived social support.
Interestingly, role limitation by physical, role limitation by emotional, social function, and bodily pain subscales of the SF-36 were significantly different in the Pay and the No pay groups. This means that regular financial support in return for grandchild care is a mediating factor related to the perceived health status by grandparents.
Despite few studies, financial support from grown-up children in return for grandchild care has been beneficial to the psychological well-being of grandparents, which is consistent with our findings [23,28]. For instance, Cong and Silverstein [23] reported that financial support from grown-up children reduced depression of grandparents. This could be explained by the financial benefits themselves or by acknowledgement for their role. Although we did not explore the direct reason for the beneficial effect of financial support, 23.9% of the grandparents claimed “financial support” to be the most needed form of support for grandchild care, which indicates a perceived financial burden associated with grandchild care. This suggests that financial support effectively mitigates the financial burden.
However, when asked the reason for grandchild care, 84.5% claimed the employment of both parents, and only 2.1% claimed financial difficulties. In particular, the amount of transferred money was not significantly correlated with the SF-36 subscale scores. This suggests that financial support from grown-up children could have been meant other than the mitigation of financial burden. Cong and Silverstein [23] reported that financial support promoted psychological benefits when accompanied by full-time grandchild care and argued that intergenerational “time-for-money” reciprocity would be not only a survival strategy to ensure economic prosperity but also contributes positively to the psychological wellbeing of grandparents.
During grandchild care, grandparents might encounter a dilemma between altruism (the pleasure of caring for grandchildren) and exploitation (the sense of being unrecognized and under-valued) [29]. When a tangible reward is lacking, the grandparents might feel unfairly treated by their grown-up children [30]. Meanwhile, financial remittance in return for grandchild care would signify an acknowledgement for their contribution by their own children and serve as psychological reward for grandparents. This acknowledgement may help to preserve grandparents’ self-esteem and self-efficacy [23].
Grandchild care is structurally ambivalent. Although it can be a joyful task to spend time with beloved grandchildren, it can also be perceived as a stressful burden that constrains an individual’s freedom. The feeling that the support from their own children has been “earned” may help mitigate the psychological distress caused by burden of long periods of care and limitation to the grandparents’ freedom. In our study, these are thought to be the reasons that regular financial support in return for grandchild care was positively associated with perceived health status, especially in the sense of role limitation by both physical and emotional problem.
Another interesting finding of our study was that the significance of the association between financial support and subscale scores on the SF-36 disappeared when the intensity of grandchild care was included as a covariate, although the intensity of grandchild care had no independent effect on the scores. This finding suggests that the intensity of grandchild care may be another strong mediating factor for the perceived health status of elderly people caring for a grandchild. This result is consistent with previous studies reporting that the intensity of grandchild care was the critical factor for mental health of grandparents caring for grandchildren [16,17].
Our study has some limitations. First, the sample size was small, which limits the generalization of the findings in our study. A study with a larger sample size is needed to confirm our findings. Second, we did not include a qualitative in-depth interview, which limited our investigation of the delicate and complicated feelings that grandparents may have regarding grandchild care and financial remittance. Whether the financial support from their own children had been included in the grandparents’ reported monthly household income or had covered the costs of caring for grandchildren was not known; these factors may also affect grandparents’ satisfaction when they take care of their grandchildren. Future study with an in-depth interview would help clarify grandparents’ feelings and may indicate more useful clinical implication to enhance the health of grandparents.
In conclusion, despite some limitations, our findings indicate that regular financial support to grandparents in return for grandchild care may be positively associated with the perceived health status of grandparents. These findings have important social implications and warrant future study to reveal the psychological mechanism of these associations and enhance the health of elderly individuals.

Supplementary Materials

The online-only Data Supplement is available with this article at https://doi.org/10.30773/pi.2019.0115.

ACKNOWLEDGEMENTS

The Mental Health Care Program was financially supported by the Suseong District Office, Daegu, Korea. The funding source had no involvement in any of study design and collection, analysis and interpretation of data, and writing of the article.

CONFLICTS OF INTEREST

The authors have no potential conflicts of interest to disclose.

Notes

Author Contributions

Conceptualization: Jung Jae Lee. Data curation: Jung Jae Lee, Un Sun Chung. Formal analysis: Jung Jae Lee, Kyung Min Kim. Funding acquisition: Jung Jae Lee, Un Sun Chung. Investigation: Jung Jae Lee, Kyung Min Kim. Methodology: Jung Jae Lee, Un Sun Chung. Project administration: Jung Jae Lee. Resources: Jung Jae Lee, Un Sun Chung. Visualization: Kyung Min Kim, Un Sun Chung. Writing—original draft: Kyung Min Kim, Jung Jae Lee. Writing—review & editing: Un Sun Chung, Kyung Min Kim.

Table 1.
Demographic characteristics of the participants
Experience of grandchild care None group Current group Past group Statistics p
N (%) 228 (63.9) 55 (15.4) 74 (20.7)
Mean (SD) years old 72.42 (7.93) 70.45 (5.94) 72.43 (6.98) 1.617 0.200
Sex (%) 10.692 0.005
 Male 109 (47.8) 20 (36.4) 20 (27.0)
 Female 119 (52.2) 35 (63.6) 54 (73.0)
Education, N (%) 9.568 0.144
 ≤6 97 (42.5) 23 (41.8) 35 (47.3)
 7 to 11 35 (15.4) 16 (29.1) 10 (13.5)
 12 43 (18.9) 8 (14.5) 17 (23.0)
 >12 53 (23.2) 8 (14.5) 12 (16.2)
Income (thousand KRW per month), N (%) 6.133 0.632
 Over 5,000 19 (9.3) 3 (5.7) 5 (6.9)
 3,000 to 5,000 34 (16.6) 8 (15.1) 13 (18.1)
 2,000 to 1,000 43 (21.0) 13 (24.5) 13 (18.1)
 Under 1,000 37 (18.0) 16 (30.2) 16 (22.2)
 None 72 (35.1) 13 (24.5) 25 (34.7)
Employment, N (%) 10.781 0.005
 Not employed 153 (73.9) 44 (83.0) 66 (91.7)
 Employed 54 (26.1) 9 (17.0) 6 (8.3)
Marriage status, N (%) 7.087 0.131
 Married 140 (67.0) 36 (67.9) 52 (72.2)
 Bereavement 58 (27.8) 17 (32.1) 20 (27.8)
 Divorced 11 (5.3) 0 (0.0) 0 (0.0)

None group: elderly people who never experienced grandchild care, Current group: elderly people who were currently caring their grandchildren, Past group: elderly people who had cared for their grandchildren previously. N: number, SD: standard deviation

Table 2.
Characteristics related to grandchild care
Grandchild care Total Current group Past group Statistics p
Financial support from grown-up children, N (%) 3.336 0.068
 No 60 (51.3) 30 (61.2) 30 (44.1)
 Yes 57 (48.7) 19 (38.8) 38 (55.9)
Amount of financial support, mean (SD) 1,000 KRW per month 490.2 (322.0) 531.3 (394.1) 464.0 (271.8) 0.420 0.521
Duration of grandchild care, mean (SD), month 81.37 (81.87) 92.02 (75.05) 73.53 (86.22) 1.564 0.213
Motivation for grandchild care (%) 0.601 0.740
 Grandparent’s own will 60 (52.6) 25 (52.1) 35 (53.0)
 By the child’s request 32 (28.1) 15 (31.3) 17 (25.8)
 Grandparent’s will and child’s request 22 (19.3) 8 (16.7) 14 (21.2)
Intensity of grandchild care, N (%) 3.924 0.416
 Daytime during weekday 25 (19.8) 10 (18.5) 15 (20.8)
 Full time during weekday 20 (15.9) 9 (16.7) 11 (15.3)
 Weekend only 3 (2.4) 2 (3.7) 1 (1.4)
 Always 73 (57.9) 29 (53.7) 44 (61.1)
 Etc 5 (4.0) 4 (7.4) 1 (1.4)
Reason for grandchild care, N (%) 19.022 0.002
 Employment of both parents 82 (84.5) 29 (67.4) 53 (98.1)
 Financial difficulties 2 (2.1) 2 (4.7) 0 (0.0)
 Accidents or disease 2 (2.1) 1 (2.3) 1 (1.9)
 Death of children’s parents 5 (5.2) 5 (11.6) 0 (0.0)
 Divorce of children’s parents 4 (4.1) 4 (9.3) 0 (0.0)
 Missing of children’s parents 2 (2.1) 2 (4.7) 0 (0.0)
Will to continue grandchild care, N (%) 1.404 0.496
 Will continue caring 27 (24.8) 13 (26.0) 14 (23.7)
 According to the situation 43 (39.4) 22 (44.0) 21 (35.6)
 Don’t want caring grandchildren again 39 (35.8) 15 (30.0) 24 (40.7)
Kind of support needed, N (%) 6.816 0.078
 Financial supports 11 (23.9) 8 (38.1) 3 (12.0)
 Academic supports for grandchildren 3 (6.5) 2 (9.5) 1 (4.0)
 Caring support for grandchildren 29 (63.0) 9 (42.9) 20 (80.0)
 Assistance for housework 3 (6.5) 2 (9.5) 1 (4.0)
Benefits from the grandchild care, N (%) 0.684 0.408
 No 21 (23.2) 7 (18.9) 14 (26.4)
 Yes 69 (76.7) 30 (81.1) 39 (73.6)

Current group: elderly people who were currently caring for their grandchildren, Past group: elderly people who had cared for their grandchildren previously. N: number, SD: standard deviation

Table 3.
Differences of perceived health and social support between the groups
Group None group (N=219) Current group (N=54) Past group (N=74) Statistics p
SF-36, mean (SD)
 General health 39.61 (22.1) 41.11 (16.95) 41.42 (18.05) 0.272 0.762
 Physical function 62.97 (32.15) 66.85 (27.1) 61.01 (28.91) 0.574 0.564
 Role limitation, physical 74.23 (29.47) 79.28 (25.26) 75.08 (27.11) 0.688 0.503
 Role limitation, emotional 84.28 (24.43) 84.41 (20.8) 85.36 (23.28) 0.058 0.944
 Social function 80.88 (25.57) 84.26 (21.88) 82.94 (23.28) 0.504 0.605
 Bodily pain 61.74 (23.88) 62.96 (23.68) 63.38 (23.48) 0.159 0.853
 Vitality 51.23 (17.93) 50 (16.51) 51.69 (15.67) 0.158 0.854
 Mental health 63.58 (19.22) 62.87 (17.82) 68.45 (16.76) 2.159 0.117
 Total mental health 66.94 (17.49) 66.88 (14.98) 69.35 (15.62) 0.610 0.544
 Total physical health 58.4 (24.37) 61.48 (20.24) 58.85 (20.98) 0.387 0.680
 SF-36 total score 62.28 (20.18) 63.86 (16.29) 63.67 (17.05) 0.241 0.786
MOS-SSS, mean (SD)
 Emotional/informational 59.61 (23.54) 64.64 (27.11) 62.2 (27.57) 0.992 0.372
 Tangible 69.32 (24.03) 71.93 (27.83) 72 (25.56) 0.450 0.638
 Positive 60.14 (26.1) 66.44 (28.82) 67.27 (28.1) 2.532 0.081
 Affectionate 62.42 (25.89) 65.43 (30.52) 65.75 (28.95) 0.551 0.577
 Overall 62.17 (21.94) 66.56 (25.4) 65.83 (24.52) 1.186 0.307

None group: elderly people who never experienced grandchild care, Current group: elderly people who were currently caring for their grandchildren, Past group: elderly people who had previously cared for their grandchildren. SF-36: the Medical Outcome Survey (MOS) 36-item short-form health survey, MOS-SSS: the Medical Outcome Survey Social Support Survey, N: number, SD: standard deviation

Table 4.
Differences of perceived health and social support between the groups who received financial support from their adult child in return for grandchild care or not
Group No pay group (N=60) Pay group (N=57) Model 1
Model 2
Model 3
F p F p F p
SF-36, mean (SD)
 General health 39.83 (17.39) 42.72 (18.40) 0.873 0.352 0.103 0.749 0.042 0.837
 Physical function 59.5 (30.18) 67.89 (27.16) 2.328 0.130 0.403 0.527 0.021 0.884
 Role limatation, physical 69.48 (32.04) 83.99 (18.94) 8.315 0.005* 4.926 0.029* 2.035 0.157
 Role limitation, emotional 78.47 (27.24) 91.08 (14.42) 9.247 0.003* 5.895 0.017* 3.089 0.082
 Social function 78.54 (28.10) 87.5 (15.13) 5.636 0.019* 3.932 0.050* 1.544 0.217
 Bodily pain 58.67 (26.52) 68.07 (19.95) 4.237 0.042* 1.644 0.203 0.289 0.592
 Vitality 47.92 (16.94) 52.63 (14.98) 2.422 0.122 1.295 0.258 0.372 0.543
 Mental health 64.00 (17.68) 67.54 (17.76) 1.179 0.280 1.329 0.252 0.322 0.572
 Total mental health 64.58 (17.27) 71.27 (12.83) 5.536 0.020* 3.881 0.052 1.472 0.228
 Total physical health 55.83 (23.14) 64.19 (18.29) 4.454 0.037* 1.630 0.205 0.195 0.660
 SF-36 total score 59.85 (18.73) 67.37 (14.23) 5.873 0.017* 2.919 0.091 0.699 0.405
MOS-SSS; mean (SD)
 Emotional/informational 63.18 (30.06) 61.61 (25.36) 0.093 0.761 0.038 0.845 0.259 0.612
 Tangible 72.40 (28.61) 70.45 (25.44) 0.109 0.742 0.001 0.974 0.247 0.620
 Positive 67.37 (28.05) 64.06 (29.85) 0.415 0.521 0.436 0.510 0.025 0.874
 Affectionate 64.17 (30.74) 65.18 (30.07) 0.010 0.919 0.020 0.886 0.026 0.872
 Overall 66.08 (26.32) 64.40 (24.57) 0.123 0.726 0.002 0.963 0.115 0.735

* p<0.05.

Model 1: crude model without any covariates, Model 2: includes the age, sex, educational level, household income level, and marital and employment status as covariates, Model 3: includes the intensity of caring for grandchildren as a covariate in addition to model 2. No pay group: grandparents who received regular financial support in return for grandchild care, Pay group: grandparents who did not receive regular financial support in return for grandchild care. SF-36: Medical Outcome Survey (MOS) 36-item short-form health survey, MOS-SSS: Medical Outcome Survey Social Support Survey, N: number, SD: standard deviation

Table 5.
Generalized linear model for scores on subscales of the SF-36 according to financial support (N=116)
Model 1
Model 2
B 95% CI p B 95% CI p
No Financial support from grown-up children referent
Financial support
 Role limitation by physical 11.0 1.9 to 20.1 0.017* 7.38 -1.9 to 16.7 0.119
 Role limitation by emotional 10.7 2.7 to 18.8 0.009* 7.8 -0.2 to 15.7 0.054
 Social function 8.2 -0.1 to 16.5 0.053 5.1 -3.3 to 13.5 0.233
 Bodily pain 5.7 -2.3 to 13.7 0.161 2.6 -5.7 to 10.8 0.540
 Total mental health 6.1 0.4 to 11.8 0.036* 3.8 -1.9 to 9.5 0.188
 Total physical health 4.7 -2.1 to 11.6 0.177 1.7 -5.3 to 8.6 0.639
 SF-36 total score 5.4 -0.4 to 11.2 0.070 2.7 -3.1 to 8.5 0.365

* p<0.05.

Model 1: includes the age, sex, educational level, household income level, and marital and employment status as covariates, Model 2: includes the intensity of caring for grandchildren as a covariate in addition to model 1

REFERENCES

1. Hank K, Buber I. Grandparents caring for their grandchildren: findings from the 2004 survey of health, ageing, and retirement in Europe. J Fam Issues 2009;30:53-73.
crossref
2. U.S. Bureau of the Census Table CH-7. Grandchildren living in the home of their grandparents: 1970-present. 2014;Available at: http://www.census.gov/population/socdemo/hh-fam/tabCH-7.pdf. Accessed October 25, 2018.

3. Laughlin L. Who’s minding the kids? Child care arrangements: Spring 2011. US Census Bureau. 2013;Available at: https://www.census.gov/prod/2013pubs/p70-135.pdf. Accessed October 25, 2018.

4. Tsai FJ, Motamed S, Rougemont A. The protective effect of taking care of grandchildren on elders’ mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders’ loneliness and depression between 1993 and 2007 in Taiwan. BMC Public Health 2013;13:567.
crossref pmid pmc pdf
6. Di Gessa G, Glaser K, Tinker A. The impact of caring for grandchildren on the health of grandparents in Europe: A lifecourse approach. Soc Sci Med 2016;152:166-175.
crossref pmid
7. Di Gessa G, Glaser K, Tinker A. The health impact of intensive and nonintensive grandchild care in Europe: New evidence from SHARE. J Gerontol B Psychol Sci Soc Sci 2015;71:867-879.
crossref pmid pmc pdf
8. Ku LJ, Stearns SC, Van Houtven CH, Lee SY, Dilworth-Anderson P, Konrad TR. Impact of caring for grandchildren on the health of grandparents in Taiwan. J Gerontol B Psychol Sci Soc Sci 2013;68:1009-1021.
crossref pmid pdf
9. Grundy EM, Albala C, Allen E, Dangour AD, Elbourne D, Uauy R. Grandparenting and psychosocial health among older Chileans: A longitudinal analysis. Aging Ment Health 2012;16:1047-1057.
crossref
10. Hierholzer R. Improvement in PTSD patients who care for their grandchildren. Am J Psychiatry 2004;161:176-177.
crossref
11. Minkler M, Fuller-Thomson E. The health of grandparents raising grandchildren: results of a national study. Am J Public Health 1999;89:1384-1389.
crossref
12. Blustein J, Chan S, Guanais FC. Elevated depressive symptoms among caregiving grandparents. Health Services Res 2004;39:1671-1690.
crossref
13. Hayslip B, Fruhauf CA, Dolbin-MacNab ML. Grandparents raising grandchildren: What have we learned over the past decade? Gerontologist 2017;57:1196.
crossref pdf
14. Dunne EG, Kettler LJ. Grandparents raising grandchildren in Australia: Exploring psychological health and grandparents’ experience of providing kinship care. Int J Soc Welfare 2008;17:333-345.
crossref
15. Arpino B, Bordone V. Does grandparenting pay off? The effect of child care on grandparents’ cognitive functioning. J Marriage Fam 2014;76:337-351.
crossref
16. Coall DA, Hertwig R. Grandparental investment: Past, present, and future. Behav Brain Sci 2010;33:1-19.
crossref
17. Chen F, Liu G. The health implications of grandparents caring for grandchildren in China. J Gerontol B Psychol Sci Soc Sci 2011;67:99-112.
crossref pdf
18. Hughes ME, Waite LJ, LaPierre TA, Luo Y. All in the family: The impact of caring for grandchildren on grandparents’ health. J Gerontol B Psychol Sci Soc Sci 2007;62:S108-S119.
crossref pdf
19. Hayslip Jr B, Blumenthal H, Garner A. Social support and grandparent caregiver health: One-year longitudinal findings for grandparents raising their grandchildren. J Gerontol B Psychol Sci Soc Sci 2014;70:804812.
crossref pdf
20. Musil C, Warner C, Zauszniewski J, Wykle M, Standing T. Grandmother caregiving, family stress and strain, and depressive symptoms. West J Nurs Res 2009;31:389-408.
crossref
21. Doley R, Bell R, Watt B, Simpson H. Grandparents raising grandchildren: Investigating factors associated with distress among custodial grandparent. J Fam Stud 2015;21:101-119.
crossref
22. Collins WL. A strengths-based support group to empower African American grandmothers raising grandchildren. Soc Work Christian 2011;38:453.

23. Cong Z, Silverstein M. Intergenerational time-for-money exchanges in rural China: does reciprocity reduce depressive symptoms of older grandparents? Res Human Devel 2008;5:6-25.
crossref
24. Ko PC, Hank K. Grandparents caring for grandchildren in China and Korea: findings from CHARLS and KLoSA. J Gerontol B Psychol Sci Soc Sci 2013;69:646-651.
crossref pdf
25. Arthur S, Snape D, Dench G. The moral economy of grandparenting. Generations Rev 2003;13:10-12.

26. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30:473-483.
crossref
27. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991;32:705-714.
crossref
28. Silverstein M, Cong Z, Li S. Intergenerational transfers and living arrangements of older people in rural China: Consequences for psychological well-being. J Gerontol B Psychol Sci Soc Sci 2006;61:S256-S266.
crossref pdf
29. Goodfellow J, Laverty J. Grandparents supporting working families. Fam Matters 2003;66:14-19.

30. Goh EC. Grandparents as childcare providers: an in-depth analysis of the case of Xiamen, China. J Aging Stud 2009;23:60-68.
crossref


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