In sickness and in health: a qualitative study of elderly men who care for wives with dementia.

1. Introduction

Caring for an aging population presents an extraordinary global challenge, especially for the most rapidly growing segment of the elderly population, the oldest and most frail. In the United States, despite the myth of abandonment and "dumping" of the elderly by uncaring families, most frail elderly individuals, even those with serious disabilities, live in their homes and are cared for by a family member (Pruchno, Michaels, & Potashnik, 1990).

Who, then, cares for frail elderly individuals? Traditionally, the question has been overwhelmingly answered in the female voice. In the wings of the caregiving arena, however, are men (husbands, sons, brothers, and other male relatives) who care for elderly family members. Their ranks are predicted to increase as an aging society enters the new millennium, men's mortality declines (Himes, 1992), and conceptions of family and gender roles continue to broaden. Well over 1,750,000 million men, 1/3 of primary caregivers in some settings, care for ill elderly family member. Of that number, it is estimated that approximately 1,000,000 are elderly men caring for spouses with Alzheimer's disease or other forms of dementia, which often coexists with other physical ailments (Kaye & Applegate, 1990), and it is their experience upon which this study will focus.

Central research questions arise about the role of elderly men who provide care to chronically ill family members. Who are they, and what do they do? What is it like to be immersed in what our culture consistently defines as "women's work"? What do their roles as caregivers mean to them, and how are such meanings derived? What are their distinctive strengths, vulnerabilities, expectations, and needs? What coping strategies do elderly men employ that enables them to ongoing challenges and demands of caregiving, and what can we learn about men and caregiving from their accounts of caregiving?

2. Caregiving and late-life masculinity

In a popular Beatles song from the 1960s, the question is asked, "will you still need me, when I'm 64?" The question speaks to the central urge to be needed and valued; for elderly men, it is especially significant in a culture that diminishes their worth, purpose, and identity in late life. What impact does the process of aging have on men, and what happens to their identities as they withdraw from the world of formal "production" and enter the Third Age?

Rubenstein (1986) argues that aged men, in general, are "forgotten" and known to others mostly through stereotypes, impressions, and anecdotes. Thompson (1997) suggests that elderly men are invisible as men in a culture that considers them to be roleless following retirement and views aging as decline and debility. Elderly men are perceived as a genderless, homogeneous collective group whose value and sense of being needed has diminished rather than a diverse group of individuals who continue to grow and transform. Much of the scholarship that does exist on older men focuses on biomedical concerns of aging such as sexuality, disease, and disability (Solomon, 1982) or "self-orientated" facets of late life such as the personal effects of retirement and widowhood. "Other-oriented" issues, such as nurturant capabilities or the experiences associated with caregiving, have seemingly been lost in the shuffle (Kaye & Applegate, 1994), and the experiences of elderly men as men, as gendered beings, as well as family caregivers, continue to go underexamined.