The Impact of Caring for Grandchildren on Gradparents' Physical Health Outcomes: A Longitudinal Study in Rural China

Background:Longer life expectancy led recent attention toward greater responsibility of grandparents caring for grandchildren. Nevertheless, only a paucity of literature examined the impacts of caring for grandchildren on grandparents’ physical health outcomes. Those existing few found negative health impacts and majority of them are US studies. Unlike American grandparents, however, grandparents from other countries may have different cultural motivations and experiences in caring for their grandchildren, which may not necessarily cause negative health outcomes. Specifically, grandparents living in a society where stronger intergenerational support from adult children exists may have distinguishable health influences compared to those in the U.S. Moreover, whether previous caregiving experiences affects grandparents’ physical health even after the termination of caregiving roles remains to be answered. Based on two competing role theories (role strain and role enhancement), the present study examined physical health outcomes among previous and continuous grandparent caregivers compared to non-caregivers in rural China. We further explored the mediating effect of intergenerational support from adult children.

Methods: Two waves’ data (2009 & 2012) were used for our study drawn from the “Well-Being of the Elderly in Anhui”. The final sample size was 799 grandparents. Caregiving status was categorized into three groups: previous caregivers (those provided caregiving in 2009 but not in 2012), continuous caregivers (those provided caregiving in both years), and non-caregivers (those provided caregiving in neither year). Physical health outcomes in 2012 (dependent variable) were measured in three aspects: self-rated health (1=poor, 2=fair, 3=good/excellent), functional limitation in activities of daily living (ADLs: 0-12), and in instrumental activities of daily living (IADLs: 0-10). Physical health in 2009 was also controlled to eliminate the possible health selection bias. Intergenerational support in the past 12 months from adult children was measured in three aspects for both years: financial (0=no, 1=yes), emotional (0-6), and instrumental support (0=no, 1=yes). Path analysis including two time point data was conducted using Mplus software to test both main and mediating effects of study variables. Other covariates such as sociodemographic variables, depression, number of chronic disease and cognitive function were also included.   

Results:The path analysis revealed that compared to non-caregivers continuous caregivers showed better self-rated health and fewer limitations in IADLs at subsequent wave. Also, previous caregivers showed better self-rated health compared to non-caregivers. However, there were no difference for the limitations in ADLs between previous caregivers and non-caregivers as well as continuous caregivers and non-caregivers. Although marginal, emotional support from adult children was found mediating continuous caregiving experience and self-rated health.     

Implications: Different from the U.S. studies, our finding suggests that caring for grandchildren is beneficial to perceived health among grandparents in rural China. Also, our finding shows that positive health outcome persists regardless of the continuum of providing caregiving roles. These findings seem to better support the role enhancement theory than the role strain theory. Mediating effect of intergenerational support from adult children was identified but future studies are needed to further explore the function of intergenerational support between caregiving and health relations among grandparents.