‘My Parent Needs Better Care': Understanding Chinese Adult Children's Caregiving Experience Through a Contextual and Cultural Perspective

Background: The rapidly increasing oldest-old population in China presents a caregiving challenge for Chinese adult children who are socialized to expect to provide physical, economic and emotional security for their parents when they reach old age. While most studies use samples of caregivers of older adults in general, this study focused on the adult-child caregivers for the oldest old in China. According to Higgins' self-concept discrepancy theory (1980), caregivers’ perception of the discrepancy between their actual performance and their expectation of the caregiver role can be an important component of stress in their caregiving experience. Guided by the stress process theory (Pearlin, 1990), the purpose of this study was to explain caregivers’ perception of the discrepancy between their caregiving performance and their expectation of the caregiver role (caregiving discrepancy). We examined the associations between contextual factors (caregivers’ socioeconomic status, significant roles, and their relationship quality with care recipients) and primary stressors, and caregiving discrepancy. Because filial piety is fundamental to the cultural context in which Chinese adult children fulfill their caregiving responsibilities, we also explored whether the extent of caregivers’ filial identity is related to caregiving discrepancy. 

Method: The sample consists of 895 pairs of adult-child caregivers and care recipients aged 80 and over in the Chinese Longitudinal Healthy Longevity Survey. The dependent variable was measure by the level of caregivers’ agreement with the statements: “My parent needs more care” and “My parent needs better care.” The independent variables include caregivers’ socioeconomic status (household income per capita, education and health status), other significant roles in work and family (employment and parenting), perception of their relationship quality with care recipients (closeness), primary stressors (care recipients’ functional health and whether care recipients were entitled to a pension or participated in a medical insurance program), and caregivers’ filial identity (frequency of participating in one type of filial activity, worshipping ancestors in significant holidays). Demographic characteristics of caregivers and care recipients were also controlled for. 

Results: More than forty percent of the adult-child caregivers reported their parents need more and/or better care, which indicated they perceived some level of caregiving discrepancy. Multiple linear regression results showed that caregivers’ higher education degrees, better health status, a closer relationship with their care recipients and a stronger filial cultural identity were associated with a higher level of their caregiving discrepancy. The caregivers who were daughters and whose care recipients had medical insurance also tended to experience a higher level of discrepancy.

Implications: The study found that contextual and cultural factors were useful in explaining caregiving discrepancy in Chinese adult-child caregivers. The findings point to the importance of studying the caregiving experience of Chinese adult children through a contextual and cultural perspective. It is also necessary to develop culturally congruent interventions to support adult-child caregivers in China.  In terms of implications in the US, these findings support the importance of understanding filial culture, when preparing social work and other professionals to provide culturally competent services for Chinese American older adults and their families.