A Systematic Review on Friend Care in Later Life

Background: In the past fifty years, friend care has been rarely examined as the focus in the studies of informal elder care, comparing to kin care. Theoretical biases and practical barriers, including hetero-normativity, nuclear family hegemony and lack of identifiers for friend caregivers in the health care system and in the community, magnified neglect of and disagreements in the investigation of friend care. The heterogeneity and versatility of friendship distinguishes friend care from kin care, while its intimate nature and potential of growth also distinguishes it from neighbor care. Sporadic studies revealed that friend care was particularly common in racial and ethnic minority groups and sexual and gender diverse communities. This systematic review aims to summarize findings from the existing scholarship on friend care in the past fifty years, to shed light on the definition, characteristics, significance and implications of friend care.

Methods: The author conducted the literature search within several online databases, including PsycINFO, MEDLINE, CINAHL, Social Sciences Abstracts, Social Work Abstract, with combinations of “friend care”, “family of choice”, “chosen family”, “non-kin care”, “friend”, “caregiver”, “elder care”, “older adults” “frail elderly”, “informal care”, “unpaid care” and their synonyms, to locate targeted articles. This author only included peer-reviewed journal articles published between 1967 and. After reviewing the abstracts and full texts to filter out irrelevant articles, the author also examined the reference lists of the identified articles.

Results: The author concluded the search with a total of 22 peer-reviewed articles that contributed significant knowledge about friend care in later life. Themes include: 1) Many studies grouped friend care with other types of non-kin care (neighbor care), while a few other studies showed there was a significant differences; 2) the length, scope of care and types of care tasks performed were heterogeneous, and could change over time; 3) as the level of care increased, friend caregivers had to confront boundary issues, such as taking over personal care, financial management and proxy responsibilities; 4) friend caregivers were often motivated by a sense of moral obligation; 5) friend caregivers constantly portrayed their relationship in kinship terms; 6) friend care was more prevalent in minority groups (e.g. racial and ethnic minority, sexual and gender diverse) than in the majority groups; 7) The caregiving process could transform, improve or undermine the quality of relationship between the caregiver and the care recipient; 8) friend care was often reciprocal.

Implications: As the aging population becomes more diversified in its racial makeup, sexuality expressions and family arrangements, a lack of recognition and investigation of this highly marginalized group shall prevent gerontology social workers from effectively identifying and supporting them during stressful life events. Also, more research on friend care is needed to help us understand its nature and potentials, whether it could substitute or merely compensate kin care.