Family Interdependence of Psychological, Physical, Social and
Spiritual Well-being within Korean Elder-Caregiver Dyads
Suk-Sun Kim, David Hayward, Harold G. Koenig and Keith G. Meador
Duke University, Center for Spirituality, Theology, and Health
Abstract
Family members are by definition interdependent and affect one another in various ways, particularly in situations where a family member is providing essential caregiving for an elder family member. There is
growing recognition of family interdependence within elder-caregiver dyads in terms of both practical and research implications; caregiver’s well-being influences elder’s well-being and vice versa. However, there is
a dearth of published research regarding family interdependence.
This study aims to examine the degree of family interdependence within elder-caregiver dyads in terms of psychological, physical, social, and spiritual well-being in the context of Korean family caring.
There was a significant degree of interdependence between elders and their caregivers in terms of psychological, social, and spiritual well-being, but not physical well-being. Moreover, after controlling for the
elder’s gender, age, marital status, education level, and monthly income, caregiver’s well-being remained a significant predictor of elder’s well-being in domains of psychological, social, and spiritual well-being.
Hypotheses
Family Interdependence Model
™ Hypothesis 2: Multivariate linear regression modeling was used to
examine Hypothesis 2
1. There is a correlation between the well-being of members of
elder-caregiver dyads on dimensions of (a) psychological wellbeing, (b) physical well-being, (c) social well-being, and (d)
spiritual well-being.
2. These correlations persist after controlling for demographic
and social background characteristics.
Elder’s
Caregiver’s
Well-being
Well-Being
Caregiver’s well-being remained a significant predictor of elder’s wellbeing in domains of psychological, social, and spiritual well-being.
Method
™Samples: 157 Korean elder-family caregiver dyads in Seoul,
Korea
™Measurement : Four well-being indexes were constructed
from several scales and items
¾ Psychological Well-being was measured with five scales:
1) Purpose in Life (PIL: Crumbaugh, 1968), 2) Center for
Epidemiological Studies-Depression Scale (CES-D: Radloff,
1977), 3) Satisfaction With Life Scale (SWLS: Diener, et al.,
1985), 4) Positive and 5) Negative Affect Schedules (PANAS:
Watson et al., 1988)
¾Physical Well-being was measured with four self-report items:
Number of days spent 1) hospitalized and 2) confined to bed due
to illness for previous six months, 3) Number of medications
currently taken, and 4) Measure of overall self-reported health
¾Social Well-being was measured by three self-report items:
Frequency of 1) visits with children and 2) other social activities,
and 3) Measure of overall satisfaction with social activities
¾Spiritual Well-being was measured with two scales:
1) Spiritual Perspective Scale (SPS: Reed, 1987) and 2) SelfTranscendence Scale (STS: Reed, 1986)
For each of the four well-being indexes described in the method,
a regression model was run with elder well-being as the dependent variable.
Independent variables in each model included the corresponding caregiver
well-being score, along with the type of elder-caregiver relationship, the
elder’s gender, age, marital status, education level, and monthly income as
controls.
Table 2. Linear regression models for elder well-being
Psychological Well-Being
b
(SE)
β
Results
™ Hypothesis 1: The intraclass correlation coefficient (ICC)
within dyads was used to test hypothesis 1
The ICC is a measure of how similar members of certain
groups (in this case dyads) are to one another.
Elders and their family caregivers were significantly related
on psychological, social, and spiritual dimensions of wellbeing, but not in terms of physical well-being.
Constant
Caregiver well-being^
Male
Age
Married
College educated
Non-spouse caregiver
Income1.88***
-9.75
0.21**
0.31
0.04
0.63
1.50*
0.51
(2.94)
(0.06)
(0.62)
(0.04)
(0.07)
(0.06)
(0.70)
(0.32)
0.22
0.04
0.07
0.07
0.20
0.07
0.40
Physical Well-Being Social Well-Being
b
(SE)
β
b
(SE) β
-2.49** (2.74)
-0.05 (0.07)
1.12* (0.58)
-0.01 (0.04)
0.39 (0.68)
0.23 (0.59)
-0.16 (0.66)
0.60* (0.29)
Spiritual Well-Being
b
(SE)
β
2.61 (2.14)
0.45
(1.54)
-0.05 0.20* (0.09) 0.19 0.30***(0.08)
0.22 0.06 (0.45) 0.01 -0.80* (0.32)
-0.01 -0.05† (0.03) -0.16 -0.02 (0.02)
0.06 -0.73 (0.53) -0.14 -0.41 (0.38)
0.04 1.31**(0.46) 0.30 1.01** (0.34)
-0.03 -0.31 (0.51) -0.07 -0.14 (0.37)
0.17 0.23 (0.23) 0.08 0.38* (0.16)
0.30
-0.24
-0.08
-0.10
0.30
-0.04
0.17
*** p < .001, ** p < .01, * p < .05, † p < .10
^For each model, the dimension of caregiver well-being corresponds to the elder well-being DV
Conclusion
Table 1. Scale statistics and intraclass correlation coefficients
Elder
Caregiver
Mean
SD
Mean
SD
Spiritual Well-Being
Spiritual perspective
4.37
1.39
4.61
1.29
Self transcendence
2.99
0.43
3.08
0.40
Spiritual well-being index
0.00
1.70
0.00
1.73
Psychological Well-Being
Depression
23.08 4.64
22.39 4.67
Satisfaction with life
15.47 4.13
15.41 4.12
Purpose in life
95.18 18.77
99.13 16.85
Positive affect
32.55 6.14
33.56 5.27
Negative affect
21.31 6.72
21.47 6.37
Psychological well-being index 0.00
3.68
0.00
3.81
Physical Well-Being
Days in bed
4.37 11.61
2.59
5.68
Days in hospital
5.71 14.94
2.68
4.69
Medications
1.79
1.69
1.38
1.73
Subjective health
3.46 0.86
3.48
0.84
Physical well-being index
0.00
2.77
0.00
2.96
Social Well-Being
Visits with children
3.90 0.71
3.61
1.31
Frequency of social activity
3.20
0.95
3.34
0.88
Satisfaction with social activity 3.41
0.88
3.66
0.71
Social well-being index
0.00 2.21
0.00
2.06
*** p < .001, ** p < .01, * p < .05, † p < .10
ICC
0.45***
0.27***
0.37***
0.22**
0.46***
0.41***
0.27***
0.30***
0.39***
0.12†
-0.01
-0.08
-0.02
-0.07
0.16*
0.17*
0.24**
0.26**
This study’s findings are important for furthering researchers’
understanding of family interdependence of well-being between
elders and caregivers living at home. In emphasizing the dyad data
from both elders and caregivers, we have shown the significant
degree of family interdependence of well-being in terms of
psychological, social and spiritual well-being within family caring
relationships. More important, the interdependence of spiritual wellbeing was explored for the first time in the present study.
Hence, there is a need for a shift in the ideas and methods of
understanding to research the well-being of elders living at home and
their family caregivers. In the future, researchers should take eldercaregiver interdependence into consideration when designing and
analyzing studies of well-being later in life. Understanding sources
of shared variability will improve the usefulness of statistical
analyses in this area.
Moreover, an understanding of interdependence within these dyads
will help to improve clinical approaches to addressing the challenges
to psychological, social, and spiritual well-being faced by both elders
and their caregivers.