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Little research focuses on the mental health of caregivers (CGs) who stop providing care to their community-dwelling spouse. We examine depressive symptoms of former primary CG spouses who stopped caregiving over a two-year follow-up period when the care recipient (CR): (1) no longer has functional problems; (2) continues having functional problems; or (3) dies. Using data from the Health and Retirement Study (2000-2014), we located 2,370 couples who were both 50+ at baseline and where one partner provided help with ADL and/or IADL limitations but did not do so two years later. OLS regressions stratified by gender indicated that both male and female former spousal CGs whose CR died had significantly more depressive symptoms than those who ceased caregiving when their spouse did or did not still have functional problems. Former wife CGs who were older and whose husbands had more baseline ADLs had fewer follow-up depressive symptoms; wife CGs whose husbands had a nursing home stay had more depressive symptoms. Former husband CGs who had provided longer monthly hours of care had fewer follow-up symptoms. Findings underscore the importance of targeting mental and physical health services to both former caregiving husbands and wives, especially after spousal death.

Objectives: To identify the interrelations between the trajectories of social isolation and dementia in older adults. Methods: Data came from the National Health and Aging Trends Study 2011–2018 surveys. Group-based dual trajectory modeling was used to examine trajectories and their interrelations. Results: Four trajectories of social isolation—rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%) and dementia risk—persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%) emerged. Two-thirds of the low-risk dementia group were in the rarely isolated group. The high-risk dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). Conclusions: Social isolation and dementia mostly evolved in the same direction. However, the pattern of associations between these trajectories is intricate and may be reversed among long-term dementia survivors.

Background and ObjectivesThere exists an imperative need to comprehensively evaluate the effectiveness of psychosocial interventions for Chinese geriatric populations’ mental wellbeing. This study conducted a systematic review and meta-analysis of psychosocial services for Chinese older adults’ depression and anxiety.Research Design and MethodsA search of nine electronic databases, five geriatric mental health journals, and reference lists was conducted for studies published between 1980 and April. 2018. Thirty-three studies (including totally 3,478 participants, 107 effect sizes) of true and quasiexperimental controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were geriatric depression and anxiety.ResultsAn overall significant treatment effect was identified for geriatric depression and anxiety (d = 0.577, 95% confidence interval [CI]: 0.288, 0.867, p < .001). Outcomes, geographic area, participants’ marriage, service setting, and types of control group were moderators for treatment effects. Subgroup analysis observed statistically significant effect size among studies in Taiwan, used innovative service methods and small group interventions. Both in-person, home-based interventions and interventions provided by nurse practitioners and specially trained providers were statistically significant.Discussion and ImplicationsPsychosocial services can benefit Chinese geriatric populations. Innovative and culturally relevant programs received strongest research supports. Future research should incorporate social interaction as an important component for serving Chinese older adults’ mental wellbeing.

This paper focuses on 30 couples who received a pension and other services from two private trusts in Detroit, Michigan beginning in 1929 or 1930. Results of the qualitative analysis of case files, which contain notes recorded chronologically for 17 of the couples and then surviving spouses, provide a portrait of older couples' lives prior to a partner's death, circumstances surrounding the death, and changes in the social support systems of widows and widowers until their deaths. Close examination of the experiences of these couples is a reminder of how old age and widowhood were experienced prior to the enactment of public pensions and health insurance in the United States.

Objectives We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts. Method Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms. Results Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment. Discussion Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.

Few Korean studies have explored factors that influence depressive symptoms, a condition that is likely to increase with age. This study examines how worries, psychosocial resources, specifically family support, are related to depressive symptoms among a sample of the oldest old in South Korea. The buffering effects of psychosocial resources previously identified as reducing the impact of worries on depression in the younger old age group were also examined.Interviews were conducted with 213 community-dwelling oldest old in Seoul, Korea in 2007. 193 of these had children and were included in the analysis. Multiple regression analysis was used to test the hypotheses.Greater worries were significantly related to greater severity of depressive symptoms among South Korean oldest old. Psychosocial resources including mastery, emotional support from adult children, and instrumental support from adult children had main effects on depressive symptoms. Emotional support from adult children had a powerful buffering effect on the relationship between worries and depressive symptoms.Worries and certain aspects of social support are important in understanding the depressive symptoms of South Korean oldest old. Incorporating filial support into the development of services for this age group could be helpful to treating their symptoms of depression.

Although respect is a crucial aspect of social work practice, few studies have examined how social workers convey their respect for elderly clients. This study explored the various forms of respect demonstrated by social workers when they were with older clients. Fifty social workers serving elderly clients were surveyed by a questionnaire with closed- and open-ended questions. Based on data on the way the social workers respected their elderly clients, the study identified seven forms most frequently practiced and considered most important. They are linguistic respect, care respect, acquiescent respect, salutatory respect, presentational respect, spatial respect, and consultative respect. The key expressions of these forms are introduced in quantitative data and a narrative form. This finding provides insights as to how social workers exhibit respect for elderly clients in their practice. The results of this exploration may be useful in developing a more comprehensive typology of the forms signifying respect for elderly clients.

Based on the premise that the experience of aging in place is different for vulnerable subgroups of older adults compared with less vulnerable subgroups, we focus on low-income older adults as a vulnerable subgroup and senior housing as an alternative to a conventional, private home environment. Using the 2008 and 2010 waves of the Health Retirement Study, regression models determined the impact of person–environment (P-E) fit between poverty status and residence in senior housing on self-rated health. Consistent with the environmental docility hypothesis, findings show that, among low-income individuals, the supportive environment of senior housing plays a pronounced compensating role and may be a key to successful adaptation in aging. As the first research effort to empirically demonstrate the positive health effects of senior housing among socioeconomically vulnerable elders, our findings provide a much-needed theoretical and practical underpinning for policy-making efforts regarding vulnerable elders.

This article discusses, from the grandmother's perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52-90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.

This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents’ depressive symptoms at follow-up, controlling for other factors identified in Pearlin’s stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings.

While a number of organizations and government entities have encouraged the development of more “age-friendly” environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health. Moreover, individual-level income and education no longer predicted self-rated health once age-friendly environment factors were taken into account. These findings highlight the need for more research documenting the effects of age-friendly environments, particularly across diverse contexts and populations.

With the emerging population of the oldest-old (those ages 85 and older), it is crucial to understand and prepare for their psychosocial needs. Worry is linked to psychological well-being and physical health, but little is known about the oldest-old's everyday worries. The authors explored four research questions: (1)What are the worries of the oldest-old? (2)What are their specific dimensions of worry? (3) How alike or different are the worry patterns over time? (4) What factors are related to variations in the pattern of change in worry? A convenience sample of 193 community-dwelling people ages 85 and older was recruited to examine various aspects of health and well-being between 1986 and 1995. This article reports on the survivors (N = 23) across three time points, waves 1,4, and 5. The findings suggest that the very old mainly worry about health and memory and that, although worry increased over the study period, there were variations in the pattern of worry over time. Results of t tests show that at wave 4 elderly respondents with a higher level of worry reported more frequent social contact than those with a lower level of worry. Implications for social work practice and future research are discussed. KEY WORDS: oldest-old; social support; very old; worry ********** Little is known about the lives of those who are very old, in particular, their everyday worries. Worry is among the more prevalent psychological conditions that people experience at all ages (Carmin, Pollard, & Gillock, 1999), conveying negative thinking about future events (Babcock, Laguna, Laguna, & Urusky, 2000), and it is associated with mental and physical well-being (Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki, Handen, & Morse, 1986). With many very old people facing diminishing physical and social resources, as well as uncertain futures because of advanced age, it would seem that they could have many things to worry about, but it is unclear what their worries are, what specifically contributes to them, and if these worries increase with advancing age. Most of the work exploring everyday worry has focused on young adults, but in recent years the topic of worry has emerged as a research area of interest among elderly people (Cappeliez, 1989; Powers, Wisocki, & Whitbourne, 1992; Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki et al., 1986). Research findings show there is age variation in degree of worry as well as content of worry. In general, older adults are relatively less worried than younger adults (Babcock et al., 2000; Powers et al., 1992). Babcock and associates suggested that there are a variety of reasons for this age variation. Younger adults are developmentally in a transition stage that may cause greater reason to worry. Older adults may be less willing to acknowledge problems dealing with stressful events and less likely to be in a state of ambiguity about their future. Also, older adults tend to experience various stressful situations as they age. Over time, elderly people might have learned better coping strategies to deal with worry more effectively, resulting in less worry than their younger counterparts. Research findings have also suggested that there are age differences in what people worry about. Powers and colleagues (1992) found that older adults expressed less worry about finances and social events than younger adults, whereas both age groups worried about health issues, although the specific dimensions of health were not identified. Similarly, Babcock and associates (2000) found that younger adults were more worried than older adults about work, relationships, and finances. Less is known about degree of worry and content of worry among the oldest-old. A study examining worry among the oldest-old reported that the greatest worries among oldest-old subjects were related to their health and functioning, such as concerns about falls, not having enough energy, or forgetting things (Dunkle, Roberts, & Haug, 2001). …

Using the Andersen-Newman model, we investigated the prevalence of activities of daily living (ADLs) limitations in married couples, and couple characteristics associated with ADL help-receipt. In this sample of 3,235 couples age 65+ in the 2004 Health and Retirement Study, 74.3%, 22.1%, and 3.6% were couples in which neither partner, one partner, or both partners had limitations, respectively. Logistic regression results indicate that help-receipt was associated with certain health needs in the couple, but not with their predisposing characteristics or enabling resources. Social workers could target couples most in need of assistance by assessing both partners’ health problems.

Framed by Pearlin’s Stress Process Model, this study prospectively examined the effects of three primary stress factors reflecting the duration, amount, and type of care (ADL, IADL, both) on the depressive symptoms of spousal caregivers over a two-year period. This study also measured whether the effects of these stressors differ between husbands and wives. We analyzed data from the 2004 and 2006 waves of the Health and Retirement Study, a nationally-representative sample of adults ages 50 and over in the U.S. The analytic sample included 774 community-dwelling respondents who were married/partnered and providing help to their spouses for Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs). We used multivariate regression models to examine the direct effects of primary stressors on depressive symptoms among the total sample and for husbands and wives. We found that none of the primary stressors were associated with depressive symptoms within the total sample. However, when examining these issues for husbands and wives, wives providing only personal care (ADLs) had significantly more depressive symptoms than wives providing only instrumental care, while husbands providing different types of care showed no significant differences in depressive symptoms. We conclude that wife caregivers’ increased vulnerability to depressive symptoms when providing personal care may reflect different gender roles in caregiving. Future studies that directly address couples’ relational dynamics and gendered experiences in personal care, including emotion work, may further illuminate strategies for reducing depressive symptoms experienced by wife caregivers engaged in personal care assistance.

Currently there is limited evidence linking age-friendly characteristics to outcomes in elders. Using a representative sample of 1,376 adults aged 60 and older living in Detroit (MI, USA), this study examined the association between age-friendly social and physical environmental characteristics and the expectation to age in place, and the potential differences between low- and higher-income elders. Based on U.S. Environmental Protection Agency's (EPA) age-friendly guide, we identified six factors reflecting age-friendly characteristics. Logistic regression models indicated that regardless of income level only neighborhood problems were significantly associated with expecting to age in place. Low-income elders were more likely to expect to age in place than their higher-income counterparts, and it is unclear whether this resulted from a desire to remain in the home or that there is no place else to go. Future research should address the ways in which financial resources affect the choices, expectations, and outcomes of aging in place. Language: en

The purpose of the current study was to compare the association between caregiver background characteristics and care recipients’ behavioral and psychological symptoms of dementia (BPSD) in Black and White community-dwelling family caregivers. Using logistic regression models, caregiver/care recipient dyad data from the Aging Demographics and Memory Study were used to describe associations between caregiver background characteristics (i.e., demographic and socioenvironmental variables) and care recipients’ BPSD (i.e., hallucinations, delusions, agitation, depression) ( N = 755). Results showed that Black caregivers were more likely to be female, younger, an adult child, have less education, and live in the South ( p ≤ 0.05); they were less likely to be married. Several caregiver background characteristics were associated with care recipients’ depression and agitation, but not with other BPSD. Caregiver background characteristics may play a role in the recognition and reporting of BPSD and should be considered when working with families of individuals with dementia. [Res Gerontol Nurs. 2015; 8(4):179–187.]

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.

Issues related to psychological recovery following coronary bypass surgeries (CABG) have emerged in recent years. Other research has shown the effects of spiritual or religious activities on health and aging. However, little is known about the relationship of spiritual coping, including religious coping, to post-CABG adjustment. This study addressed multifactorial determinants of postoperative psychological recovery and the effects of private prayer, a form of spiritual coping, on the recovery of 151 older patients. Results show that most patients pray about their postoperative problems and that private prayer appears to significantly decrease depression and general distress one year post-CABG.

This research examined the role of self-care behavior of 151 patients (aged 40 to 80) on general psychological distress at one year after coronary artery bypass graft (CABG) surgery. A tested hypothesis was that self-care practices would be associated with a lower level of distress one year after surgery. The results supported the beneficial effect of self-care on psychological adjustment, after controlling for the effects of the number of other chronic illnesses and post-CABG depression. The findings suggest that social work in health care and in-home care may help promote the psychosocial recovery process following surgery.

This research investigated gender differences in psychological adjustment among patients (112 males, 39 females) one year after coronary artery bypass graft surgery (CABG). Information regarding post-CABG depression, non-cardiac chronic conditions, and socioeconomic variables were obtained from a survey. Additional cardiac, surgical, and demographic data were retrieved from a hospital computer database. Women were more likely than men to experience postoperative depression, attributable to their poor health. Depression one year post-CABG was predicted by non-cardiac chronic illnesses, postoperative fatigue and shortness of breath and socioeconomic status.

The social networks of older individuals reflect personal life history and cultural factors. Despite these two sources of variation, four similar network types have been identified in Europe, North America, Japan, and China: namely 'restricted', 'family', 'friend', and 'diverse'. This study identified the social network types of Korean older adults and examined differential associations of the network types with well-being.The analysis used data from the 2008 wave of the Korean Longitudinal Study of Aging (KLoSA: N = 4251, age range 65-108). We used a two-step cluster analytical approach to identify network types from seven indicators of network structure and function. Regression models determined associations between network types and well-being outcomes, including life satisfaction and depressive symptomatology.Cluster analysis of indicators of network structure and function revealed four types, including the restricted, friend, and diverse types. Instead of a family type, we found a couple-focused type. The young-old (age 65-74) were more likely to be in the couple-focused type and more of the oldest old (age 85+) belonged to the restricted type. Compared with the restricted network, older adults in all other networks were more likely to report higher life satisfaction and lower depressive symptomatology.Life course and cohort-related factors contribute to similarities across societies in network types and their associations with well-being. Korean-specific life course and socio-historical factors, however, may contribute to our unique findings about network types.

Objectives: To examine the factors associated with urban African American elders’ utilization of home and community-based services and explore whether these factors differ by category of service. Methods: Data came from a representative sample of 1,099 African American older adults living in Detroit. Logistic regression models were used to explore the predisposing, enabling, and need factors associated with any service use and five categories of service use: in-home care, household services, functional care, out-of-home services, and financial/legal services. Results and Discussion: Findings suggest that previous studies using the Andersen model may not be generalizable to an urban African American population. Service use was related primarily to enabling resources, particularly in terms of financial resources, not driving a car, and social resources and support. Future research should further examine the facilitators and barriers to service use by urban African Americans to improve their access to care.

Gays and Lesbians Older and Wiser (GLOW), a support group sponsored by a geriatric medical clinic in the midwest, is described. GLOW has been meeting monthly for 7 years. Scheduling, professional involvement, and special attention to social support seem critical for the group's success. Older gay men and lesbians often have unique support needs that may not be met by either general services to the elderly or by gay organizations, which typically cater to a younger population. We conclude that carefully designed support groups can meet some support needs for this older population.

The purpose of this pilot study was to assess the attenuating effects of physical, psychological, and social resources on the relationship between stress and mental health among the oldest old. Physical resources include perceived health and independence in functional and instrumental activities of daily living, while psychological resources include mastery, self-esteem, and coping. Social resources are measured by frequency of social interaction and size of the social network. Among the 124 women and 31 men (M = 89 years), greater independence in IADLs and greater perceived control of events significantly attenuated the adverse effects of strain on psychological well-being.

Factors influencing expansion of instrumental activities of daily living (IADL) caregiver networks beyond the spouse/partner were studied, using data from the Asset and Health Dynamics among the Oldest Old (AHEAD) nationally representative sample of American elders (ages 70 and older). Analyses were based on 427 Black and White couples in which one partner regularly received IADL assistance; nearly 20% had expanded networks. Logistic regression showed expanded networks were significantly more likely when spouses had IADL or basic personal activity of everyday living (ADL) limitations and help recipients were wives or had numerous IADL or ADL limitations; they also tended to be more common ( p < .10) for couples with numerous nearby daughters and help recipients with proxies and those without serious cognitive problems. Network expansion was unrelated to recipients' number of health conditions and Medicaid coverage or couples' ages, marital duration, income, and number of proximate sons. Implications for service programs and caregiving theories of the circumstances linked to IADL assistance from outside the marital dyad are discussed.

This article describes the rationale, design and implementation of a support and education group for parents caring for disabled children in later life. In a supportive and informative environment, parents found peers facing similar challenges relating to the provision of care in light of their own aging, a lifetime of caregiving, and their concerns about their children's futures. The experience of this group intervention strategy provides insight into the needs and strengths of this neglected segment of the caregiving population and suggests implications for future research and practice.

To date, formal studies on rehospitalization have used clinical diagnoses to predict and avoid costly readmission (Gooding & Jette, 1985). However, other studies have found that rehospitalization could be avoided in nearly half of patients if appropriate discharge planning and services are provided (Graham & Livesley, 1983). Nevertheless, most studies of readmissions ignore environmental and psychosocial influences. Placement planning and readmission have special importance under prevailing Medicare pressures to shorten hospitalizations. In 1983, Medicare cost-containment efforts led to the use of the prospective payment system and diagnosis related group (DRG) classifications. Lohr and Schroeder (1990), as well as Russell and Manning (1989), speculated that elderly people would be discharged too soon and in poorer health, thus leading to spiralling hospital costs as a result of readmissions. According to the U.S. Congress, Senate Special Committee on Aging (1989), older adults are often discharged from acute-care hospitals early because of the DRG system, thus leading to readmissions. Readmissions already account for 24 percent of Medicare expenditures among hospitalized patients (Anderson & Steinberg, 1984). Because Medicare funds most older adults' hospital care, the impact of DRGs on the discharge planning process is an important issue for medical social work (Abramson, 1988; Coulton, Dunkle, Goode, & MacKintosh, 1982; Dunkle, Coulton, MacKintosh, & Goode, 1982; Morrow-Howell, Proctor, & Mui, 1991). This study explores how rehospitalization is influenced by the older person's health and social status prior to hospitalization, the patient's perception of family environment, family and professional involvement while the patient is hospitalized, the elderly person's involvement in the decision-making process in the hospital, and the type of discharge placement made. Implications of the findings and their relationship to the social worker and the discharge planning process will be discussed. CONCEPTUAL FRAMEWORK This study is based on the model for explaining rehospitalization contained in Figure 1. The authors assumed that rehospitalization is most likely for individuals with fewer personal resources, including personal competence as measured by a scale of ability to perform activities of daily living (ADLs), the presence of a spouse, and the economic resources that accompany higher socioeconomic status (SES). However, if such factors are adjusted for in discharge placement decisions (as they should be and sometimes are), we assumed that their effect would be moderated. Conversely, poor placement decisions can exacerbate the problem. Thus, Figure 1 shows a direct relationship of ADL, SES, and marital status to rehospitalization. The relationship of rehospitalization to discharge placement is in turn assumed to be influenced by ADL, SES, and marital status. The other factor that has a direct influence on rehospitalization is the degree of the patient's involvement in the discharge placement process. Patient involvement is also assumed to have an indirect effect on rehospitalization through its impact on the placement decision. The quality of patient involvement is in turn affected by the patient's overall mental and physical capacity; the interactions of patient, family, and professional staff; and the patient's state of mind, which includes levels of depression and sense of (or locus of) control. Evidence for the impact of SES, ADL, marital status, and depression on rehospitalization is straightforward. For example, elderly people's reduced capacity to perform ADLs--to walk, bathe, dress, groom, feed, transfer, and toilet themselves (Katz, Downs, Cash, & Grotz, 1970)--increases their chances of being rehospitalized (Victor & Vetter, 1985). People living alone are also more likely to be at lower socioeconomic levels than those living with someone else (Kasper, 1988); they are also more likely to be in poorer health and less able to perform ADLs without assistance, making them more prone to institutionalization (Kasper, 1988). …

Current advances in discharge planning have focused on comprehensive assessment, levels of care, and reducing the length of hospital stays. However, evidence also indicates the importance of involving patients and their families in making decisions about long-term care. This article identifies nine factors related to the patients' involvement in decision making.

This paper explores the effect the elderly care recipient's contribution to the household has on his or her well-being as indicated by level of depression. The purposive sample consisted of 647 families referred from over 100 sources representing a total of 27 counties in Ohio, Pennsylvania, and New York. Results of a multiple regression analysis indicated that contributing to the household has a significant impact on the elder's level of depression. The effect was not significantly different for elders living with a caregiving spouse or child or grandchild. It was determined that aspects of the living arrangement did differentially affect the elder's level of depression in these two familial living situations. The elder seemed less depressed when the caregiving relationship with a child or grandchild was of longer duration, suggesting that dissatisfaction may abate with time.