Family Relationships in Later Life [1 ed.] 9781452252414, 9780803933224

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FAMILY RELATIONSHIPS IN LATER LIFE

O T H E R R E C E N T V O L U M E S IN T H E SAGE FOCUS EDITIONS 3

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Evaluation Research Methods (Second Edition) Leonard Rutman Controversy (Second Edition) Dorothy Nelkin M a j o r Criminal Justice Systems (Second Edition) George F. Cole, Stanislaw J. Frankowski, and Marc G. Gertz Black Families (Second Edition) Harriette Pipes McAdoo Family Relationships in Later Life (Second Edition) Timothy H. Brubaker Organizational Theory and Inquiry Yvonna S. Lincoln Men in Families Robert A. Lewis and Robert E. Salt Communication and Group Decision-Making Randy Y. Hirokawa and Marshall Scott Poole The Organization of Mental Health Services W. Richard Scott and Bruce L. Black Community Power Robert J. Waste Intimate Relationships Daniel Perlman and Steve Duck Children's Ethnic Socialization Jean S. Phinney and Mary Jane Rotheram Power Elites and Organizations G. William Domhoff and Thomas R. Dye Responsible Journalism Deni Elliott Ethnic Conflict Jerry Boucher, Dan Landis, and Karen Arnold Clark Aging, Health, and Family Timothy H. Brubaker Critical Issues in Aging Policy Edgar F. Borgatta and Rhonda J. V. Montgomery The Homeless in Contemporary Society Richard D. Bingham, Roy E. Green, and Sammis B. White Changing Men Michael S. Kimmel Popular Music and Communication James Lull Life Events and Psychological Functioning Lawrence H. Cohen The Social Psychology of Time Joseph E. McGrath Measurement of Intergenerational Relations David J. Mangen, Vern L. Bengtson, and Pierre H. Landry, Jr. Feminist Perspectives on Wife Abuse Kersti Yllö and Michele Bograd

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Common Problems/Proper Solutions J. Scott Long Falling from the Faith David G. Bromley Riosocinl Perspectives on the Family Erik E. Filsinger Measuring the Information Society Frederick Williams Behavior Therapy and Religion William R. Miller and John E. Martin Daily Life in Later Life Karen Altergott Lasting Effects of Child Sexual Abuse Gail Elizabeth Wyatt and Gloria Johnson Powell Violent Crime, Violent Criminals Neil Alan Weiner and Marvin E. Wolfgang Puthways to Criminal Violence Neil Alan Weiner and Marvin E. Wolfgang Older Adult Friendship Rebecca G. Adams and Rosemary Blicszncr Aging and Health Kyriakos S. Markides The V C R Age Mark R. Levy Women in Mass Communication Pamela J. Creedon Midlife Loss Richard A. Kalish Cultivation Analysis Nancy Signorielli and Michael Morgan Black Students Gordon La Vern Berry and Joy Keiko Asamen Aging and Caregiving David E. Biegel and Arthur Blum Societal Psychology Hilde T. Himmelweit and George Gaskell Bilingual Education Amado M. Padilla, Halford H. Fairchild, and Concepcion M. Valadez Foreign Language Education Amado M. Padilla, Halford H. Fairchild, and Concepcion M . Valadez Debates on Evaluation Marvin C. Alkin Theories on Creativity Mark Andrew Runco and Robert S. Albert Understanding Troubled and Troubling Youth Peter E. Leone Preserving Families Ying-Ying T. Yuan and Michele Rivest Fashioning Family Theory Jetse Sprey

FAMILY RELATIONSHIPS IN LATER LIFE Second Edition Edited by Timothy H. B r u b a k e r

S A G E PUBLICATIONS The International Professional Publishers Newbury Park London New Delhi

Copyright © 1990 by Sage Publications, Inc. All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

For information address: [K\

SAGE Publications, Inc. 2111 Wesl Hilicrcst Drive Newbury Park, California 91320 SAGE Publications Ltd. 28 Banner Street London EC 1Y80E England SAGE Publications India Pvt. Ltd. M-32 Market Greater KaiJash 1 New Delhi 110 048 India

Printed in the United States of America

Library of Congress Cataloging-in-Publication Data Main entry under title: Family relationships in later life / edited by Timothy H. Brubaker. — 2nd ed. p. cm. Includes bibliographic references. ISBN 0-8039-3321-5. - ISBN 0-8039-3322-3 (pbk.) 1. Aged —United States —Family relationships. 2. Aged— United States —Social Conditions. I. Brubaker, Timothy H. HQ1064.U5F295 1990 306.87-dc20 89-10547 CIP FIRST PRINTING 1990

This book is dedicated to Puffin —a family member who is ageless.

Contents Preface Acknowledgments 1. An Overview of Family Relationships in Later Life TIMOTHY H, BRUBAKER PART I: Family Relationships

9 11

13 27

2. Aging Couples and the Family System JANIE K. LONG and JAY A. MANCINl

29

3. Sexuality and Marital Quality Among Older Married Couples LINDA ADE-R1DDER

48

4. Th e Adult Child and Older Parents ROBERTA. LEWIS 5. Sibling Interaction in Later Life JEAN PEARSON SCOTT 6. Grandparent and Grandchild Relationships KAREN A. ROBERTO PART II: Issues Related to Later-Life Family Relationships 7. Sex Roles in the Older Family PAT M. KEITH and ROBBYN R. WACKER 8. Widowhood : Loss, Change, and Adaptation GLORIA D. HEINEMANN and PATRICIA L. EVANS

68 86 100 113

115

142

9. The Unmarried Elderly: Age, Sex, and Ethnicity CHARLES M. BARRESl and KIMBERLYHUNT

10. Elder Abuse: Myth and Reality SUZANNE K. STEINMETZ 11. Family Support in Relation to Health Problems of the Elderly VICTOR G. CICERELLI

12. Variations Among the Elderly in Black, Hispanic, and White Families E. PERCH STANFORD K. MICHAEL PEDDECORD and SHIRLEY A. LOCKERY

PART HI: Practice and Policy Issues

169

193

212

229

243

13. Toward Understanding Health in Older Families Impacted by Catastrophic Illness JOSEPH KUYPERS and VERN L. BENGTSON

245

14. Stress Perceived by Elderly Recipients of Family Care ELLIE BRUBAKER

MARY ANNE GORMAN and MICHELE HIESTAND

267

References

282

About the Contributors

316

Preface Since the publication of the first edition (1983), research on some aspects of later-life family relationships has increased. Family relationships of older people are an important concern to social gerontologists and family scholars. Later-life family relationships are crucial to the designs and programs developed by researchers and practitioners. Family members of various ages are actively involved in older persons' family networks. Older people who live independently and need little assistance have frequent contact with family members. Family members assist the older relatives who need assistance and who live in the community, as well as those who live in an institutionalized setting. In short, the later-life families are vital. This vitality contributes to the lives of older people and, at the same time, older persons enrich the lives of other family members. This book is directed to researchers and practitioners in family studies and gerontology. Its premise is the assumption that attention to later-life family relationships is important to the development of reliable research designs, as well as to the establishment of service delivery systems that meet the needs of older persons and their families. One primary objective of this volume is to provide a review of research on family relationships in later life. In many cases, new research or theory is presented. Within recent years, research has been directed toward specific family relationships of older people. Dyadic relationships such as husband-wife and intcrgencrational relationships including elderly parent-adult child and grandparent-grandchild have been examined. Other members (e.g., siblings, family caregivers, fictive kin) of the later-life family network have received attention. Research has focused on issues related to the older persons' life events and family situations (e.g., retirement, sexuality, sex roles, widowhood, divorce, abuse, and minority issues) that may influence family interaction in the later years. The chapters discuss these later-life family relationships and situations to provide information for future research directed toward older persons and their families. 9

10

Preface

The second primary objective is to suggest practice and policy implications of the research. Programs and policy directed toward older people and their families can be grounded in the family relationships identified by the research. Services and policies can enhance and compliment older persons' family relationships. Knowledge of the various family relationships such as the husband-wife, adult child, sibling, and grandparent relationships is necessary to build services and policies that strengthen these relationships. For many older persons, the strength of their families is evidenced by the families' lengthy history. Consequently, practice and policy may want to recognize the family history of older clients. Strong families complement services to older persons. One hopes that services and policies complement strong families. From the perspectives of research and practice, each chapter focuses on one aspect of later-life family relationships. A thorough review of the literature is presented, and then, either new research or suggestions for applying this information to practice is discussed. As a collection of chapters, this volume provides a research-based description of the family relationships of older persons. While the contributors to this volume represent a variety of disciplines, their attention is directed toward the family relationships of older people. The contributors include sociologists, psychologists, social workers, gerontologists, and family studies specialists. Their emphases reflect theory, research, and practice. It is hoped that this blend of disciplines and emphases will bridge the gaps between theory, research, and practice. This volume is organized into three sections. Part I focuses on specific family relationships (e.g., husband-wife, parent-child, sibling, grandparent) of older people. Part II addresses a number of issues (sexuality, sex roles, widowhood, abuse, minority family) related to later-life families. Finally, Part III considers older persons' family relationships and the implications for the development of practice and policy directed toward older persons. Older persons' family relationships are alive and well. Neither the importance of the family to older persons nor the reciprocity between older and younger generations can be minimized. Later-life families have a potential for enhancing family relationships at various stages of the family life cycle. Understanding family relationships in later life is useful to both family and gerontological researchers and practitioners.

Acknowledgments The development of a book is very similar to the navigation of a vessel through a turbulent storm. The journey begins with heightened anticipation that soon gives way to the details of guiding and sailing the vessel. Then, the excitement returns when the vessel arrives safely at its destination. Most vessels have a crew to whom the drudgery is assigned. This book navigated through heightened anticipation, detailed organization, and development. Now, it is done and it is the crew who helped to bring the book to completion. First, appreciation is expressed to each contributor. Their willingness to prepare their chapters and make revisions is admirable. The contributors' patience and understanding in the development of this volume are appreciated. The second group of individuals deserve special appreciation. These individuals worked on the tedious tasks associated with references, format, and other details. Mary Tharp was involved in every phase of the project, and it would not have been completed without her. Her pleasant approach and willingness to make changes are commendable. The laborious task of compiling a combined reference list was expertly handled by Julie Smith. She meticulously checked every reference. Both of these individuals contributed enormously to this project. Jennifer Bollinger, Samantha Inskeep, and Robin Heltzel professionally performed many tasks associated with the project. To each, I am grateful. Finally, appreciation is expressed to the Family and Child Studies Center and the Department of Family and Consumer Sciences at Miami University. In many ways, these units facilitated completion of this project. To all who participated in this project, we have, at last, completed our journey.

11

1 An Overview of Family Relationships in Later Life T I M O T H Y H. B R U B A K E R

Family relationships in later life have been the focus of family scholars and gerontologists. As the number of persons experiencing later life increases, attention has been directed toward the interpersonal relationships at the latter stages of the family life cycle. Research clearly indicates that the family relationships of older people are important. Long-term marriages, marriage and remarriage in later life, sibling relationships, intergenerational relationships, family caregiving, widowhood, and divorce are topics that have been addressed. For many older persons, family relationships are key to receiving support and negotiating everyday demands. Practitioners, as well as researchers, have identified the family as a crucial support group for older persons, and the family ought to be considered when seeking to meet the needs of the elderly. However, the dynamics of later-life family relationships are not fully understood, nor is the complexity of these relationships fully described. There is no doubt that family relationships are alive and well for many older persons. At the same time, later-life family relationships are heterogenous. Some older persons are members of a long-term marriage, others enter later life unmarried (never married, divorced, or widowed), and still others become single (through divorce or widowhood) in their later years. Their intergenerational relationships may be characterized as frequent and 13

14

Overview

vibrant or their intergenerational relationships may be hindered by experiences that occurred before they entered the later years. Similar to family relationships in the earlier years, family relationships in the later years may exhibit positive and/or negative characteristics. Within this chapter, the concept of later-life families is defined; a discussion of the unique characteristics of later-life families is included; the context of later-life families is explicated; and demographics related to older families are presented. Finally, positive and negative aspects of the family relationships in later life are discussed.

LATER-LIFE FAMILIES DEFINED

Later-life families vary in size, composition, and background. While there are many differences between later-life families, one commonality is the need to address issues related to the contraction of the family orientation. Based on the family development approach, later-life families refers to families who are beyond the child-rearing years and have begun to launch their children. Examining the family from the perspective of the family life cycle, the nuclear family unit is contracting (Duvall, 1977). The primary focus of the family of orientation is the remaining members after the children have initiated their own families of procreation (T. Brubaker, 1985a) and the establishment of links to the individuals with whom their children have established family ties. Later-life families are beyond the child-rearing years and have launched their children. Consequently, family issues differ from those during the years when they were rearing children. Because the definition of later-life families is tied to the maturation of children, individuals without children are not easily categorized. Yet, childless individuals deal with many of the same family issues related to the later years as do individuals who have children. For example, childless people retire, their family networks contract, their parents need care, and they themselves experience health difficulties. For individuals who have been childless, living beyond age 50 suggests that they may be dealing with late-life family issues. As Troll, Miller, and Atchley (1979) note, chronological age is not a reliable indicator, because individuals and families do not experience life events at the same chronological age. However, there are many people who follow similar life courses (Atchley, 1980; Neugarten, More, & Lowe, 1965). Over the life course, individuals marry,

TIMOTHY H. BRUBAKER

15

produce children, raise and launch children, make occupational choices, and retire within a range of several years. By age SO, many couples have seen their last child leave home, and these couples begin to phase out of their employment with an anticipation of retirement (Atchley, 1976). While age is not the best indicator, it is a reasonable indicator of the beginning of later-life families for childless individuals. Later-life families have a number of unique characteristics that are important to researchers and practitioners. First, later-life families are multigenerational. Many later-life families include three, four, or five generations. Increased longevity and the age at which the first child is born increase the opportunity for multiple generations. For example, if an 85year-old woman had her first child at age 18 and each successive generation had a child by age 18, she would be a member of a five-generation family. However, if another 85-year-old woman had her first child at age 30 and each successive generation had a child by age 30, she would be a member of a three-generation family. Each woman is a part of a multigeneration family network that may be important in the later years. The existence and number of generations within the family network are important because the family is influenced by, and influences, the various generations (Troll & Bengtson, 1979). The interrelationships between the generations vary. The multiple generations may provide support in dealing with the later-life changes. Family caregiving is a topic that has received considerable attention in the past few years. Researchers and practitioners have discussed the linkages between the generations, and many multigeneration families are characterized by reciprocity. For example, the adult-child generations provide assistance to older family members. At times, the adult-child generations have been "caught in the middle" because older and younger generations need assistance (Brody, 1981; Cantor, 1983; Lang & Brody, 1983; Miller, 1981; Neugarten, 1979; Scharlach, 1987). The older generations provide assistance to younger generations in later-life family networks. Indeed, older parents may be a resource to adult children in dealing with a variety of issues (Greenburg & Becker, 1988). The interface between the generations differs because the needs and abilities of the generations vary between families. In some families, the adult-child generation is experiencing difficulty with aging at a time when the older generation may also need assistance, while in other families, the multiple generations may coalesce and form a group of people on whom older persons can rely. In any case, the multigenerational aspect of late-life families is important for research and practice (Hirschfield & Dennis, 1979).

16

Overview

Another unique characteristic of late-life families is their lengthy family history. Older families may be experiencing new life events, but they have a large reservoir of experience. They have interacted with each other for many years and in different settings. For example, they have developed communication and coping patterns over the years as family members. Within the lengthy family history, events and responses to events may be remembered, and positive or negative feelings may result from the perceptions of these events. There may be unfinished business or tensions from earlier life experiences that influence behavior in later life (Peterson, 1979). An example of the importance of the family history of intrafamily relationships is when older parents reside in the same household as their adult children (Blazer, 1978; Cohler & Grunebaum, 1981; Glasser & Glaser, 1962). Brubaker and Brubaker (1981, p. 248) note that "the way family members previously dealt with stress, as individuals and as members of the family system, is likely to be similar to the way in which stress is handled in the multigenerational household." The development of stress in later-life families (T. Brubaker, in press) and the use of extrafamilial services (Brubaker & Brubaker, in press) may be influenced, in part, by the lengthy family history characteristic of these families. For both research and practice, family history is a salient variable when studying later-life families. A third unique characteristic of later-life families is that they are experiencing a number of new life events that they have not had an opportunity to previously experience. Launching of children, becoming a grandparent, retiring from an occupation, experiencing normal aging processes, and coping with widowhood are life events that occur to families in later life (Duvall, 1977). These life events are important to the older persons as well as to other family members because they influence family interactions. For example, retirement may have an effect on the marital relationship of the older couple and may influence the relationship between the older couple and their children and grandchildren. With retirement, some couples have more time to visit their children and grandchildren. The older family members may be able to help their adult children now that they are retired. Another example is that the death of an older family member is a crucial event to the surviving spouse and is important to the children, grandchildren, siblings, and other relatives. Later-life families experience life events associated with the normal aging process, and these experiences influence family relationships.

TIMOTHY H. BRUBAKER

17

The study of families in later life is focused on family systems in which a couple has launched their children (postchildbearing years) and anticipate or have already experienced retirement. From a family development perspective, the later-life family continues until the death of both husband and wife. As Duvall (1977, p. 385) suggests, "the aging couple continue to be 'family' to their grown children, grandchildren, and greatgrandchildren." To study the family in later life, it is important to examine the family relationships from the perspective of the older couple, as well as from the vantage points of the other family members. Being a grandparent is important and having a grandparent is crucial to the grandchild. Thus, consideration of the family in later life needs to focus on the total family system.

FAMILIES IN LATER LIFE AS SOCIAL SYSTEMS

Interactions between the generations within later-life families suggest that these families are interrelated and characterized by interdependency. Older family members are a part of a family network. First, research clearly indicates that older persons and their children maintain relationships throughout life (T. Brubaker, 1985a; Cantor, 1975; Hess & Wariag, 1978; Shanas, 1979a). In one study, Cantor (1975) reported strong family relationships in inner-city families. A second indicator of the family network is that family members, older persons, and their children expect to help an older family member in need of assistance. A number of studies (Blieszner & Mancini, 1987; Finley, Roberts, & Banahan, 1988; O'Brien & Wagner, 1980; Riley & Foner, 1968; Seelbach & Sauer, 1977; Shanas, 1979b; Thomas, 1988) provide evidence of the mutual expectations held by older parents and their children. Another indication of interdependency within later-life families is the degree to which family members are involved in helping their older relatives (Poulshock & Masciocchi, 1978; Horowitz, 1985a, 1985b; Lebowitz, 1978; Seelbach, 1984; Shanas, 1979a; Sheehan & Nuttall, 1988; Stolar, Hill, & Tomblin, 1986). Several national surveys (American Association of Retired Persons, 1988; Comptroller General, 1977; Doty, Liu, & Wiener, 1985; Stone, Cafferata, & Sangl, 1987) indicate that family are providing extraordinary care for older family members. Family members as-

18

Overview

sist older relatives before and after institutionalization (Chenoweth & Spencer, 1986; Lund, Pett, & Caserta, 1987; York & Caslyn, 1977). After institutionalization, family members continue to experience stress (George & Gwyther, 1986; Pratt, Schmall, Wright, & Hare, 1987). Studies of visiting patterns in nursing homes suggest that family members do most of the visiting (Hook, Sobal, & Oak, 1982; Greene & Monahan, 1982). In short, families with older members are interdependent and interrelated. Later-life families consist of a network of family members in which the eldest family members are experiencing the postchildbearing years. Generally, a number of generations and nuclear family units are parts of this network. Many older couples (or single parents) are enmeshed in a supportive family system. While the older couple is experiencing the latter stages of the family life cycle, the younger generations may be at various developmental stages of the family life cycle. For example, a 70-year-old widow may have a 50-year-old son who has retired and whose children have left home. She may also have a 30-year-old daughter who recently married for the first time and has not had a child. These adult children may develop different patterns of interaction because they are experiencing different developmental stages of the family life cycle. In any case, it is clear that many families evidence a reciprocal relationship between the older and younger family members. The interrelationships and interdependencies provide an important support system for older persons as they experience their later years. The later-life family social system is important to both researchers and practitioners.

DEMOGRAPHICS OF LATER-LIFE FAMILIES Recent attention has been directed toward the increase in the number and proportion of older Americans during the twentieth century. There were 3.1 million persons aged 65 years and older in 1900. Eighty-seven years later, the number had increased to nearly 30 million (U.S. Department of Commerce, 1988). Also, there were more than 22 million individuals aged 55-64 years of age in 1988. In 1900, individuals 65 years and older accounted for 4% of the total population. By 1980, 11% of our total population was 65 years and older (Brotman, 1981). These trends are expected to continue. Brotman (1982) reports that life expectancy at birth is expected to increase. Newborn males in 1981 have a life expectancy of 70.7 years, and newborn females are expected to live 78.3 years. By the

ΉΜΟΤΗΥ Η. BRUBAKER

19

Table 1.1 Distribution of Men and Women Aged 55 Years and Older by Age Group and Marital Status (March 1988) Males Number a. % 55-04

Married, spouse present Married, spouse absent Widowed Divorced Never married

65-74

Married, spouse present Married, spouse absent Widowed Divorced Never married

75 and Over

Married, spouse present Married, spouse absent Widowed Divorced Never married

Females Number a. %

8312 290 380 703 501

81.6 2.8 3.7 6.9 4.9

7715 383 1915 986 458

67.3 3.3 16.7 8.6 4.0

6152 182 670 360 372

79.5 2.3 8.7 4.7 4.8

5010 182 3535 565 445

51.5 1.9 36.3 5.8 4.6

2739 119 970 100 173

66.8 2.9 23.7 2.4 4.2

1643 89 4599 190 433

23.6 1.3 66.1 2.7 6.2

a. Number in thouunds SOURCE: U. S. Bureau of the Census (1988a), "Marital Status and Living Airingeraents: March 1988," Current Population Reports, Series P. 20, No. 433, p. 3.

year 2005, the male life expectancy is expected to increase to 81.3 years. It is clear that the number and proportion of older persons are sizeable and will increase in future years. The majority of older persons are members of family networks. Older persons are married and have siblings and/or children and grandchildren. Therefore, there are a large number of American families in which one or more members are experiencing later life. These families are dealing with the changes associated with the later years and have a lengthy history of interaction with one another. Table 1.1 presents the distribution of men and women aged 55 and older by age group and marital status for 1988. Most men (84.4%) and women (70.6%) aged 55-64 years are married. There are nearly 4.5 widows for each widower at this age. For ages 65-74 years, most of the men (81.8%) are married, while slightly more than one-half (53.4%) of the

20

Overview 200 -|

5. S Ä

Male

100

in

F-Vmalc

1950

1960

1970

1980

1990

Figure 1.1 Divorced Persons Aged 65 Years and Over per 1,000 Married Persons with Spouse Present SOURCE: U.S. Bureau of Census (1988c). "Marital Status and Living Arrangements: March, 1988." Current Population Reports, Series P. 20, No. 433, p. 60.

women are married. Nearly 40% of the women are widowed. Approximately 7 out of 10 (69.7%) men aged 75 years and older are married, and less than one-quarter (23.7%) are widowed. For women aged 75 years and older, less than one-quarter (23.6%) are married and nearly 7 out of 10 (66.1%) are widowed. These figures indicate that (1) most older men are married, (2) most of the women aged 65 and younger are married, and (3) most women over 65 are widowed. Two other characteristics are evident in these data. For all age groups, a small percentage (2-9%) are divorced. For both men and women, the older the group, the lower the percentage of divorce. Figure 1.1 indicates that the rate of divorce for older men and women has increased over the past 20 years and is anticipated to continue to rise in 1990. In 1960, there were 44 divorced older women per 1,000 married persons. By 1981, there were 95 per 1,000 married persons. For older men, there were 24 divorced per 1,000 in 1960 and 44 per 1,000 in 1981. In 1980, the ratio for older men was 48 per 1,000. The estimates of the number of divorced older men and women in 1990 suggest that the proportion of divorced older persons will continue to increase. In any case, divorce in later life is experienced by a small minority of older persons, but the size of the minority has more than doubled in the past 20 years. Further, the number is expected to continue to increase.

TIMOTHY H. BRUBAKER

21

Table 1.2 Percentage of Never-Married Men and Women by Age: 1970, 1980, and 1988 Men

Women

1970 1980 1988

55-64 Years 7.8 5.3 4.9

55-64 Years 6.8 4.5 4.0

1970 1980 1988

65 Years and Older 7.5 4.9 4.6

65 Years and Older 7.7 5.9 5.3

SOURCE: U.S. Bureau of the Census (1988b). "Marital Status And Living Arrangements: Match 1988," Current Population Reports, Series P. 20, No. 433, p. 59.

Table 1.1 indicates that a smaller portion (4-6%) of older persons never experience marriage. Data presented in Table 1.2 demonstrate that the percentage of single older persons has decreased over the past decade. For both men and women, a smaller portion were single in 1980 compared to 1970, and this trend continues into 1988. Unlike divorced older persons, the never-married elderly are a decreasing minority. The living arrangements for noninstitutionalized older men and women are presented in Table 1.3 for 1970, 1980, and 1984. In each year, most of the married men (72%-87%) and women (79%-89%) live with spouses. A minority but sizeable proportion of older married men and women live with spouses and other relatives. Most likely, many of these live in intergenerational households. Few of the married men (less than .5%-3%) and women (.7%-3%) live with other relatives. Generally, most of the older married men and women are living in family relationships. Unmarried older men and women are most likely to live alone. However, between 25% and 40% live with relatives. Few live with other persons to whom they are not related. Most older men live in a family setting, while most older women live alone or with nonrelatives. It is important to note that older persons who live alone or with nonrelatives receive support from family and other kin. Cantor (1980) studied inner-city elderly and reported that most had children. These children provided emotional support and companionship to their older parents. Thus, the family is an important group to older persons.

22

Overview

Table 1.3 Living Arrangements of the 65+ Noninstitutional Population by Sex and Age Group (1970,1980,1984)

Age 65-69 Years Married With spouse only With spouse & others Other Unmarried Alone With relatives With unrelated others Age 70-74 Years Married With spouse only With spouse & others Other Unmarried Alone With relatives With unrelated others Age 75-79 Years Married With spouse only With spouse & others Other Unmarried Alone With relatives With unrelated others Age 80 and Over Married With spouse only With spouse & others Other Unmarried Alone With relatives With unrelated others

1970

Male 1980

1984

1970

Female 1980

1984

%

%

%

%

%

%

72.7 25.3 2.0

75.1 24.4 0.5

75.1 24.0 0.9

80.3 17.5 2.2

82.9 16.4 0.7

82.2 16.7 1.1

59.1 31.6 9.3

63.6 29.5 6.9

62.3 30.1 7.6

58.2 36.3 5.5

63.8 34.2 2.0

67.4 29.2 3.3

78.0 19.7 2.3

81.9 17.3 0.8

84.0 15.5 0.4

80.2 17.0 2.8

85.2 13.7 1.1

88.4 10.0 1.6

54.6 31.8 13.6

65.1 30.3 4.6

59.0 27.1 13.9

57.7 36.5 5.8

69.2 29.3 1.5

70.0 26.6 3.4

77.8 19.1 3.1

83.3 16.1 0.6

86.8 11.1 2.1

79.0 18.0 3.0

86.4 12.4 1.2

89.4 8.2 2.4

58.9 32.7 8.4

64.7 29.9 5.4

65.7 24.4 10.0

57.2 38.8 4.0

64.1 34.2 1.7

70.4 27.5 2.0

74.8 22.0 3.1

82.6 15.5 1.9

86.3 10.9 2.8

69.8 23.1 7.2

80.1 17.6 2.3

85.2 10.3 4.4

49.4 42.5 8.1

59.9 38.3 1.9

58.8 33.5 7.7

42.8 53.1 4.1

58.2 40.4 1.4

60.9 35.4 3.6

SOURCE: Congressional Budget Office (1988). "The Living Anangements of the Elderly, 1960-1984: March, 1988." Changes in the Living Anangements of the Elderly, pp. 8-11.

TIMOTHY H. BRUBAKER

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Although children provide support to their older parents, few elderly live with their children. Brotman (1981) reports that 6% of older men and 11% of older women live with their children. Further, there is a trend toward a decreasing number of older persons living with their children. For example, there were more than twice as many older women living independently in 1980 than in 1950. When older parents live with their children, they usually live with a daughter (Lopata, 1973; Shanas, Townsend, Wedderburn, Friis, Milhoj, & Stehouwer, 1968; Stone, Cafferata, & Sangl, 1987). The living arrangements of older men and women indicate that family relationships are significant, even though few live in intergenerational households. The number of children within a family system has been declining in recent years. Fifty years ago, nearly 50% of older women had four or more children. Now, about 25% have four or more children (Brotman, 1981). Approximately 20% of older women have had at least one child. Data suggest that nearly 80% of persons 65 years and older have surviving children (Brotman, 1981). It appears that most older people have children, but the number of children in a family has decreased, and this trend is expected to continue. This suggests that the size of a family network may be decreasing. Remarriage is an event that is experienced by few elderly. Two studies (Cleveland & Gianturco, 1976; Treas & Van Hilst, 1976) focused on the possibility of remaniage in later life. Both report that the likelihood of remarriage after widowhood or divorce is small. Men are more likely to remarry than women. For example, Cleveland and Gianturco (1976) report that less than 25% of widowers aged 65 years or older ever remarry. For widows aged 55 years or more, less than 5% remarry. Men are more likely to marry younger women than vice versa (Treas & Van Hilst, 1976). Most of the older men and women who marry are marrying widows or widowers CTreas & Van Hilst, 1976). Remarriage in later life may be attractive, but few remarry in later life. Demographic characteristics of older persons indicate that they are or have been members of family networks. Most are married or have been married. Most have children. Few have never married. Most older women experience widowhood, and few remarry. In any case, a family network exists for most older persons. Later-life family relationships are heterogenous and important to both older and younger family members. Gerontological and family studies researchers and practitioners need to be sensitive to the vitality of later-life family relationships.

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Overview POSITIVE AND NEGATIVE ASPECTS OF LATER-LIFE FAMILIES

Later-life families vary in structure and patterns of interaction. Cultural factors and a variety of other factors influence the interrelationships with later-life family networks. Research (Horowitz, 1985a, 1985b; Noelker & Wallace, 1985) indicates that the existence of the family network of laterlife families provides a reservoir of individuals. These individuals may be mobilized to provide help for older persons in emergencies or to provide support for day-to-day activities (Brody, 1985). Also, the family may provide financial assistance or advice. For emotional support, the family may be the primary resource for the older person. Lebowitz (1978) suggests that the family provides extraordinary amounts of support to older members. As a society, older persons' families contribute large amounts of support to the elderly. As Nydegger (1983, p. 28) notes, "charity really does begin at home." The extraordinary financial, physical, and socioemotional support available with later-life families is a positive aspect. While the family generally provides support, it should be noted that there are negative aspects associated with later-life family relationships. Some of these negative aspects relate to the intense family involvement in later-life families. Research (Finlay, Roberts, & Banahan, 1988; Scharlach, 1987; Thomas, 1988) has suggested that family caregiving of an older family member may increase stress within later-life families. For some families, the use of extrafamily supports to supplement family supports may alleviate some of the stress but, nonetheless, stress continues (T. Brubaker, in press; Brubaker & Brubaker, in press; Noelker & Bass, 1989). Tensions may arise when an older parent and an adult child reside in the same household. The need to provide community support for intergenerational households is suggested by Brubaker and Brubaker (1981). The primary reason for the need for such support relates to the negative aspects of family relationships. Family members may recall unpleasant family experiences or may be overwhelmed with the needs of the intergenerational household. Identification of negative interactions or remembrances within the family history arc important to both researchers and practitioners (T. Brubaker, in press). Another example of negative aspects of later-life family relationships is reported by Quinn (1983). In a study of older parents and adult children, it

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was found that excessive filial expectations of older parents are negatively related to communication patterns. The adult child may feel a burden from older parents' expectations; consequently, a strain is created on the family relationships. Later-life families are characterized by positive and negative experiences and the remembrances of these experiences may influence interaction in later life. Nydegger (1983, p. 31) cogently summarized the positive and negative aspects of later-life family relationships: Supportive families can be found in all societies. So can their opposites. We must accept these negative aspects as natural outcomes and attempt to pinpoint those structural features that encourage conflict before we can fully understand the aged and their family ties. Animosity exists in some later-life families and be useful in studying or working with later-life negative aspects of later-life families need to be grams and services for later-life families can be context in which later-life families live.

an awareness of it can families. Positive and identified. Then, prodeveloped within the

BASIC PREMISES FOR STUDYING LATER-LIFE FAMILIES The study of later-life families is exciting because the family relationships are crucial to older persons. The heterogeneity of later-life families is intriguing. The unique ways in which later-life families interact, cooperate, and deal with the challenges of later years provide insights into family life that may be applicable to other segments of the family life cycle. Families are resilient, and they approach new situations with a lengthy history of interaction. One result of the lengthy history of interaction is the development of a family ethos (T. Brubaker, in press). The family ethos provides a family definition of who is responsible to provide assistance, who. can perform specific tasks within the family, and ways to deal within extrafamilial groups. In many ways, the family history provides families with a repertoire of adaptations that, when mobilized, may be useful in later life. To understand later-life families, examining the interrelationships and interdependencies among the marital dyad, generations, and extrafamilial organization is necessary.

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Overview

The study of later-life families is premised on the following: 1. A viable family network exists for many older persons. 2. Later-life family relationships are important to both older people and other family members. 3. Positive and negative aspects characterize later-life family relationships. 4. Policy and practice directed toward older people need to recognize the importance of the family network in late life.

PARTI Family Relationships

This part focuses on the later-life family relationships of the couple, adult child and older parent, siblings and grandparents. The husband-wife relationship is dyadic and, usually, is based on many years of interaction. As marital partners, the latter part of the family life cycle provides a time of change that may be different from the changes the couple has previously negotiated. The first two chapters address the older marital couple relationship. Using a family systems approach, Janie K. Long and Jay A. Mancini examine the older marital relationships with particular attention to the development of strain. As a system, the marital couple deals with changes related to retirement, finances, physical health, leisure time, residence, distribution of power, and the loss of friends and siblings. Three case examples are presented. This chapter provides a theoretical framework for research and practice directed toward older married couples. Linda Ade-Ridder explores the relationship between sexuality and marital quality of older persons' marriages. Initially, research on sexuality in later life is reviewed. Then, data from a sample of 244 older couples are analyzed. The primary focus is the relationship between marital quality and sexual interest and behavior. The findings suggest that most men and women continue sexual activity in the later years and, for those who are active, marital quality and sexual activity are related. Implications for future research and practice conclude the chapter. 27

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Family Relationships

The relationship between the adult child and older parent is discussed by Robert A. Lewis. This intergenerational relationship is viewed from a family development perspective, and family interdependencics as well as dependencies are explicated. The dependencies between adult children and older parents are defined within the framework of a dependency cycle that develops over the family life cycle. The chapter illustrates the saliency of the lengthy family history of interactions and its influence on family relationships in later life. Within the family network of older persons, siblings are often important and vital members. Jean Pearson Scott examines the sibling relationships of older persons. The chapter highlights the differences between the various types of sibling relationships and presents data from 82 older men and women. This study explores salient factors of sibling interaction to further clarify a typology of sibling relationships in later life. The findings suggest that frequency of interaction with siblings may not be an accurate indicator of the meaning of the sibling relationship to older persons. The grandparent relationship is the fourth family relationship addressed in this part. Karen Roberto reviews research focusing on grandparenthood. The meaning of the grandparent relationship, satisfaction associated with being a grandparent, and the consequences of grandparenting are discussed. This chapter concludes with suggestions for future research related to grandparenthood.

2 Aging Couples and the Family System J A N I E K. LONG JAY A. M A N C I N I

More than one-third of all older adults are married and living together independently of others (Beckham & Giordano, 1986). For those 65-74 years of age, 8 out of 10 men and 5 of 10 women are married. For people 75 and over, 7 out of 10 males and 2 of 10 women are married (T. Brubaker, 1985a). These older marriages face unique challenges, such as retirement, changing health, and change of residence. Later-life transitions have the potential to be instances of growth and positive change, but they also hold the potential for dysfunction and loss (Walsh, 1980). When the clinician works with the troubled older couple and their extended family, it is important that the clinician not only have an awareness of the needs of older couples but also have the necessary tools to use when working with such couples. Among those older couples who seek professional support while dealing with stress, a family systems framework can be helpful in examining the roles of the couple in relation to one another and to other family members. An understanding of family roles and patterns will aid the clinician in working with family members when problems arise within the family system.

AUTHORS' NOTE: An earlier version of this paper was presented at the Annual Meeting of the American Association for Marriage and Family Therapy, October 1985, in Chicago. Appreciation is expressed to Robert Fields for his guidance in the formulation of this paper.

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The elderly have been involved with the family for many years, and changes in the older couple reverberate throughout the family system. T. Brubaker (1983) suggests that to study the family in later life, it is important to look at family relationships through the lens of the older couple, as well as from the perspective of other family members. For these reasons, both the impact of the needs and concerns of the older couple upon the family system and the impact of the needs and concerns of the family system upon the older couple will be examined. This chapter presents family systems concepts developed by Murray Bowen (1978) and examines the potential strains in the older marital relationship. Implications from Bowen's systems framework for working with older couples and their families in clinical settings are also discussed.

BOWEN'S FAMILY SYSTEMS FRAMEWORK Bowen's theory focuses on the emotional forces that influence the functioning of both the nuclear and extended family, and for this reason, is conducive for working with older couples who arc often involved with extended-family members. Bowen's perspective enables the clinician to look beyond the older marital couple to include a broader context for the relationship. The theory centers around two core concepts, the degree of anxiety and degree of integration of self. Low-anxiety people appear symptom-free, while chronic anxiety and its accompanying tension will express itself in the form of a symptom or dysfunction. Many life-situation changes can precipitate a change in the level of anxiety in relationships, examples being loss of income, the death of a sibling, or the institutionalization of a family member. Unfortunately, the effects that these and other changes have on the older married couple are not clearly known (Alzenberg & Treas, 1985), and, for the most part, few theories of family life have been applied to these situations (Mancini, 1984b). One applicable theory that deserves attention in assessing older marriages and family relationships is that expressed by Bowen. It is clear that this perspective is best applied to the minority of families who have more difficulty dealing with change, and for that reason the focus of discussion is in a clinical context. Brief descriptions of the basic concepts of Bowen's theory follow. These concepts include differentiation, triangles, nuclear family emotional process, family projection process, multigenerational transmission process, and emotional cut off.

JANIE K. LONG & JAY A. MANCINI Differentiation An individual's level of differentiation describes the degree of autonomy the person exhibits in relation to the family system. A lack of autonomy (enmeshment) signifies overinvolvement in the family. Bowen (1978) emphasized that emotional enmeshment draws the family together. The power of the family pull is so strong that any attempt on the part of the individual to establish a separate identity is met with harsh disapproval by other members of the family. The family exerts a strong influence on the individual to behave in ways that will maintain the emotional stability of the family unit. Bowen suggests that a person's level of differentiation is, for the most part, determined by the time she or he leaves the parental home. Thereafter, one tends to reproduce in one's own family the family patterns of one's family of origin. The individual usually chooses a spouse who is at the same level of differentiation, thus facilitating this repetitive process. Few life experiences are able to drastically change this basic level of differentiation. However, it is likely that even the couple who has a high level of differentiation can have this stability tested by chronic or severe stress.

Triangles The triangle is a three-person emotional configuration that serves as the cornerstone of the family's emotional system. Within the family's emotional system, tensions shift in an orderly series of emotional alliances and rejections. The concept of triangling reveals the behavior of the dyad when stressed. The triangle describes the automatic movement of individuals within the system to maintain the degree of closeness/distance that produces the lowest level of anxiety. When life is calm, the two-person system may remain calm, but when anxiety increases, the system triangles in the most vulnerable or available third party or an "outsider." The two-person relationship system has a low tolerance for anxiety even when both persons are highly differentiated or autonomous. The triangle, then, is a three-person emotional behavior pattern and is the smallest stable relationship system (Bowen, 1978). When tension within the solitary triangle is too high, it pulls in others to form a system of interlocking emotional triangles. After available family triangles

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are depleted, the family system triangles in people from outside the family, such as medical personnel, social workers, and educators. Nuclear Family Emotional Process The nuclear family emotional process describes patterns of emotional functioning in a family within a single generation. Certain patterns between the father, mother, and children are repetitive of patterns from past generations and will be repeated in future generations. The lower one's level of differentiation, the more intense the emotional fusion of marriage. In the marital relationship, one spouse becomes the dominant partner, the decision maker, while the other spouse adapts to situations. The dominant spouse increases in self-esteem while the adaptive spouse loses self-esteem. The dominant and adaptive positions are determined by the position that each spouse had in their families of origin. Bowen has stated that partners long for but are allergic to closeness. He suggests four ways that spouses control the intensity of the closeness between them: marital conflict, emotional distance, dysfunction in one spouse, and the impairment of a child, including adult children. Marital Conflict A couple uses marital conflict to control closeness when neither spouse is willing to take on the adaptive role. These marriages are very intense, with each partner investing a lot of emotional energy. The relationship flows through an intense cycle of closeness, followed by conflict that results in distance, and then reconciliation that initiates another period of closeness. Each partner in conflict focuses on the "unreasonable" and "uncaring" qualities of the other and is convinced that the fault lies primarily with the other, whom they are trying to change (Papero, 1983). Emotional Distance Emotional distance refers to the reactive efforts of spouses to ensure distance instead of closeness. This distancing strategy is reminiscent of the ones used by the spouse during adolescence to become autonomous from parents. This distance can occur through actual physical distance or through internal processes in each person that works against emotional closeness (Papero, 1983). For example, the husband who withdraws rather than verbally working through his feelings about his wife's lack of atten-

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tion establishes physical distance, which reflects an inner decision to avoid confrontation. Dysfunction in One Spouse As the dominant spouse assumes more responsibility, the adaptive spouse eventually becomes dysfunctional. The dysfunction can be physicaily, emotionally, or socially oriented, such as developing bulimia, heavy drinking, or irresponsible behavior. Even a moderate increase in stress can result in dysfunction in the adaptive one (Nichols, 1984). In some cases the dominant spouse becomes stressed beyond the tolerance level and will collapse into dysfunction. This collapse will often motivate the adaptive partner to take charge for a short period of time until the dominant spouse is ready to reassume responsibility.

Impairment of a Child This is a process through which parents impair one or more children. Bowen felt that this idea was so important that he included it as a major concept in his theory and called it the family projection process. This process is described in more detail in the following section. For the purposes of this chapter, focus is on the impairment of the adult child or the impairment of the grandchildren.

Family Projection Process The family projection process is the pattern through which parental undifferentiation is projected to a child or children. Most families have one child who is more triangled than the others and whose adjustment to life is more difficult. This process is initially driven by anxiety in the parent rather than a problem in the child. Bowen suggests that the process often begins with an overanxious mother who is dedicated to being the best possible mother and having the most wonderful child (Bowen, 1978). The child then becomes anxious in response to the mother's anxiety. This pattern eventually becomes a vicious cycle. The father adds his approval to the mother's actions by playing a passive role in the triangle. Some of the factors that may influence the selection of a child for fusion are sibling position, the mother's preference for girls or boys, and the mother's level of anxiety upon conception and birth (Bowen, 1978).

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Some of the most vulnerable children for the projection process are the oldest child, an only boy or girl, a child born when anxiety is high, and a child with a handicap. Multigenerational Transmission Process This concept describes the passage of the family's emotional process through multiple generations. In the nuclear family, the parents pass on part of their immaturity to one or more children. The multigenerational process details the projection of undifferentiation to various children over several generations. The problem or the blame is not found in the children nor in the parents. "Instead, the problem is the result of a multigenerational sequence in which all family members are actors and reactors" (Nichols, 1984, p. 352). Emotional Cut-Off Emotional cut-off refers to the avoidance of an intensely emotional area or topic in the family, whether it be past or present, between the generations. This process could also be described as the vehicle by which individuals separate themselves from the past in order to begin life in the present. People distance themselves from their families in order to avoid emotional intensity, ". . . yet their reactive need for closeness and intense emotionality leads them into relationships to which they are equally reactive" (Papero, 1983, p. 151). The more intense the cut-off with one's own family, the more likely one is to have an exaggerated version of the parental problem in her or his own marriage and the more likely one is to have children who establish an even more intense cut-off in the next generation. Therefore, the more a nuclear family fosters some type of viable emotional contact with previous generations, the less symptomatic both generations will be. Several concepts that are germane to Bowen's systemic framework have been discussed. While some of these concepts are subject to debate and may be in conflict with other approaches to the troubled family, it is the goal of this chapter to apply the perspective in as pure a form as possible. These concepts describe how individuals and families respond to stressful situations with respect to their anxieties and how their sense of self is influenced by these stresses and responses. Both dyadic and triadic

JANIE K. LONG & JAY A. MANCINI aspects of family responses have been noted. Thus far, the discussion has focused on the intraphysic and the interpersonal without saying much about the environment contingencies that affect individuals, couples, and their families. Therefore, an exploration of environmental Stressors that the older family often faces is appropriate. The Stressors represent one level of the context in which the family system operates. Following the section on potential Stressors older couples face, the Bowen perspective will be connected with the process of aging through the use of case examples.

FAMILY CHANGE IN LATER LIFE Retirement One of the first major events facing the older couple is the retirement of one or both partners. Retirement is followed by more negative changes than any other single life event (Palmore, Cleveland, Nowlin, Ramm, & Siegler, 1979). However, for many the postemployment years are highly satisfying (Atchley, 1982). Retirement experiences vary and are often tied to the physical fitness of one or both partners and to their financial status (Hill & Dorfman, 1982). In considering the impact of retirement on the couple, Kelley (1981) suggests that there will likely be an increase in husband-wife interdependence, which will have varied effects on marital satisfaction, depending on the nature and extent of preretirement interdependence. If the couple have led very autonomous lives prior to retirement, increased interdependence and interaction could potentially lead to increased conflict. Some couples may, however, plan for ways to continue their autonomy by involvement in social and civic groups, hobbies, and other activities. Hill and Dorfman (1982) have found that housewives are likely to reveal both positive and negative aspects about their husband's retirement. Positive reactions include more time to do what they want, increased companionship, more flexibility, and more shared responsibility for household duties. Keating and Cole (1980), however, report that a brief period of sharing of household chores eventually reverts to the preretirement division of labor. Negative aspects found in the Hill and Dorfman (1982) study included financial strains, husbands who were bored, and revelations about "too much togetherness" in early retirement. Many wives report an increase in their

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duties upon the husband's retirement (Keating & Cole, 1980). Not only were they still responsible for prior tasks, but they were also serving as social directors for their husbands. However, these wives were not dissatisfied but, in fact, felt needed and found fulfillment in nurturing their husbands. Relatively little research has been done concerning the impact of retirement upon the working woman or upon dual-career couples. It is likely that these topics will draw increased interest as current cohorts of dual-career couples retire and as those married women who are in the work force in record numbers retire. The impact of retirement on the man varies not only for reasons already discussed but because of how satisfying he found his work, how much prestige he perceived his job afforded him, and how much of his personal identity was tied up in his work (Atchley, 1982). Upon retirement, some men show resentment at being asked to participate in household duties, especially if they have previously seen such tasks as woman's work (Zube, 1982). After losing the sense of power associated with their work outside the home, many men seek power within the home by demanding a greater role in household decision making (Hill & Dorfman, 1982).

Finances A second Stressor often related to retirement is the potential for added strain on the couple's finances. The couple must now rely upon their pension, Social Security, and whatever savings they have been able to accumulate. The median after-tax income in 1984 for families headed by persons under 65 was $23,104; the median income for families headed by a person 65 and older was $15,745 (U.S. Bureau of the Census, 1987). Rising food costs, rent increases, and cuts in Social Security, Medicaid for medical care, federal housing subsidies, and food stamps are all possible matters of concern to an older couple whose real income is shrinking. Sanoff and Cole (1982) report that 3.84 million senior citizens were living in poverty in 1982 and an additional 2.5 million were in the "near poverty" category. Some elderly couples also continue to help support children and grandchildren (T. Brubaker, 1985a). With more marriages ending in divorce, adult children and grandchildren are moving back into grandparents' homes or are calling on grandparents for day care (Mancini & Blieszner, 1985). There is the potential for a sense of overload and loss of autonomy (Cohler, 1983).

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Increased expenses for health care are also an added burden to many older couples. As one example, the costs incurred annually in caring for a senile demented elderly person at home have been estimated to average $11,735 and in a nursing home $22,458 (Hu, Huang, & Cartwright, 1986). Besides dealing with the actual physical challenges of illness, the elderly are faced with increased financial strain. Couples who have planned for a secure retirement may find themselves facing devastating medical bills not covered under Medicaid or Medicare.

Physical Health Approximately 47% of all older adults are limited in their activities because of chronic conditions (U.S. Senate Special Committee on Aging, 1984). Many persons survive for long periods of time while suffering from cancer, alcoholism, Parkinson's disease, dementia, emphysema, and other conditions. We have been able to prolong life, but in many cases the quality of life is significantly decreased. Family members furnish a great deal of support to older adults (Springer & Brubaker, 1984). Family members may provide care in the older person's own home or they may co-reside. No more than 5% of older people live in institutions at any time (Mindel, 1979). When age is partitioned, less than 2% of people who are between 65 and 70 are institutionalized, and for those who are 85 years of age and above, 25% of the females are institutionalized and 16% of the males (Rosenwaike, 1985). For the married couple these illnesses and the ways in which they are manifested can become a tremendous burden on the marital relationship. "Regardless of which spouse gives care, the attendant burdens on both spouses have consequences that severely test the social and emotional resources that maintain the marital bond" (Gilford, 1986, p. 19). The spouse who is sick must contend not only with illness but also with feelings of helplessness, frustration, and a loss of self-esteem. The caregiver spouse often assumes increased responsibilities. Five to eight million family members, mostly women, provide care to one or more older adults (George, 1987). Fifty percent of this group are spouses. Seventy percent of Alzheimer's disease care is directly provided by families (George, 1987). Wives as caregivers tend to report more strain and are less likely to turn to community support than husband caregivers (Johnson, 1985a). Beckham and Giordano (1986) indicate that over 80% of spouses report the role of caregiver as stressful, with half indicating caregiving as a seri-

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ous problem. Older spouse cavegivers may contend with illnesses of their own in addition to the illness of the spouse (Fengler & Goodrich, 1979). Cavegivers (including adult children) may also experience financial distress as savings are spent on care for the elderly family member (Springer & Brubaker, 1984). Caregivers not only must deal with an increased workload but may also contend with feelings of self-blame, depression, and loss of control (Pagel, Becker, & Coppel, 1985). Some caregivers may experience role overload (Springer & Brubaker, 1984). Many couples and family members face the possibility of being overwhelmed when dealing with illness and impairment in later years, and often an ensuing sense of crisis develops. Referral to social services usually does not occur until this point has been reached (Ratna & Davis, 1984). Changes in a couple's sexual habits may be brought about by illness, by the lack of privacy in a reestablished multigenerational household, or, in a small percentage of cases, as the result of institutionalization of one or both spouses. However, Masters, Johnson, and Koiodny (1986) report that there is no biological cause related to aging that automatically brings an end to sexual functioning. Neither heart disease nor most other common illnesses frequently found in the elderly need result in an end to sexual relations (Krupp & Chatton, 1986). At the same time, biological changes do take place for both men and women. Sexual reactions are often slower and less intense. Misinterpretation of these changes often brings about anxiety and can lead to dysfunction. Wise, Rabins, and Gahnsly (1984) found that in individuals over 50 years of age who were seeking treatment for sexual difficulties, the most common were erectile problems in men and lack of orgasm and sexual desire in women. Husbands and wives both report that the husband is likely to stop sexual interaction because of declining health (Pfeiffer & Davis, 1972).

Use of Leisure Related to retirement, health, and finances is the question of what couples will do with their leisure time (Mancini & Orthner, 1982). In 1975, a nationwide survey reported that the majority of respondents indicated that the best thing about being 65 and over was having more leisure time (NCOA, 1975). Individuals with good health and higher incomes are more likely to engage in leisure activity. Social participation is considered to play an important role in determining happiness and greater life satisfaction for older adults. An important variable in the life satisfaction of older

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adults is the continuity of activity patterns between middle and old age. Persons who engage in more social activities as opposed to isolated activities register higher life satisfaction (Burrus-Bammel & Bammel, 1985). Even though one's activities generally do not change after retirement, there is a potential increase in the number of activities. Popular leisure activities include visiting friends, watching television, doing odd jobs at home, travel, and walking (Burrus-Bammel & Bammel, 1985). The relationship between leisure and the extended family is significant because leisure participation can help promote quality family life (Orthner & Mancini, 1980). "Determinants of whether spending time together is beneficial include whether the older adult is invited to be a full participant in family life, as opposed to being defined as a bystander; the past history of family relationships (i.e., what conflict patterns have existed over the years); whether the generations feel obligated to spend time together and do so with reluctance; whether cooperative decisions are made about the nature of leisure experiences not mandated by a particular individual; and the quality of current interaction that may leave family members feeling motivated to spend either more or less time in shared leisure" (Mancini, 1984a, p. 69). Tensions may arise if couples disagree on the use of leisure time. There may also be differences of opinion as to the affordability and practicality of certain activities. If couples have not enjoyed doing things together prior to retirement, it is unlikely that their feelings will change. There is also the question of whether to engage in activities always as a couple or separately. Some spouses feel left out if the other spouse spends time with friends. Guilt may evolve if one spouse is ill and unable to participate in planned activities. The ill spouse often feels that he or she is keeping the other from enjoying life, and the spouse who leaves a sick mate behind feels guilty about having a good time.

Change of Residence Stein, Linn, Slater, and Stein (1984) examined the future life concerns of elderly community residents. Even though many of the respondents indicated concern about health and their abilities to function, the item of greatest concern was the fear of having to move to a nursing home. A change of residence for the older couple can take different forms. Lower income may mean selling a home that they have lived in for many years in order to move into a smaller apartment. Not only must the couple cope

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with great feelings of loss, but they must also often deal with issues of limited space and freedom. Some couples choose to move closer to children, and some are forced to move in with their children's families. A loss of privacy and less independence may result. Research indicates that most elderly persons consider living with relatives as an undesirable arrangement even though the elderly often want to live in the same area (Aizenberg & Treas, 1985). Older persons prefer to maintain their independence. Making new friends and adjusting to a new city or neighborhood may be difficult. Older couples may be deeply attached to their neighborhood and community and to long-lasting friendship bonds. Older people often fear that they will be the victims of assault and robbery, and many older couples choose to stay home rather than explore unfamiliar territory. Long-term care facilities are often not set up to accommodate couples, and in some marriages one spouse is institutionalized while the other spouse lives elsewhere.

Redistribution of Power The issue of power is a very important one for the older adult. There is often a shifting in the balance of power in the marital dyad. Zube (1982) reports that most men, as they grow older, are no longer achievement-oriented but tend to become more affiliative, showing an increase in intimacy and family activity — while the wife tends to become more aggressive and assertive. Time-use studies of the life cycle demonstrate this shift (Mancini & Orthner, 1978). Just when the husband is turning to the family to have needs met, the wife is often looking outside the family. After retirement, the husband frequently desires to have more input into decisions previously made by the wife, and often the sharing of household duties must be renegotiated. Some men will always be considered the "head of the household" because of a more traditional orientation, but a recent study noted that men were considered the boss of the family by everyone except the older women, who attributed such dominance to themselves (Zube, 1982). Not only is there a shifting in the balance of power between spouses, but adult children often gain power relative to their aging parents. Mancini and Blieszner (1985) report that an increasing number of adult children are moving back into their aged parents' homes, which blurs the parent-child roles in the later stages of life. Even though children often live a significant distance from their parents, viable relationships are

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maintained. As many adult children are providing direct care to older parents, Brody (1985) has suggested that care of older parents could be considered a normative life event of adult children. Caregiving is but one of several provisions that flow from adult children to aging parents (Long & Mancini, 1989). With bureaucracies assuming more of the responsibility of caring for the aged, in some cases the role of the child has changed to one of mediator between these various agencies and the parent. In some respects, the role of the child as caregiver has not vanished but rather taken on new meaning. However, the data on who cares for elderly parents are not definitive (Mancini & Blieszner, 1989). Losing power in the family can cause a loss of self-esteem. Sometimes older couples try to restore the equilibrium by the use of informal power. For example, an elderly couple can delay admission to a long-term care facility by one of the spouses suffering from a recurring illness that requires short-term hospitalization and family attention (Duffy, 1984). These attempts to regain or reestablish power often go unnoticed for what they are and can bring about further tension in the family. Negotiation and conflict are two processes that families addressing the needs of the aged face (Bengtson, 1981). Bargaining frequently occurs in families, and conflict is often a part of negotiations. These tensions then may spill over into the marital dyad, especially if the couple is not in agreement about dealing with conflict.

The Loss of Loved Ones The death of close friends and siblings and the fear of the spouse's death also appear to create tensions in the elderly couple's relationship. Watching brothers and sisters die can bring about an atmosphere of impending demise. Losing a close friend may be more significant in that older adults often rely on age-peers to fulfill many of their needs (Stein, Linn, Slater, & Stein, 1984). Making and keeping new friends at this life stage is relatively more difficult. It is not always easy to meet new people, and some reports suggest that the elderly are likely to begin to withdraw from emotional investments (Zube, 1982). The older adult who experiences an accumulation of losses all in a short time frame may look to one source, usually the spouse, for gratification that previously came from many sources. Of course the fear of the death of the spouse can also create tensions. Feelings of loss and abandonment will arise, especially if one of the pair is suffering from an illness. Some spouses devise elaborate

42

Aging Couples and the Family System

plans for health promotion in an attempt to control their fears. If the other spouse does not follow these regimens, conflict and anger ensue (Johnson, 1985a). Several life-changing events that are typically part of the aging experience, especially at later-life stages, have been discussed. While not all aging people experience each of the events described, all will experience at least one of them. Across all of these events are potentials for anxiety, for conflict in the family, for changes in how one's self is integrated. Some of these events will be experienced by the older married couple, while others will become family issues far beyond that dyad. Case studies will be used to elaborate the connection between the life events just discussed and Bowen's family system approach.

IMPLICATIONS FOR PRACTICE

How are these life changes and the great sense of loss handled by the older couple, and how might the informed clinician help them? The practitioner can avoid linear (i.e., cause and effect) thinking by utilizing systems thinking to understand human behavior in these stressful situations. How the couple or family adapts to later-life changes develops from patterns established in earlier family life. These patterns were used to bring about stability. How couples cope in old age is heavily dependent upon the type of system they have created and its ability to adjust to losses and new demands (Walsh, 1980). As the life cycle needs of the couple change, patterns that were once functional may become dysfunctional. Symptoms often emerge in the family during periods of system imbalance; that is, retirement or the death of a loved one. Understanding the intricate emotional system of the family can help the practitioner to restore balance to the system. Following are some examples of how real-life strains faced by older couples might be understood when viewed through Bowen's family systems framework. Case Example 1 In this case example, family changes in later life pertaining to health and redistribution of power are linked with Bowen's concepts of triangling, differentiation, and the nuclear family emotional process, including

JANIE K. LONG & JAY A. MANCINI

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marital conflict and distance/closeness. A 67-year-old man has returned home from the hospital after being treated for a heart attack. He exhibits depression, anxiety, and irritability. He has little appetite and only eats meals when his wife insists. He withdraws when he initially becomes angry, but his agitation builds until he explodes in an outburst of rage. His wife is very concerned about her husband's recovery and is determined that he will follow the doctor's prescribed regimen. She seeks to limit his activities and to monitor what he eats which usually results in his rising agitation and her withdrawal for fear of an open conflict that might result in another heart attack. The more protective and controlling she is, the more irritable he becomes. She makes an appointment with a mental health counselor to talk about her fear of another heart attack and to enlist the counselor in helping her husband understand why he must follow her instructions. The counselor might view this scenario as one of the wife being overprotective. Using Bowen's concepts, the counselor would, however, suspect that the wife is seeking a third party, the counselor, to involve in a triangle to stabilize her relationship with her husband. The counselor would explore the pattern of marital conflict in the nuclear family emotional process both before and after the heart attack. To explore these areas, the counselor would ask questions that focused on how decisions were made: Does the couple share in decision-making responsibilities or does one of them usually make the final decision? How often do they have open conflict? Who usually gives in first during an argument? In this case, the husband had retired shortly before the heart attack. After his retirement the husband sought ways to remain productive, including taking more responsibility around the household and implementing changes in the way the wife had run the household. The wife had experienced the husband's entrance into the household as an invasion of the domain that had given her life meaning and satisfaction. The more responsible he became at home, the less competent she felt. The level of marital conflict before the heart attack had risen significantly since the husband's retirement, with the wife struggling to maintain boundaries and the husband seeking success and mastery at his new "job." The struggle for control after the heart attack was a continuation of the struggle that developed upon the husband's retirement. The counselor could work with the couple to redistribute power in the relationship, finding ways for both to feel competent and to bolster self-esteem. Boundaries and roles could be renegotiated to reestablish differentiation, thus decreasing the intensity of the closeness between them. The counselor could help the couple di-

44

Aging Couples and the Family System

vide up household responsibilities as well as find new avenues of self-expression, including volunteer service, hobbies, and leisure interests. Case Example 2 This case is an example of how a later-life transition, the retirement of a parent, brings about dysfunction in the family system, including an adult daughter. Bowen's concepts of differentiation, the nuclear family process, triangles, the family projection process, and emotional distance are helpful in understanding this case study. A 26-year-old woman appears at the office of a marriage-and-family therapist with a self-identified presenting problem of depression resulting from separation from her husband. The young woman also reveals having suicidal and homicidal thoughts. The husband is often away from the home at work or at school, leaving her at home alone. She fears that he is having affairs with other women because their own sexual relationship has become nonexistent. Toward the end of the session, the young woman mentions that she has also been upset because her parents' relationship seems to be in trouble as well. The therapist could deal only with the client or with the couple's relationship in the next session but chooses to explore the client's family-oforigin to examine her level of differentiation and to review the nuclear family process. The clinician discovers that the client's 65-year-old father has recently retired from the military and has returned home to live with her mother after being away for ten years. The retirement of the father brings about a drastic change in this family system. Not only does the father have to adjust to retirement, but he has returned to live with his wife after being away for most of the previous ten years. They have had a built-in system for maintaining distance/closeness, his job, which is no longer functional. The transition may also be hindered by an unsatisfying marital relationship. The client is very concerned because her mother and father were very distant to one another during her last visit home. Her mother calls the client every weekend to inquire about the status of her separation and to encourage the client to move back home with her and the client's father. Not only is the retirement transition exacerbated by marital conflict but also by overinvolvement with an adult child. The adult daughter has become involved in a triangle with her parents and has become symptomatic or impaired. Examining the client's broader family system enables the therapist to become aware of the triangling and dis-

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45

tancefcloseness issues in the family, as well as to examine the family's projection process. The therapist is able not only to work with the client but also with her parents, who come to therapy out of concern for their daughter. The therapist can address the triangling issue by suggesting to the client and to her parents that meddling in each other's marriages helps to keep them close even though none has the right to meddle in each other's business. The therapist could also explore the ways that the inability of the daughter to differentiate from her parents interferes with her ability to focus on her own marriage. Questions would focus on why the client spends more time trying to be her father's "wife" than her husband's, how her husband feels about her "marriage" to her father, how her mother feels about sharing her husband, and why the client did not bring her husband in for marital therapy. If the parents so desire, the therapist could work with them as a couple to explore their own relationship. The therapist would work with the couple to find new ways of regulating distance/closeness that did not involve the daughter.

Case Example 3 This final case study involves a chronic health condition, alcoholism, and traces the spread of anxiety through multiple generations of the family system as exhibited by the impairment of a grandchild and the marital conflict of an adult daughter. A wife who is 55 years of age has turned to her adult daughter for help in solving what has become labeled as "your father's drinking problem." The older husband had been a sporadic heavy drinker throughout their marriage but over the past six years had begun to drink every day, often not stopping until passing out. He fell down the steps while intoxicated and required a trip to the emergency room to receive stitches in his knee and treatment for a mild concussion. During the previous two years he has lost a lot of weight and sometimes suffers from memory lapses. He has withdrawn from all social activities and fills his time with drinking. He was recently arrested for driving while intoxicated and was scheduled to appear in court. The older wife has often called upon her adult daughter to help in crisis moments and has spent a lot of time complaining to the daughter about her husband's behavior. The daughter has spent so much time and energy helping her parents that marital conflict has developed in her own marriage. Her husband feels

46

Aging Couples and the Family System

that she is neglecting her own marriage and family responsibilities because she is often away from home and has little energy for her own family after dealing with her parents. The anxiety in this family transmits through multiple generations to the adult daughter's son, who begins to have problems at school. The grandson is acting out with both teachers and other students, most recently shoving one of his teachers into a wall. The grandson and his parents are called in for a conference in the principal's office and are referred to a family therapist. Bowen describes how a surge of anxiety anywhere in the family can spread and intensify across the generations to involve finally a professional helper. In this instance the therapist is able to discover that the most important triangle in this system is not father-mother-child but is rather older father-older mother-adult child. The therapist can then focus on modifying this important triangle by changing the function of one or more persons in the triangle. For example, the therapist would explore with the elderly couple the ability of the husband to control his drinking. Questions would include: Does his life revolve around his drinking?, Does he continue to drink even though it has a deleterious effect on his health?, and Does he continue to drink even though it has a negative effect upon other family members? If the husband were alcoholic, a treatment program would be suggested including involvement in Alcoholics Anonymous. He would be asked to find a sponsor in A.A. who would provide him with support. The therapist would also facilitate the wife's involvement in AlAnon and other support groups, working to reduce her co-dependency on her husband through more differentiation. By working to stabilize the elderly parents' marriage through initiation of ways for them to seek support individually, the therapist encourages the adult daughter to channel her energies back into her own family. The therapist would also suggest the daughter attend meetings for Adult Children of Alcoholics (ACOA) and begin to explore her own enabling characteristics, which are tied to her inability to differentiate. CONCLUSION It has been the goal of this chapter to explore the utility of Bowen's family systems framework for the marriage and family life of older people. The processes described by Bowen can be related to events in the life of an individual, a married couple, or a family. Life events serve as pre-

JANIE K. LONG & JAY A. MANCINI

47

cipitators of particular responses to other people, whether they be a spouse or an adult child. Thus far, the family gerontology field has not provided its researchers or its practitioners with workable frameworks (Mancini, 1984b). While the efforts of this chapter are exploratory, it appears that Bowen's framework can be helpful for the therapist, clinical social worker, minister, or mental health counselor who is called on to deal with the fallout from an older couple's life situation. These life situations typically involve others in the family and the responses of older adults are historic and patterned, rather than transitory. Consequently, a framework that captures the role of family history is quite relevant. And a framework that is broad in its approach to who in the family is "involved" in the problem or issue would also appear important. However, other theoretical frameworks also need to be applied to older couples and their families because no single theory has the answer for every family problem (Constantine, 1986). Some years ago Ethyl Shanas (1980) referred to the aged and their families as the "new pioneers." She meant that so much of what today's aged and their kin are experiencing is new that there exists little guidance for the resolution of problems. If the aged and their families are still breaking new ground in what they experience as a family, then those who intend to provide a formal support system for them are important guides. While the application of the Bowen approach requires further refinement, knowing that it attempts to deal with the multiplexity of family life indicates promise.

3 Sexuality and Marital Quality Among Older Married Couples LINDA ADE-RIDDER

Few would question the notion that sexuality is of intense interest to young or even middle-aged people. Evidence of that interest can be seen in the myriad cultural images projected by advertisements, television, movies, books, plays, and print media. Yet, older people are rarely portrayed in romantic ways, much less as having sexual interests or needs. Existing research reflects these cultural stereotypes in that an absence of information persists about sexuality in the relationships of older persons. Garza and Dressel (1983) point out that the most obvious shortcoming of existing research in later-life relationships is the lack of concern with the role of sexuality within the marital relationship. Contributing to this dearth of information are cultural taboos that one should not talk about sex, especially with one's elders, and myths about the absence of sexuality in later life. Both myths and taboos have been the subject of numerous writings (Weg, 1983). Despite the persistent calls for more research, the challenge is largely unmet, with a decline in published studies that focus on sexuality within relationships of older people. As longevity increases, so does the need to better understand the human relationships experienced during the later years of life in their fullest perspective. In this chapter, current research findings about sexual behaviors and interests of older men and women as they relate to marital quality are 48

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reviewed. Physiological aging factors that may influence sexual functioning are considered, as are the reported behaviors and interests expressed by the older persons who have participated in the small number of research studies. Then, data are presented for 488 married older men and women about their sexual interests and behaviors. The relationship of marital quality with sexual behavior and interest is also examined for this group of older American couples. Finally, the implications for professionals are discussed. Systems theory is useful in explaining the role of sexuality in the lives of older couples. The notions that any change in one person impacts on the other in a relationship and that external factors are also influential are central to systems theory. Homeostasis imposes a criteria that a certain balance is critical to the functional health of the relationship, and that couples will adapt as needed in order to maintain that equilibrium. Equifinality suggests that some individuals will cope differently under the same conditions, while others will have very different beginnings and yet will end up with similar patterns (Broderick & Smith, 1979). Societal attitudes about appropriate sexual behaviors for older persons may currently limit the expectations older men and women bring to their marriages or, in the future, could impose expectations for functioning beyond the capacity for some. Health problems of one partner would potentially alter the sexual expression of the spouse. And, under ordinary circumstances, couples would be expected to vary from one another in their expressed needs and interests. It is anticipated that in marriages of long duration, couples who have found ways of striking a balance in meeting their sexual needs would be happier than those couples who have not. Therefore, sexual interest and behavior should be related to marital quality.

LITERATURE REVIEW Sexual Physiology of Older Men and Women Masters and Johnson (1966, 1970) remain the pioneers in expanding the information about sexual functioning and problems from an anatomical point of view. Generally, they reported that as the body ages, sexual response time slows and muscle tone diminishes, but as long as individuals maintain some degree of regularity of sexual practice, the capacity for

50

Sexuality and Marital Quality

functioning continues throughout life. Continuity theory supports this "use it or lose it" philosophy. In their study of 11 women over 60 years of age, Masters and Johnson (1970) explained that postmenopausal women have thinner vaginal walls that exude less lubrication during the sexual excitement process. In addition, with age, the vaginal barrel becomes less elastic and is slower to respond. The clitoris and its ability to respond to sexual stimuli remains unchanged (Masters & Johnson, 1970). The relative inelasticity of the vagina combined with poor lubrication may contribute to painful intercourse, particularly for women who do not participate in regular coitus (Masters & Johnson, 1966). The length of the orgasmic and resolution phases were also shorter for older women than for younger females (Masters & Johnson, 1970). The general pattern of slowed reactions is also true for older men. The 20 men over 60 studied by Masters and Johnson (1966, 1970) exhibited slower times in achieving an erection and in ejaculation. In addition, the general vasocongestion of genital tissues is minimal, and penile erection is less full than in younger males. The ejaculation is less forceful with a reduced volume of fluid. Following a shortened orgasm, the penis returns to a flaccid state very quickly, and the refractory period lengthens considerably. Finally, ejaculation is less likely to occur with every intercourse experience, but this was considered satisfactory to these men in Masters' and Johnson's sample (1970). For older men, the quality of sexual relations is more important than the quantity (Gibson, 1984). Chronic or acute illness can also affect sexual capability. However, most diseases do not warrant a cessation of sexual activity (Gibson, 1984). Following a heart attack, sexual intercourse can usually be resumed within 12 to 16 weeks and is usually advised; in fact, an active sex life may prevent future attacks. Of course, a physician's advice is needed and should be followed. In an unpublished study of sexuality in Alzheimer's disease victims from the spouse perspective, 9 of 13 subjects reported a change in sexual functioning with disease progression (Duffy, 1988). Impotence was a problem for 8 of the 13 couples, although 7 of 13 reported increased sexual interest on the part of the mate with Alzheimer's. Gibson (1984) stressed that in studies done in Germany and Canada, physician and spouse support is vital to the resumption of sexual intimacy in the face of erectile disorders (radical prostate surgery or medication side effects).

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Sexual Behavior and Interest Among the Elderly Sexual behavior and interest is the focus of attention of an increasing number of researchers, particularly during the recent past. However, most researchers are studying young and middle-aged populations. The bulk of the reported research on soxual behavior and interest among the elderly springs from the ongoing Duke Longitudinal Studies begun in 1955 (Newman & Nichols, 1970) to investigate noninstitutionalized "normal" aging of men and women over 60 years until death. Newman and Nichols reported a gradual decline in the frequency of sexual interest and intercourse from the first wave of testing between 1955 and 1959 with 256 participants. Subsequent waves of testing confirmed this pattern. Fifty-four percent of the subjects aged 60 to 93 (n = 150) who were still married at the second wave of testing were sexually active, with a frequency range of once every two months to three times a week. The mean frequency of sexual intercourse was once a month (Newman & Nichols, 1970; Verwoerdt, Pfeiffer, & Wang, 1970). However, the men in the sample were more active than the women; blacks reported higher activity rates than do whites, and subjects with lower socioeconomic status levels indicated more activity than did higher level socioeconomic status subjects. It should be noted that blacks were disproportionately represented in the lower socioeconomic status category. All subjects reported a gradual lessening in the sexual urge as age advances such that a strong degree of sexual interest beyond 70 years is exceptional and nearly absent beyond 75 years. Declines in sexual activity were noted in the mid-70s for males but seem to be related more to health status than to age. Marital status had little effect on activity or interest (Newman & Nichols, 1970; Verwoerdt et al., 1970). Palmore's (1981) summary of the second Duke Longitudinal Survey demonstrated similar findings, with two notable exceptions. First, no respondents claimed total absence of sexual activity; second, increases were seen in sexual interest and activity in all age categories. Overall, a pattern of stability was the modal response. In another reporting of the same data, gradual declines in sexual activity were noted over subsequent waves of testing, with males reporting higher levels of sexual activity than females at every age level in this sample of 278 married men and women (George & Weiler, 1981). However, the oldest subjects were only 70 to 75 years old. As previous reports found that the most dramatic declines occur at a later age, cautious interpretation seems warranted.

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Sexuality and Marital Quality

Following the deaths of most of the first wave of participants, Palmore (1982) reported that longevity is significantly related to a number of variables when the effects of age, race, and sex are controlled. Frequency of sexual intercourse was a significant predictor of longevity for men but not for women. Past enjoyment of intercourse was a significant and moderately strong predictor of longevity for women and present enjoyment was significantly related but only minimally so. Others noted a decline in sexual intercourse with age (Keller, Eakes, Hinkle, & Hughston, 1978; Edwards & Booth, 1976), although patterns established during middle age were likely to persist into the later years (Huyck, 1977). However, female sexual behavior seemed to reflect male capabilities and the availability of a partner (Pfeiffer, Verwoerdt, & Davis, 1972). Male ability and interest appeared to be related to health capability (DeNicola & Peruzza, 1974; Pfeiffer & Davis, 1972); both men and women attributed the cessation of sexual intercourse to the male (Roberts, 1980; Pfeiffer et al., 1972; Pfeiffer, Verwoerdt, & Wang, 1970). Other variables related to sexual activity among the elderly include education, income, and social class —socioeconomic status. As noted, the first Duke study reported an inverse relationship between socioeconomic status and sexual activity (Newman & Nichols, 1970). Further analysis excluded the black respondents who were primarily lower class and examined 502 older white men and women. A positive, although low, relationship between socioeconomic status and sexual behavior was reported (Pfeiffer & Davis, 1972). The second Duke study data showed socioeconomic status to be one of the most important positive correlates of sexual behavior and interest for men but not for women (Palmore, 1981). Previously, Christenson and Gagnon (1965), in a survey of 241 married white women, reported that sexual intercourse frequency was not related to education, but was inversely related to religious devoutness. Knowledge of sexuality was also related to sexual behavior. White and Catania (1982) recruited 30 elderly persons, 30 immediate relatives of an elderly person, and 30 nursing home staff. These three groups were randomly divided into experimental and control groups and were given preand post-tests. These groups were not generalizable to the population at large due to the volunteers' higher than average education and Caucasian race. The experimental groups were given three education sessions about sexuality: (1) myths; (2) physiological and psychological facts about aging; and (3) disease and drug effects. Elderly persons in the experimental group reported significantly higher levels of sexual satisfaction and frequency of sexual behavior (400% increase) after the educational inter-

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vention. Family and nursing home staff in the experimental groups demonstrated greater knowledge of and permissiveness towards sexual expression among the elderly after the sessions. Some research in other cultures suggests that cultural factors influence sexual functioning. Gibson (1984) reported that older Israeli women emigrees enjoy sexuality more while Arab women from traditional Islamic cultures report diminished pleasure, a reflection of their roles within the societies from which they immigrated. And, Spanish men experienced sexual declines associated with retirement (Gibson, 1984). There is a great diversity in cultural attitudes toward sexuality for aging persons (Gibson, 1984). In some African societies, the elderly are the sexual teachers or advisors of the young. In an examination of the 293 cultures represented in Murdock's Human Relations Area Files, Winn and Newton (1982) reported data on 106 societies which included findings relating to sexuality in older men and women. In 70% of these societies, the males continued sexual activity into the later years, and females remained active in 84% of them. These societies tended to have cultural expectations that do not anticipate a loss of sexual functioning. Biological functioning sets the stage for how male and female sexual roles will be defined within a specific cultural setting. Culture determines the ways in which men and women enact those expectations; generalizations from one culture to another should be avoided.

Marital Quality and Sexuality More recently, the assumption was made that "frequent and satisfying sexual intercourse is conducive to overall marital satisfaction and by implication to marital stability" among older Americans (Garza & Dressel, 1983, p. 98). Starting with Davis' (1929) pioneering work, sexual behavior was linked repeatedly with marital quality for younger samples of men and women. Long-term attention to marital quality was well-documented by the large number of studies devoted to it (Spanier & Lewis, 1980). While it is logical to assume that marital quality is positively related to sexual activity, the cause and effect relationship between marital quality and sexual behavior and interest has not been examined for older couples (Garza & Dressel, 1983). Sexual behavior has been related positively to marital quality for younger men and women (Glass & Wright, 1977). Parron and Troll (1978) reported that the relationship between sex and marital satisfaction peaks in

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Sexuality and Marital Quality

middle age. The Duke studies do not directly address this issue; some reportings of their results are of samples of married men and women, although these men and women are not necessarily married to each other. The Duke studies have reported that the married individuals' present activity and enjoyment of sexual behavior is linked to past behaviors, especially for females (Pfeiffer & Davis, 1972). Palmore (1981) concluded that sexual activity tends to enhance both health and happiness for both men and for women. It could be presumed that marital quality is also enhanced. In his follow-up study of the factors contributing to longevity, Palmore (1982) found that being married does not relate to longevity. He concluded that it is not marriage that is related to longevity, rather it is sexual activity and enjoyment associated with marriage that are predictive of longevity. In a sample drawn from the ongoing Normative Aging Study, Vinick and Ekerdt (unpublished, 1987) reported that for 45 couples married an average of 36 years, husbands are less satisfied than their wives with the sexual behavior of their partner. Men's marital happiness is significantly correlated to their sexual desires for their wives, while their perceptions of their spouses' desires are not related to marital quality. The opposite pattern was found among the wives in this sample; wives' perceptions of spouses' desires for change are significantly related while their own desires are not. If a change in sexual behavior is desired, husbands always want an increase in sexually expressive behaviors; wives are divided — some want an increase and some desire a decrease. In all cases, the spouses accurately perceive their partners' wishes for change. On the other hand, Roberts (1980) interviewed 100 elderly respondents about the happiness of their marriages and factors that contribute to that happiness. Most subjects say they are happily married. Most recall having strong or moderate sexual feelings during their younger years; slightly more than one-third still claim that level of sexual feeling after an average length of marriage of 55 years. Frequency of intercourse varies from none (slightly less than half) to three times per week (one couple). As all of these couples are "successfully" married in terms of length of marriage and self-ratings of marital happiness, it seems that marital quality is not related to sexual activity for this nonrandom sample of older men and women. Murphy, Hudson, and Cheung (1980), in a study of 378 noninstitutionalized, multiethnic married persons aged 40 to 86, concluded that "the impact sex-related problems have on the seriousness of marital discord is much greater for younger age groups than for the older ones" (p. 14).

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Verwoerdt (1976) suggested that sexually active older persons tend to be healthy emotionally and physically, as well as being socially involved. And, Traupmann, Eckels, and Hatfield (1982) demonstrated that sexual satisfaction is a strong component of overall satisfaction with intimate relationships as expressed by 240 midwestern women ranging between 50 and 82 years of age. Clearly, the role of sexuality in long-term marriages is not clearly understood as yet. A STUDY OF 244 COUPLES Further exploration of the relationship between marital quality and sexual behavior and interest is pursued among a sample of 488 older married men and women. It is expected that marital quality is positively related to frequency of sexual behavior for these older married men and women. It is also expected that marital quality is positively related to interest in sexual behavior for these same older citizens.

Method Sample Intact, married couples were asked to complete mailed questionnaires; 670 men and women in the stage of later maturity, with at least one spouse over age 65, were sampled. All were living independently as married couples, thereby controlling for health. All couples were affiliated with a United Methodist retirement community in southwestern Ohio, either as residents (n = 206) or on the waiting list for admission (n = 464). Separate questionnaires, one for the husband and one for the wife, were sent to each couple. Each person was asked to complete the questionnaire independently and seal it in the envelope provided before discussing the content with his or her spouse. Both envelopes were then to be inserted into a larger envelope and returned via mail. Usable responses were received from 244 couples (N = 488) for a 72.8% response rate. The age range for the sample is 56 to 92 years, with a mean age of 72.4 years. Length of marriage ranges from less than one year to more than 63 years. Representing late-life marriage, 11 couples report marriages of shorter duration than two years. The overall mean length of marriage is 42.9 years, and 30.3% of these couples report marriages of 50 years or

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Sexuality and Marital Quality

more. Most are well-educated; only 12 persons have less than a grade school education. Two-thirds of the women and three-fourths of the men have completed some college or technical school; and 21% of the women and 39% of the men have pursued or completed graduate degrees. Nearly all of the participants are retired; the average age of retirement is 62.8 years. Median preretirement incomes range between $15,000 and $19,999. Only 3 people stated that they are not Protestant. The residents of the retirement community differ significantly from the waiting-list members in only three areas: age, preretirement income, and frequency of church attendance. The retirement community residents are significantly older. They range from 61 to 92 years of age and average 74.8 years. People on the waiting-list range in age from 56 to 87 years and average 71.2 years. Waiting-list participants have significantly higher average preretirement incomes ($15,000 to $19,999) than do retirement community members ($10,000 to $14,999). Postretirement incomes do not differ significantly. Finally, 96% of the residential community members and 84% of the community-at-large residents attend church at least once a week, a significant difference between the two groups. Procedures and Measures A modified, cross-sectional design controlling for cohort membership and life cycle stage is used. Some questionnaire items ask for retrospective reports by the participants. These are used to compress the time interval typical of a longitudinal design into a cross-sectional format, as suggested by Goulet and Baltes (1970). Huston and Robins (1982) suggest that using retrospective specific questions is less likely to produce socially desirable responses. Spanier's Dyadic Adjustment Scale (1976) measures marital quality. One modification is made for application to this older sample as few, if any, have living parents. The item: "Ways of dealing with parents or inlaws" (Spanier, 1976, p. 27) is changed to "Ways of dealing with children." Scoring ranges theoretically from 0 to 151, with high scores indicating higher levels of marital quality. Spanier's original samples have a mean response of 114.8 (SD = 17.8; n = 218). The range of responses in this study is from 38 to 146, with a mean score of 115.9 (SD = 14.6; n = 383). Pfeiffer et al. (1970) find they obtain more complete information regarding sexual behavior from their sample of older individuals by using self-administered paper and pencil instruments. Consequently, an adapta-

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Table 3.1 Sexual Interest Scores (n = 488)

Sexual interest and feelings during the first years of marriage Sexual interest and feelings at the present time General sexual interest and feelings

η

Mean

SD

Range

413

7.2

1.0

3-8

413

5.3

1.9

2-8

413

14.0

2.5

8-16

tion of the Duke Longitudinal Study Sexual Behavior Scale is used. The wording of some items is changed to reduce ambiguity. This scale of 13 items generally solicits information regarding the frequency of sexual behavior and the level of interest and enjoyment of sexual relations. Sexual interest is measured three ways. General sexual interest and feelings include 5 items. Scores for sexual interest early in the marriage and sexual interest at the present time range from 4 for strong sexual interest down to a score of 1 for absent sexual interest. The scale for noted change in sexual interest over time ranges from a decrease to an increase in sexual interest. These 5 sexual items are scaled with a theoretical range of 5 to 19; high scores indicate high levels of sexual interest. The actual range is from 8 to 16, and the mean response for this sample is 14.0. Two subscales, of 2 items each, allow comparisons between recalled early marriage sexual interest with current interest and feelings. The theoretical range for each of these subscales is 2 to 8. The actual range for early sexual interest and feelings is 3 to 8, and the mean is 7.2. The actual range for current sexual interest and feelings is 2 to 8, with a mean of 5.3. One additional item measures the age at which a change in sexual interest is noted. Sexual interest responses are shown in Table 3.1. Sexual behavior is measured via 7 items. Three items are focused upon: (1) frequency of intercourse during the first years of marriage, (2) frequency of intercourse at the present time, and (3) noticed change in sexual activity over time. The three items are not summed; they are reported separately by number of respondents and percentage of the sample, as shown in Table 3.2. These men and women report declines in the frequency of sexual intercourse from early marriage to the present time. During the first years of marriage, most individuals say they recall having intercourse two to three times per week. Now, those still sexually active claim an average of two to four episodes of sexual intercourse per month. And, 3% of these men and women indicate an increase in sexual activity over time, mostly due to the 11 couples with very recent marriages. The

58

Sexuality and Marital Quality

Table 3.2 Sexual Behavior Scores (n = 488) % Frequency of Sexual Intercourse During the First Years of Marriage: Never Once a month or less Two to four times a month Two or three times a week More than three times a week TOTAL Missing Cases = 62

1 0.2 8 1.9 144 33.8 225 52.8 48 11.3 426 100.0

Frequency of Sexual Intercourse at the Present Time: Never Once a month or less Two to four times a month Two or three times a week More than three times a week TOTAL Missing Cases = 66

132 116 140 28 6 422

31.3 27.5 33.2

6.6 1.4

100.0

Noticed Change in Sexual Activity Over the Years: Decrease No change Increase TOTAL Missing Cases = 94

321 81.5 62 15.7 11 2.8 394 100.0

other 4 sexual behavior items ask about the age when a change in sexual behavior was first noted, whether sexual intercourse has ceased, and if so, when and why. Nearly one-third of these people no longer engage in sexual intercourse. On average, the last coitus experience for those no longer sexually active was seven years ago. Analysis and Results Sexual Behavior The relationship of sexual behavior to marital quality is measured using Pearson's r, as shown in Table 3.3. Significant positive correlations are found for marital quality with frequency of intercourse at the present

r = .75··· #1 = 397

r = .36··· « = 421

#■ = .07 #1 = 417

#■=.12» #1 = 389

#• = .02 »1 = 415

r = .26··· #i = 275

r=.04 n = 293

#• = .21*** n = 294

#■ = .13· #1 = 281

#• = -.08 #1 = 295

General sexual interest and feelings

Frequency of intercourse early in the marriage

Frequency of intercourse at the present time

Change in sexual behavior noticed

Ceased sexual intercourse

•p3,4,5;4,5>3)

7.03*** (6>3,4)

6.84*** (3,4>5,6) 1.37

12.49*** (3,4>5,6) 1.56

Satisfaction Evaluation/ Performance

3.81*· (6>3,4)

3.83·· (6>3,5;4>3

Role Strain

3.29* (3>5,6) .31

3.80·· (3,4>6) .30

5.32*** (3,4,5>6)

10.22*** (3,4,5>6;5>3

2.63* (3>4,5)

8.26*** (4,5,6>3)

Depression Involvement in the Household: Feminine Tasks Masculine Tasks

*p