End‐of‐Life Treatment Preferences Among Older Adults: An Assessment of Psychosocial Influences1

We explore the content and correlates of older adults’ end‐of‐life treatment preferences in two hypothetical terminal illness scenarios: severe physical pain with no cognitive impairment, and severe cognitive impairment with no physical pain. For each scenario, we assess whether participants would reject life‐prolonging treatment, accept treatment, or do not know their preferences. Using data from the 2004 wave of the Wisconsin Longitudinal Study (N = 5,106), we estimate multinomial logistic regression models to evaluate whether treatment preferences are associated with direct experience with end‐of‐life issues, personal beliefs, health, and sociodemographic characteristics. Persons who have made formal end‐of‐life preparations, persons with no religious affiliation, mainline Protestants, and persons who are pessimistic about their own life expectancy are more likely to reject treatment in both scenarios. Women and persons who witnessed the painful death of a loved one are more likely to reject treatment in the cognitive impairment scenario only. Consistent with rational choice perspectives, our results suggest that individuals prefer treatments that they perceive to have highly probable desirable consequences for both self and family.     

Family Matters: Research on Family Ties and Health, 2010 to 2020

Family ties have wide-ranging consequences for health, for better and for worse. This decade review uses a life course perspective to frame significant advances in research on the effects of family structure and transitions (e.g., marital status) and family dynamics and quality (e.g., emotional support from family members) on health across the life course. Significant advances include the linking of childhood family experiences to health at older ages, identification of biosocial processes that explain how family ties influence health throughout life, research on social contagion showing how family members influence one another's health, and attention to diversity in family and health dynamics, including gender, sexuality, socioeconomic, and racial diversity. Significant innovations in methods include dyadic and family-level analysis and causal inference strategies. The review concludes by identifying directions for future research on families and health, advocating for a “family biography” framework to guide future research, and calling for more research specifically designed to assess policies that affect families and their health from childhood into later life.     

Activity Engagement in Residential Care Settings: Findings from the National Survey of Residential Care Facilities

Assisted living and similar residential care is an important source of care for elders, including those with dementia. Meaningful activities may help residents maintain function, improve self-esteem, and enhance quality of life. Using data from the 2010 National Survey of Residential Care Facilities, this study identifies the extent of resident engagement in different types of activities; examines the extent to which cognitive status, other resident characteristics, and residential care community characteristics relate to activity engagement; and, among cognitively impaired residents, assesses whether being in dementia-specific settings is associated with activity engagement. Compared with persons without cognitive impairment, those with severe cognitive impairment are less likely to go on outings (79% versus 36%) and talk with family and friends (85% versus 72%). Residents with mild to severe cognitive impairment have higher participation in leisure activities than other residents if they live in dementia-specific settings (73% higher) than those who do not.     

Some responses to economic change in Scottish farming and crofting family life, 1900–25

Our investigation of some of the processes involved in the emergence of ‘the modern family’is based on evidence from oral histories conducted with people who grew up in Scottish farming and crofting families in the early decades of the century. After showing how peasant and capitalist modes of production shaped both family structures and strategies for getting a living, we examine some of the ways in which the encroachments of the cash economy helped create new forms of gendered inequalities. Our discussion concludes with an analysis of recent papers concerned with the ways in which families are embedded in community life and the implications for long term change in authority structures.     

The Composite Biography as a Methodological Tool for the Study of Childhood in History

This article presents a composite biography of an orphaned girl and her mother in Medieval London. Though the mother was sound in mind and body, she had no control over her daughters inheritance and place of residence. In addition, her underage daughter was married without her consent. The composite biography can bring to life the otherwise dry renditions of families experiences that are present in court records and other historical documents.     

Life Course Social Science Perspectives on the GLBT Family

Abstract

The life course perspective in the social sciences focuses on the place of generation-cohorts in understanding social life. Emphasizing shared understanding of self and society among a group of persons born in some adjacent birth years (often a decade) and the impact of the experience of certain events (a reminiscence bump) taking place across the early adult years, this approach to the study of social life and social change emphasizes social timing and role changes in understanding the course of life. The life course perspective is used in this discussion in understanding sexual minority families including both families in which an offspring self-defines as GLBT across the years of young adulthood, and families in which a parent self-identifies as GLBT, and which includes offspring of one or both partners. Issues in family formation and morale of family members are explored from this life course perspective emphasizing time, social change and the role of the state as factors influencing sexual minority families.     

Depression,the Family,and Family Therapy

The potential contribution of family therapists to the treatment of depression remains underdeveloped. Family therapists need to articulate how changes in family functioning might benefit depressed persons, as well as how other problems in the families of depressed persons tend to go unrecognised. Furthermore, family therapists need to be alert to how undetected depression in adults and children may interfere with their ability to meet their goals with families who seek therapy for other persons. This article provides family therapists with (1) an overview of the nature and experience of depression; (2) an introduction to antidepressant medication; (3) a summary of research findings relating depression to its family context and (4) a brief overview of developments in the marital and family treatment of depression.     

Complex Families and Late‐Life Outcomes Among Elderly Persons: Disability,Institutionalization, and Longevity

The authors examined the effects of marital status and family structure on disability, institutionalization, and longevity for a nationally representative sample of elderly persons using Gompertz duration models applied to longitudinal data from 3 cohorts of the Health and Retirement Study (N = 11,481). They found that parents with only stepchildren have worse outcomes than parents with only biological children. Elderly mothers with only stepchildren become disabled and institutionalized sooner, and elderly men with only stepchildren have shorter longevity relative to their counterparts with only biological children. The effect of membership in a blended family differs by gender. Relative to those with only biological children, women in blended families have greater longevity and become disabled later, whereas men in blended families have reduced longevity. The findings indicate that changing marital patterns and increased complexity in family life have adverse effects on late‐life health outcomes.     

Family concepts—a social pedagogic approach to understanding family development and working with families

Drawing upon insights from family research, this article argues that in modern Western societies the reflection of individual notions of family as well as the development of concepts of a fulfilling everyday family life has turned into a recurrent challenge throughout the life course, a challenge particularly relevant during family transitions. Professionals in the field of social work with families are increasingly faced with the task of supporting such processes of reflection and development. At the same time, there is little knowledge about how these processes look like. Building upon results of a pilot study and merging recent theoretical developments in family research with the (German) tradition of social pedagogy, a conceptual framework to study family concepts theoretically and empirically is developed. The potential as well as the limitations of this research approach are discussed drawing upon a case example taken from an ongoing longitudinal study. This study aims at revealing family concept-related processes of informal learning and thus provides an understanding of family development from a social pedagogic point of view. Finally, an outline will be given of how this research could contribute to develop an intervention method standing in the tradition of social pedagogy.     

Strengthening army families: A family life cycle stage perspective

The Armed Forces have made a commitment to strengthening families in an effort to reduce the risk for families and to facilitate family adaptation to the strains and hardships of military life. However, research on enlisted families needed to guide the development of family programs is limited. Assuming critical family strengths may be observed in the context of family transitions, this study of 1,000 Army families faced with the crisis of family relocation to West Germany revealed the importance of Stressors and strains, family and personal strengths, and community supports — which varied across stages of the family life cycle. The findings highlight the importance of developing family programs tailored to meet the needs of families at the couple, preschool and schoolage, adolescent and launching, and empty nest stages of the family life cycle. Specific family strengths and community supports relative to family life cycle stages are identified.     

Meanings of lone motherhood within a broader family context

In this paper, the theoretical approach to the concept of lone motherhood is adopted from ‘new’ family sociology where families are understood to be dynamic processes constituted by webs of relationships. I analyse life stories written by lone mothers in order to examine the meanings that they give to their lone motherhood in relation to their larger family context. This approach reveals that, along with the concept ‘family’, the category ‘lone motherhood’ can be questioned. The life stories show that as with all families, the representations of ‘the lone mother family’ vary. Lone motherhood emerges less as a distinct family form and more as an experience coloured by the lone mother's position in a web of family relationships, as well as her place in her broader personal, social and historical context.     

Families Under the Microscope: Repeated Sampling of Perceptions,Experiences, Biology,and Behavior

Families are not frozen dioramas; they are alive, active, and changing. Models of real‐life marital and family processes require many moving pieces. An intensive repeated measures approach reaches beyond static representations of the family toward more dynamic models that depict “life as it is lived.” The appearance of studies that use diaries and biological sampling in everyday life has burgeoned in the family research literature. These methods are part of a larger class of naturalistic methods that assess families in action and that includes direct video and audio recordings of families in their everyday environments. This article summarizes research that uses diaries, observations, and biological data collected over time in natural settings to study families. It provides an overview of the major research questions, designs, methods of data collection, and statistical models used in those literatures. Theoretical contributions and next steps in naturalistic research on families are discussed.     

Integrating Social Justice into the Practice of CBFT: A Critical Look at Family Schemas

Many families come to therapy struggling with the negative consequence of social inequity. Family therapy modalities have been developed to address these negative consequences and attend to power and social equity (Transformative family therapy: Just families in a just society. Boston, MA: Pearson Education; Socio‐emotional relationship therapy. New York, NY: Springer). We argue that many family therapy modalities can be adapted to include social equity (Applying critical social theory in family therapy practice. AFTA Springer Series. New York, NY: Springer Publishing). Specifically, cognitive behavioral family therapy can be used to address the inequality in social systems that negatively affect the family system. We focus on schema formation and suggest an emphasis on societal schemas within the therapy milieu as a tool to help families see how societal inequality can affect the problems faced in family life.     

Suburban taste*

The cultural production of Japanese suburban housing between 1910 and 1939 was informed by changing perceptions of family and self in relation to domestic space and the everyday. This article focuses on the Hankyu Corporation, an Osaka-based railway company that presented itself as a cultural authority for middle-class families in a wide range of enterprises, including the construction of suburban estates. By revisiting its publicity material, including a monthly magazine and housing catalogs, we demonstrate the complex process through which Hankyu narratively visualized and materialized an image of suburban life in its housing designs. We address the subjective nature of taste in influencing and shaping consumer choices around the spatial production of neighborhoods and the conduct of daily life in the suburbs.     

Siblings of individuals with first-episode psychosis: understanding their experiences and needs

The growth of early intervention in psychosis services (EIPS) has prompted needed research to provide a robust evidence base to underpin practice. The typical service model embraces key psychosocial interventions, including family interventions. A literature review revealed a number of relevant studies that recognized the role of siblings in families affected by severe mental illness or mental impairment, but little was found about the impact of first-episode psychosis on siblings. To address this apparent oversight, we conducted a study to gain an understanding of sibling experiences. Ten siblings (ages 16 to 30) with a brother or sister diagnosed with first-episode psychosis took part in individual semi-structured interviews. The key findings were grouped in regard to emotional impact, relationships in the family, and siblings' roles and coping patterns. The study also revealed that families are able to identify positive gains out of a fundamentally negative experience.     

Private lives and public programs: an Australian longitudinal study of the elderly

Major late life events, reported in the Dubbo longitudinal study of older Australians, are used to examine the interaction of private lives with public programs. First, the data indicate strong supportive effects of publicly funded income, health, and aged care programs in reducing family burdens from major life changes. In particular, financial crises were rarely mentioned, directly or indirectly, as major threats. Next, the central role of informal social support in these events is demonstrated, first, as in previous studies, family support was responsive to risky events and to aging itself. Also, in new findings, one-third of surviving elderly respondents coped with the burdens of family crises as a substantial proportion of the "major" life changes that occurred over 13 years of the study. Within the security and support provided by the Australian welfare system, and with strong social networks, families with older persons in the Dubbo study manage multiple, major life changes. With rapid population aging, the development of more, and more easily accessible, services for a growing population of older people is a priority. The critical challenge will be to harmoniously grow public financing, private funding, and informal caregiving to deal with the growing burden arising from an aging society.     

Nonresident fathers' parenting, family processes, and children's development in urban, poor, single-mother families

With dramatic growth in nonrmarital births, an increasing number of children are growing up in single-mother families. This study examines the relationships among nonresident fathers' parenting and children's behavioral and cognitive development in low-income, single-mother families. It also considers the personal characteristics of the children's single mothers as well as family processes and economic circumstances. Analyses use the first three waves of longitudinal data from a subsample of single and noncohabiting mothers in the Fragile Families and Child Wellbeing Study. Results suggest that nonresident fathers' parenting is indirectly associated with children's behavior problems and cognitive development. The findings further suggest that those estimated associations are transmitted through mothers' parenting. The study also discusses the policy and practice implications of its findings.     

Toward a scheduling congruity theory of family resource management

This article presents the elements of a theory to explain the dynamic construction and execution of production processes. The theory takes into account both the cognitive underpinnings and observable streams of purposive action necessary for managerial behavior. It attempts to explain both the consciously planned and executed action of individuals and the more routine, repetitive activities which dominate most resource allocation behavior. Further, it provides a framework within which goal directed actions of individuals may be translated into goal directed actions of groups of individuals.The authors wish to thank two anonymous reviewers for their helpful comments on an earlier draft of this article.Rosemary J. Avery is an Assistant Professor in the Department of Consumer Economics and Housing at Cornell University, 103 Martha Van Rensselaer Hall, Ithaca, NY 14853. She received her Ph.D. from The Ohio State University in 1988. Her research areas include family management and time use, family decision making, and family formation via adoption.Kathryn Stafford is an Associate Professor in the Department of Family Resource Management at The Ohio State University, Campbell Hall, Neil Avenue, Columbus, OH 43210. Her research focuses upon management by families who generate income at home, and she has also done work in the areas of family time use and household production. She received her Ph.D. from Cornell University in 1978.     

Not Broken but Strengthened: Stories of Resilience by Persons with Acquired Physical Disability and Their Families

This study seeks to understand the processes in families of resilient individuals with an acquired physical disability. Specifically, we were interested in getting to know more about the role of the family in the individuals’ resilience, and in turn, the impact on the family of the individuals’ disability and resilience. A multiple‐case narrative methodology with three families was adopted. In total 19 family members participated in the construction of three stories. This described how the families were transformed and how family members continually moved and energised one another in virtuous circles of support. Empathy and altruism were motivators for these virtuous circles whilst adequate amounts of support contained the experience of each family member. Identifying, strengthening, and building on these relational processes was found to be vital in enabling both the individuals affected by disability and their families to grow following their adversity.     

Therapeutic Maps For Therapeutic Mazes: The ‘Time Sphere’ as an Interventive Mapping of Family Movements in Context

In this paper I want to describe the use of a technique which I have termed the ‘Time Sphere’. The combination of a life cycle model with the chronological mapping of closeness–distance has allowed for useful consideration of various relational events not previously explored by the family or therapist. By sharing the information visually with the client family we are able to explore context, family of origin influences and life cycle transitions within an extended family model. Ultimately my hope is to develop this model further as a creative means of exploring how family patterns and relationships are repeated, and how context is ultimately the key to understanding. To preserve confidentiality, my ‘case’ is an amalgam of several real client families.