A study was carried out which explored the impact of current support services in identifying and meeting the support needs of older male caregivers (aged over 65) caring for a chronically ill spouse/partner at home in Northern Ireland. Support services are defined as practical caregiver support including respite (such as day care for the care recipient), help with medication or personal care, or the provision of information and advice; along with psychological caregiver support including talking therapies, managing stress courses, or befriending.  These services may be delivered by health and social care practitioners (such as nurses or social workers) employed by the local health trust, or staff employed by community-based agencies or charities. These services are referred to throughout this blog article as support service providers.

A mixed methods approach was employed, which was informed by masculinity and coping theories, over four distinct phases, outlined in the following table:

Phase	Method	Stakeholder & Data Collected
1	Survey (n=39)	Collection of quantitative data through a survey of community-based agencies and charities about the range of support services offered to caregivers.
2	Interviews (n=24)	Collection of qualitative data through individual interviews with older male caregivers, about their experience of caregiving.
3	Focus Groups (n=84)	Collection of qualitative data through nine focus groups (participants: n=84) were undertaken with health and social care staff (such as nurses and social workers), and support staff from community-based agencies, about their experiences of supporting older male caregivers.
4	Deliberative workshop (n=36)	A deliberative workshop was facilitated for stakeholders such as policy makers, funders, male caregivers, support service staff and academics. Group discussions of study findings supported formulating recommendations for the way forward.

Finally, a software statistical package (SPSS) was used to analyse data from Phase 1, and thematic analysis was adopted to analyse data from Phases 2, 3 and 4. Data were integrated and key themes identified. The following is a summary of findings based on these key themes.

1) The approach of older male caregivers who care for a chronically ill spouse/partner can be influenced by views on traditional masculinity ideals such as strength and self-reliance.  Study findings suggest that traditional masculine ideals (such as strength and self-reliance) subtly underscore many males’ approach to their caregiving role. Although older male caregivers that we interviewed generally viewed an

independent approach to caregiving as positive, support service providers in the focus groups observed that this could limit men’s wellbeing. Some support service providers perceived reluctance from male caregivers to engage with services or offers of support (such as a break away from their caregiving role) and suggested that this could result in a crisis or a breakdown in caregiving arrangements.

2) Although many older male caregivers derive satisfaction and meaning from their role, caregiving can also involve social isolation, loneliness and challenges to spousal intimacy. Study data suggested that many older male caregivers experienced loneliness and isolation, coupled with changes to spousal intimacy (sexual or emotional).  Many study participants felt committed to their spouse and expressed a desire to abide by their marriage vows. Although these participants generally accepted that declining sexual or emotional intimacy may be part of chronic illness progression, they were also challenged as they had needs around spousal intimacy which were no longer being met. It was clear from these participants that there was little specialised support from support service providers to enable them to navigate this.  Evidence also suggested a desire for more peer support and to maintain social or sporting connections (such as playing golf or attending football matches). Some data indicated a preference for male-centred or activity-based social support as opposed to talking therapies or support groups.

3) Support service providers should be mindful of the gendered nature of caregiving and consider this when engaging and providing support to older male caregivers.  Many support service providers acknowledged a difference in approach to caregiving between males and females. Some recognised that older male caregivers were more reluctant than older female caregivers to identify as caregivers or to accept offers of help, and were often harder to build and maintain relationships with. There was also general acknowledgement that traditional support measures such as support groups did not work well with older males. Support service providers generally agreed that if men could be engaged in caregiver support, this support should be tailored to individual need.

 

Key Messages

Gender: It should be recognised that caregiving support needs could  be influenced by gender. Support service providers should acknowledge the potential impact of social conditioning and gender constructions on older men’s identification with traditional masculine ideals, and how this impacts on their caregiving role.

Intimacy and social isolation. Many spousal caregivers (regardless of gender) experience loneliness, social isolation, and changes in spousal intimacy (either sexual or emotional) associated with their caregiving role. However, findings from the present study are especially pertinent for males given evidence that men are more likely than women to rely on their spouse for emotional support (Liao et al. 2018), so when this support declines due to chronic illness, men can be particularly vulnerable to a lack of emotional support, leading to loneliness and social isolation.

Identification of older male caregivers: Given older male caregivers’ reported lack of social networks and reluctance to engage with formal support (Milligan and Morbey 2013), it is vital that support service providers are proactive in identifying older male caregivers who need support. This may include adopting a ‘gender sensitive’ approach to identifying and providing caregiver support. 

Engagement of older male caregivers: Support providers should not assume that a perceived reluctance to engage with services means that male caregivers do not need help, rather that more suitable support should be explored and provided. It is suggested that support service providers engage with men regarding the type of support that they would find most beneficial. Also, the under-pinning principles for supporting men as used in other men’s support initiatives (such as Men’s Shed) should inform the development of support for older male caregivers. 

Conclusion: This study explored the impact of current support services in identifying and meeting the support needs of older male caregivers caring for a chronically ill spouse/partner at home. Findings demonstrate that some older male caregivers can experience negative caregiver outcomes, such as social isolation, loneliness and challenges to spousal intimacy, associated with their caregiving role. These negative outcomes may not be alleviated by existing caregiver support services, due to a reluctance by male caregivers to access support, or an assumption by support service providers that older male caregivers do not need support.

The potential impact of gender constructions on some older men’s’ identification with masculine ideals, how this impacts on their caregiving role, and on their support needs should be considered when developing and providing support for this population. Support service providers should engage with men regarding the type of support that they would find most beneficial. Also, support services within the wider area of men’s healthcare (such as Men’s Shed) could inform the design of innovative support that directly targets male caregiver support needs, as these have previously been shown to be effective at reducing stress and improving caregiving outcomes with older men.

Further reading: You can read the full report about this study here: PhD Study Report, Findings and Recommendations.

Funding: This research was funded by HSC R&D Division, Public Health Agency Northern Ireland.

References:
Liao, J. et al. (2018) ‘Gendered trajectories of support from close relationships from middle to late life’, Ageing and Society, 38(4), pp. 746–765. doi: 10.1017/S0144686X16001264.

Milligan, C. and Morbey, H. (2013) Older men who care: understanding their support and support needs. Lancaster University. Lancaster University Centre for Ageing Research.

Morgan, T. et al. (2016) ‘Gender and family caregiving at the end-of-life in the context of old age: A systematic review’, Palliative Medicine, 30(7), pp. 616–624. doi: 10.1177/0269216315625857