Consideration must be given to whether potential caregivers are willing and able to perform the tasks necessary to keep the older person at home. Strongly motivated families usually can perform elaborate and detailed care, but they may be indifferent or become resentful or worn out from assuming such responsibility. Home care often involves a long-term commitment and may prove an unremitting burden to a family. Physicians should watch for and be ready to intervene if elder abuse is suspected (see Ch. 111). The very old may be cared for by equally aged spouses or elderly children whose own frailty or impairment may preclude providing the necessary care, regardless of how much they may wish to do so.

Although social support includes help from neighbors and friends, family members usually provide most of the physical, emotional, social, and economic support. Family caregivers play a key role in delaying, if not preventing, institutionalization of the chronically ill older person. In fact, about 80% of home health care is provided as informal support by family members (as opposed to purchased services). This care is provided to elderly persons living with adult children or in their own homes.
The amount and type of care depend on economic resources, family structure, quality of relationships, and competing demands on family time and energy. Family caregiving can range from minimal assistance (eg, periodically checking in) to elaborate full-time care. On average, caregivers spend about 4 h a day on caregiving tasks. Women are more likely than men to be both receivers and givers of such care.
Spouses are major providers of care for the frail elderly. While adult children frequently care for mildly or moderately impaired elders, a spouse (usually a wife) is more likely to care for a severely disabled elderly person. Spouse caregivers experience considerable stress and suffer associated health problems. As a group, caregiving couples are disproportionately poor, and the caregiver is usually in poor health.
Recent demographic trends of delayed procreation and increased longevity have created a “sandwich generation” of caregivers who find themselves responsible for care of both their children and their parents. Many of these caregivers who have jobs experience significant conflict between the demands of their job and those of elder care. Although society tends to view families as having special rights and responsibilities in caring for one another, the limits of filial and spousal obligations vary among families and individuals.
Family members’ willingness and ability to provide care may be enhanced by services that support family caregivers (technical assistance in learning new skills, counseling services, family mental health services, or personal supports) and services that supplement family caregiving (personal care, home health care, adult day care, meals programs, and social services).
Lack of support or social isolation is associated with an increased risk of mortality. Social supports, however, appear to buffer the elderly from the negative effects of life transitions, such as the departure of children, retirement, and widowhood.