Everyday Support to Aging Parents: Links to Middle-Aged Children’s Diurnal Cortisol and Daily Mood (2024)

Abstract

Purpose of the Study

Middle-aged adults are often called upon to support aging parents. However, providingsupport to an aging parent with health problems and disability may be a stressfulexperience. This study asked whether giving everyday support to parents in the contextof health problems and disability has implications for middle-aged children’s diurnalcortisol and daily mood.

Design and Methods

During four consecutive days, 148 middle-aged adults (mean age = 55) reported thesupport they gave to their parents and provided saliva 4 times a day (wake, 30 minpost-wake, lunchtime, and bedtime). Multilevel models estimated within-persondifferences in positive affect (PA) and negative affect (NA), cortisol awakeningresponse and area under the curve with respect to ground (AUC-G) as a function of givingsame-day and previous-day support. We examined whether these associations areexacerbated when a parent has health problems or activities of daily living (ADL)needs.

Results

Middle-aged children had significantly higher next-day AUC-G on days after they gavesupport to parents with ADL needs. When participants gave support to parents with ADLneeds, they had significantly greater same-day PA and lower next-day NA. Giving supportto parents with health problems was associated with significantly higher next-dayNA.

Implications

Giving support to parents is an ambiguous experience with implications for biologicalstress and daily mood. A biopsychosocial approach reveals under what conditions givingsupport to parents may become detrimental to health and well-being; this knowledge isessential for the development and implementation of interventions.

Keywords: Parent–child relationships, Social support, Family issues, Intergenerational relationships

Providing support and caregiving to aging parents is a longstanding normative but stressfulexperience for individuals and families (Brody,1985). Much inquiry has focused on caregiving, which by its pervasive definition isthe provision of support specific to activities of daily living (ADL). However, there isgrowing recognition that middle-aged children are often involved in less intensive and moreroutine exchanges of everyday support with aging parents including giving advice (e.g.,helping with a decision or giving suggestions), practical assistance (e.g., fixing somethingaround the house, running an errand, or providing a ride), and emotional support (e.g.,listening to concerns or being available when someone is upset). Everyday support representsordinary, albeit critical, exchanges that may have a more proximal effect on familyrelationships. Everyday support is often exchanged at the daily level and may be more fleetingthan support given following a crisis or a major life event. Thus, assessing everyday supportas it is exchanged at the daily level is advantageous; however, few studies have taken a dailyapproach to assessing everyday support exchanges between aging parents and middle-agedchildren. Moreover, little research has examined whether providing everyday support to elderlyparents has implications for daily mood and biological stress responses of middle-agedchildren. The present study utilized a daily approach to explore the link between middle-agedchildren’s daily mood, diurnal cortisol, and the everyday support they give to their agingparents. We also tested whether parent health problems and ADL needs exacerbate theassociation between everyday support, diurnal cortisol, and daily mood.

Health and ADL Needs in Late Life

Health problems and disability are inextricably linked to family support. Specifically,illness, health issues, or limitations in ADLs shift norms and needs such that supportgravitates toward family members with greater need for support (Fingerman et al., 2011). Middle-aged children provide more support toparents with ADL needs; this support can be directly tied to assisting with ADL but may alsocomprise emotional, financial, and social exchanges (Kimet al., 2016). Providing social or emotional support has positive implications forthe mental health and well-being of the individual giving support () but is also associated withpsychological and emotional distress in different contexts (). As such, middle-aged adults may findthat providing support to a parent in the context of health decline may have some positiveimplications for well-being, but may also be more stressful than providing support to aparent who is otherwise in good health.

Giving everyday family support is associated with daily mood. Savla, Almeida, Davey, and Zarit (2008) found that providing routineassistance to aging parents had immediate negative associations with the daily mood ofmiddle-aged children; these associations were stronger among children who had fewersocioeconomic resources and greater demands on time. Other work shows that middle-agedchildren reported more positive affect (PA) on days when they provided support to their ownchildren and more negative affect (NA) on days when they provided support to their parents(). These studies established the important link between giving support anddaily mood. However, self-report measures of PA and NA do not establish how specificfeatures and circumstances of support provision contribute to specific biological pathwayswhich in turn affect health and well-being. This research would be improved by taking abiopsychosocial approach in order to understand the implications of giving support.

The Hypothalamus Pituitary Adrenal Axis and Cortisol

Research that explores the biological processes of stress often focuses on the hypothalamuspituitary adrenal (HPA) axis. The HPA axis is a major endocrine system that helps humansadapt to bodily and environmental challenges, thus improving ability to adjust tohomeostasis (). Cortisol is a critical component of the HPA axis that activates the body’sresponse to stress and leads to behavioral changes that improve chances of survival (; ).

Cortisol secretion follows a diurnal cycle with a large increase released into thebloodstream after awakening and a steady decline throughout the day with lowest levelsduring the first half of the night (). The cortisol awakening response (CAR; Pruessner et al., 1997) is hypothesized to indicate HPA axisactivation related to anticipation of the upcoming day (Fries et al., 2009). CAR is an indicator of negative psychosocial factors, health,well-being, and daily stressors (; Fries et al., 2009). The overalloutput of daily cortisol is assessed as the area under the curve with respect to ground(AUC-G) which accounts for sensitivity (the difference between the single measurements fromeach other) and intensity (the distance of these measures from ground; ). AUC-G isused to assess the overall secretion of hormones over a specific time period (e.g., over thecourse of a day), which may be elevated in response to stressors but may assume a bluntedform with chronic exposure to more severe stressors (). CAR and AUC-G tend to be highly interrelated andhave been shown to represent two main underlying components of cortisol (i.e., totalcortisol production and change in cortisol levels; Khoury et al., 2015). Some stressors may be initially distressing, indicating amore immediate association with cortisol, whereas other stressors may lead to prolongedcortisol reactivity (). Thus, the association between stressors and cortisol may vary depending onwhether previous-day or same-day stressors are considered (). Moreover, individualfactors, such as age and gender are associated with cortisol output () as well as use of certainmedications and nicotine consumption (). Other factors that occur at the daily level includethe time of awakening and type of day (weekend/weekday; Fries et al., 2009; ).

Research has examined cortisol among caregivers of stroke survivors () and personswith dementia (Klein et al., 2016) revealing thatcaregiving has implications for dysregulated HPA axis. However, it is unclear if givingeveryday support to aging parents has similar implications for same-day or next-daycortisol. The present study takes a biopsychosocial approach to examine the implications ofgiving everyday support to aging parents by examining middle-aged children’s diurnalcortisol and daily mood. We test whether parents’ health problems and ADL needs exacerbatethe association between diurnal cortisol and everyday support. We propose the followinghypotheses:

Hypothesis 1: There is an association between giving support to aging parents onmiddle-aged children’s PA and NA (same-day and next-day). At the daily level, we predictedthat giving support to parents would be associated with lower PA (same-day and next-day)and higher NA (same-day and next-day).
Hypothesis 2: The association between giving support and PA/NA will be exacerbated byparent ADL needs and parent health problems. By testing cross-level interactions betweendaily support, daily mood, and parent ADL needs/parent health problems, we expected thatgiving support to aging parents with ADL needs or health problems would be associated withlower PA (same-day and next-day) and higher NA (same-day and next-day).
Hypothesis 3: There is an association between giving support to aging parents andmiddle-aged children’s diurnal cortisol (same-day and next-day). At the daily level, wepredicted that giving same-day and previous-day support to parents would be associatedwith a blunted CAR and higher AUG-G.
Hypothesis 4: The association between giving support to aging parents and middle-agedchildren’s diurnal cortisol is exacerbated by parent ADL needs/parent health problems. Weanticipated that cross-level interactions would reveal that giving support to parents withADL needs or health problems would be associated with a more reduced CAR and higher AUG-G(same-day and next-day).

Methods

Sample

Participants are drawn from wave 2 of the Family Exchange Study (FES;), which sought to understand family relationships between middle-aged adults,their parents, and their adult children. Wave 1 of FES recruited a target sample of 633middle-aged adults who had at least one living adult child and one living parent. At wave2, 78% of FES wave 1 participants participated in the study, which included a one-hoursurvey completed by telephone or via the internet. A random selection of middle-agedparticipants completed a daily study consisting of brief telephone interviews for sevenevenings; 87% (n = 270) accepted the invitation and 248 participantscompleted daily interviews. Participants completed five to seven daily interviews (mean[M] = 6.83, standard deviation [SD] = 0.45). Of the248 participants who participated in the daily interviews, 81% also completed the four-daysaliva component of the study. Most participants (75%) reported having at least one livingparent. Because the present study sought to examine cortisol responses associated withsupport provision to parents, participants who did not have any living parents(n = 56) were not considered for the present analyses.

For the saliva component, salivary collection kits with salivettes were sent toparticipants after they completed the main survey and scheduled their first diaryinterview. Interviewers prompted respondents to collect the saliva on days 2–5 of thediary calls, though allowances were made for deviations from this schedule. Participantswere instructed to provide salivary samples: (1) when they woke and before they got out ofbed, (2) 30 min after waking, (3) at lunchtime, and (4) before bed. Participants wereinstructed to not eat or drink anything other than water and to avoid caffeinated products(e.g., coffee, tea, soda) 30 min before collecting their samples. On saliva collectiondays, respondents were asked to report their collection times and if they had any problemswith the salivary collection process. In accordance with standard saliva collection andstorage procedures (Nicolson, 2008),participants stored samples in their home refrigerator and were given instructions forreturning the samples in a prepaid overnight mailing package at the end of collection.Refrigeration has been shown to prolong the stability of cortisol and serves as amechanism by which to avoid molding of saliva samples, which can occur after about fourdays if left at room temperature (). Participants received $50 for completing all four saliva daysin addition to $50 for completing the diary component.

We examined saliva data for indicators that samples may not be valid. A total of 34 dayswith potential problems were present in our data. Saliva collection days whereparticipants were awake for less than 12 hours during the day (n = 9),were awake for more than 20 hours during the day (n = 4), woke up after12:00 noon (n = 1), or reported more than 60 min between the first andsecond saliva sample (n = 21), were removed from the data set. Further,participants who identified as nightshift workers (n = 2) were removedprior to analyses resulting in a final sample of 148 (See Table 1 for sample characteristics).

Table 1.

Descriptive Statistics

	N (%)	M (SD)
Age		55.36 (4.56)
Gender (1 = female)	81 (54.73)
Minority status (1 = yes)	41 (27.70)
Married (1 = yes)	103 (73.65)
Education
Some high school	4 (2.70)
High school	33 (22.30)
Beyond high school	42 (28.38)
College graduate	34 (22.97)
Post college	35 (23.65)
Number of living parents		1.34 (0.47)
Mother only	75 (50.68)
Father only	22 (14.86)
Both living	51 (34.46)
Total daily support given to parents		0.53 (0.91)
Parent had health problem in the past 2 years	90 (60.81)
Parent needs help with ADL	94 (63.51)
Parent ADL needs^a		2.15 (1.86)
Personal care	35 (23.65)
Housework	67 (45.27)
Transportation	84 (56.76)
Finances	59 (39.86)
Frequency of help with ADL^b		5.00 (2.88)
Positive affect		3.19 (0.52)
Negative affect		1.29 (0.42)
Area under the curve with respect to ground		197.26 (73.82)
Cortisol awakening response		15.17 (24.37)
Cortisol measurement occasion	Time, M (SD)	Cortisol (nmol/l), M (SD)
Wake time	6.74 (1.37)	22.12 (11.02)
30 min after wake time	7.28 (1.38)	30.06 (11.75)
Lunchtime	13.08 (1.62)	9.05 (5.74)
Bedtime	23.01 (1.23)	4.74 (4.95)

Measures From the Daily Interview

Support

On each day of the study, participants reported whether they gave support to theirparent(s) using three items from the Intergenerational Support Scale (ISS; Fingerman et al., 2011). ISS items assessedwhether or not the participant gave their parent: (1) emotional support, (2) practicalassistance (e.g., fixing something around the house, running an errand), and (3) advice.The ISS asks respondents to indicate “Did you give your mother/father… [insert type ofsupport]… since we spoke yesterday?” Items were summed (α = .76), and a dichotomousvariable was created to indicate whether support was provided on a particular day (i.e.,same-day support or no same-day support) or on a previous day (i.e., previous-daysupport or no previous-day support).

Affect

During each day of the diary interview, participants indicated their PA by rating sixpositive emotions (e.g., happy, determined, calm) and NA by rating nine negativeemotions (e.g., distressed, lonely, nervous) drawn from assessments of daily emotions(Birditt, 2014). Responses were rated from1 (none of the day) to 5 (all of the day), and meanscores were calculated across items (α = .68 for PA; α = .89 for NA).

Salivary Cortisol

Saliva samples were frozen and stored at −80 °C. After thawing, salivettes werecentrifuged at 3000 rpm for 5 min, which resulted in a clear supernatant of lowviscosity. Salivary concentrations, reported in nmol/l, were measured using commerciallyavailable chemiluminescence immunoassay with high sensitivity (IBL International, 2016, Hamburg, Germany).

Area Under the Curve

AUC-G was calculated for each day to estimate total daily output of cortisol using thefollowing formula (Pruessner et al.,2003):

$\begin{array}{l} AUC - G = [(\frac{{Cort A + Cort B}}{2}) \times (Time B - TimeA)] \\ + (\frac{{Cort B + Cort C}}{2}) \times (Time C - Time B)] \\ + (\frac{{Cort C + Cort D}}{2}) \times (Time D - Time C)] . \end{array}$

Cortisol Awakening Response

CAR was calculated for each day by subtracting the first salivary cortisol measure ofthe day (immediately upon waking) from the second measure (~30 minutes after waking) andthen dividing the difference scores by the time interval between the two measures (Fries et al., 2009): ([Cort B − Cort A]/[Time B −Time A]).

Measures From the Main Interview

Parent ADL Needs

Limitations in parent ADL was measured using four items from the Community DisabilityScale ().Participants indicated whether their parent(s) need help with: (1) personal care, (2)housework, (3) transportation, and (4) finances. Items were summed to indicate parent’stotal ADL needs (α = .78) and categorize parents ADL needs (0 = no, does nothave ADL need, 1 = yes, has ADL need).

Parent Health Problems

Participants reported whether or not their parent(s) experienced a serious healthproblem or injury in the past two years (0 = no, did not experience a healthproblem or injury, 1 = yes, experienced a health problem orinjury). Past research examined health problems in this manner (; ).

Covariates

An extensive literature review determined several covariates considered for modelsestimating daily mood and cortisol. We considered participant age and gender; at thedaily level, we considered daily medication use (yes/no), daily smoking(yes/no), person-mean daily wake time, and type of day(weekend/weekday; Almeida et al., 2009; Fries et al., 2009; Kunz-Ebrecht, et al., 2004; Matta et al., 1998; ). Next, we estimated correlations between outcomes andcovariates; we limited the covariates in the models to those that correlated with theoutcome variable (Table 2; ). Based on correlations betweencortisol outcomes and covariates, the model estimating CAR controlled for person-meancentered daily wake time. For AUC-G, we controlled for participant gender, person-meancentered daily wake time, whether the participant smoked on that day, whether theparticipant used medication on that day, and whether data were collected on a weekend.For PA, we controlled for participant age. NA models controlled for participant age,whether the participant smoked on that day, and whether the participant used medicationon that day.

Table 2.

Correlations Between Covariates and Outcome Variables

	Age	Gender	Wake time	Smoke day	Medication day	Weekend
PA	.11*	−.04	.06	−.07	.01	.03
NA	−.13**	−.01	−.01	.31***	.11*	−.00
CAR	.05	−.05	−.15**	.02	−.04	−.03
AUC-G	−.01	.09*	−.24***	.10*	−.12**	−.10*

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Notes: AUC-G = area under the curve with respect to ground; CAR =cortisol awakening response; NA = negative affect; PA = positive affect.

*p < .05; **p < .01;***p < .001.

Analysis

Multilevel modeling was used to examine variability in cortisol and daily mood amongparticipants. Two-level multilevel models (SAS PROC MIXED) were employed to examine dailydiary data nested within persons (). Separate models were run for CAR and AUC-G.Models were built using a parsimonious approach such that variables correlated with theoutcome variable (Rovine et al., 1988). Basedon correlations between each daily outcome (i.e., PA, NA, CAR, and AUC-G) and covariates(Table 2), models included different sets ofcovariates. Specifically, the following Level 1 equations were utilized:

$\begin{matrix} {CAR}_{d i} = β_{0 i} + β_{1i} ({samedaysupport}_{d i}) \\ + β_{2 i} ({previousdaysupport}_{d i}) \\ + β_{3 i} ({waketime}_{d i}) + e_{d i} \\ AUC - G_{d i} = β_{0 i} + β_{1i} ({samedaysupport}_{d i}) \\ + β_{2 i} ({previousdaysupport}_{d i}) \\ + β_{3 i} ({waketime}_{d i}) + β_{4 i} ({weekend}_{d i}) \\ + β_{5 i} ({smokeday}_{d i}) \\ + β_{6 i} ({medicationday}_{d i}) + e_{d i} \\ {PA}_{d i} = β_{0 i} + β_{1i} ({samedaysupport}_{d i}) \\ + β_{2 i} ({previousdaysupport}_{d i}) + e_{d i} \\ {NA}_{d i} = β_{0 i} + β_{1i} ({samedaysupport}_{d i}) \\ + β_{2 i} ({previousdaysupport}_{d i}) \\ + β_{3 i} ({smokeday}_{d i}) + β_{4 i} ({medicationday}_{d i}) + e_{d i} \end{matrix}$

At Level 2, we included parent health problems and parent ADL needs for the intercept andslopes of same- and previous-day support in all outcomes. Thus, we examined cross-levelinteraction terms between daily support (same day and previous day) and parent healthproblems and ADL needs. For between-person controls, gender was included for AUC-G modelsand age for PA and NA models (See Supplementary Appendix A for the full equations).

Results

Descriptive statistics are found in Table 1. Out of484 valid days of data used in analysis, participants provided support to parents on 144days (29%) with an average daily total number of support of 0.54 (SD =0.72; range = 0–3). Participants provided emotional support (e.g., listening to concerns orbeing available when someone is upset) most frequently (n = 102) followedby advice (e.g., helping with a decision or giving suggestions; n = 90) andpractical support (e.g., fixing something around the house, running an errand, or providinga ride; n = 66). Sixty percent of participants indicated that theirparent(s) had a serious health problem or injury in the past two years while 63% ofparticipants indicated their parent(s) had at least one ADL need (M = 2.15;SD = 1.89; range = 0–6). Parent health problems and parent ADL needs werepositively correlated r(146) = .28, p < .01; however,the magnitude of this correlation did not suggest problematic multicollinearity (Kennedy, 2008). Participants reported that theirparents’ most frequent ADL need was transportation or driving (56%), followed by daily care,shopping cooking meals and housework (45%), finances and managing money (39%), and personalcare needs such as bathing and dressing (23%).

On average, participants provided usable saliva samples on 3.27 out of 4 total salivacollection days (SD = 0.85). Samples were unusable when participants misseda collection time, did not provide enough saliva to assay, did not record the time of salivacollection, or if the saliva value exceeded 60 nmol/l. The average CAR for participants was15.17 (SD = 24.37); the mean AUC-G was 197.26 (SD =73.82). The intraclass correlations were estimated in order to calculate the variancebetween persons for all outcomes. For cortisol, 16% of the variance in CAR and 35% of thevariance in AUC-G was between persons, indicating that a substantial portion of variance indiurnal cortisol was drawn from within-person variation. Likewise, 24% of the variance in NAwas between persons, indicating a substantial degree of variance in NA can be attributed towithin-person fluctuation, whereas variance in PA was largely attributed to between-persondifferences (67%).

Daily Mood

Results for multilevel models can be found in Table3. Hypothesis 1 predicted that giving support to parents would be associated withlower same-day and next-day PA, and higher same-day and next-day NA. Hypothesis 1waspartially supported. Consistent with our prediction, PA was lower on days whenparticipants gave support to their parents. In contrast to our hypothesis, PA did notfluctuate as a function of previous-day support and there were no significantwithin-person differences in NA based on same-day support or previous-day support.

Table 3.

Effect of Same-Day and Previous-Day Support, Parent Health Problems, and Parent ADLNeeds on Cortisol and Daily Mood

	Cortisol			Daily mood
	CAR		AUC-G		PA		NA
	β	SE	β	SE	β	SE	β	SE
Intercept	18.39***	2.94	193.23***	10.18	2.7***	0.55	1.96***	0.06
Within-person predictors
Same-day support	−2.58	4.78	−6.35	12.85	−0.17*	0.07	−0.01	0.03
Previous-day support	1.75	4.56	0.44	12.51	0.02	0.04	0.01	0.05
Wake time	−4.78**	1.25	−24.12***	3.72	–	–	–	–
Weekend	–	–	4.35	8.07	–	–	–	–
Smoke day	–	–	13.54	12.75	–	–	0.25**	0.86
Medication day	–	–	−9.62	6.15	–	–	0.05	0.03
Between-person predictors
Age	–	–	–	–	0.01	0.01	−0.01	0.01
Gender (1 = female)	–	–	11.05	8.86	–	–	–	–
Parent ADL	−0.41	3.47	−12.26	10.67	−0.11	0.1	0.01	0.07
Parent health problem	−5.11	3.46	8.2	10.49	−0.09	0.09	−0.04	0.07
Interactions
Same-day support × parent ADL	NS		NS		0.21*	0.09	NS
Same-day support × parent health problem	NS		NS		NS		NS
Previous-day support × parent ADL	NS		32.09*	14.37	NS		−0.16*	0.06
Previous-day support × parent health problem	NS		−27.02^†	14.47	NS		0.17*	0.06
Intercept variance	88.65**	29.82	1748.6***	334.59	0.23***	0.03	0.16	0.02
Residual variance	481.29***	36.96	3081.44***	240.16	0.11***	0.01	0.04***	0
−2 Log likelihood	4,432.0		5381.2		609.5		269.2
AIC/BIC	4,456.0/4,491.9		5,409.2/5,451.1		627.5/654.5		293.2/329.2
Observation, n	484		481		484		484

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Notes: Nonsignificant (NS) interaction terms were trimmed. ADL =activities of daily living; AIC = akaike information criterion; AUC-G = area underthe curve with respect to ground; BIC = Bayesian information criterion; CAR =cortisol awakening response; NA = negative affect; PA = positive affect;SE = standard error.

^†p < .10; *p < .05; **p <.01; ***p < .001.

Hypothesis 2 projected that the associations between giving support and PA/NA would beexacerbated by parent’s ADL needs or health problems. In contrast to our prediction,results indicate a significant previous-day support × parent ADL interaction such thatparticipants had lower NA on days after they gave support to parents with ADL needs. As wehypothesized, analyses show a significant previous-day support × parent health probleminteraction indicating that, NA was higher on days following support provision to parentswith health problems. In opposition to expectations, results reveal a significant same-daysupport × parent ADL interaction signifying that giving support to a parent with ADL needswas associated with greater same-day PA.

Cortisol

Hypothesis 3 predicted that giving same-day and next-day support would be associated withlower CAR and higher AUC-G. This prediction was not supported by our findings; for CAR andAUC-G, we found no significant within-person differences based on giving same-day orprevious-day support.

Finally, Hypothesis 4 predicted that when parent had a health problem or ADL needs,giving same-day and previous-day support would be associated with a lower CAR and a higherAUC-G. Hypothesis 4 was partially supported. Specifically, results indicate a significantprevious-day support × parent ADL interaction such that when participants gave support toparents with ADL needs, they exhibited higher AUC-G the following day, but not on the sameday. In contrast to our prediction, there were no significant interactions for parent ADLneeds and giving same-day or previous-day support on CAR. We did not find any significantinteractions for giving same-day or previous-day support and parent health problems on CARor AUC-G.

In summary, results indicate that giving support to aging parents has differentialimplications for daily mood and diurnal cortisol of middle-aged children. Whenparticipants gave support to parents with ADL needs, they had significantly greatersame-day PA and lower next-day NA. Giving support to parents with health problems wasassociated with significantly higher next-day NA. When examining cortisol as an outcome,middle-aged children had significantly higher next-day AUC-G on days after they gavesupport to parents with ADL needs.

Discussion

Support to aging parents, who are living longer than ever before, is a customary butdemanding practice for middle-aged adults (Brody,1985). Parental health problems and disability establish differential contexts inwhich giving support to parents may be more challenging for middle-aged children, who arefaced with balancing work and family obligations associated with midlife, thereby affectinghealth and well-being. This notion is supported by our finding that AUC-G was higherfollowing days when participants gave support to parents with ADL needs. Higher cortisollevels over the course of the day are associated with greater negative emotion and poorerwell-being (Adam et al., 2006) and mental healthoutcomes. Other research has found similar lagged patterns such that negative interactionswith adult children with lifestyle-behavioral problems were associated with middle-agedparents’ higher cortisol on the next day (Birditt etal., 2016). It may be that giving support to a parent with ADL needs prologues theactive cognitive representations of the stressor and therefore physiological activation ispresent in the overall secretion of next-day cortisol.

Our study suggests that giving support to aging parents is an ambiguous experience which isshaped in part by the health and ADL needs of parents. Participants reported lower PA ondays when they gave support to aging parents and higher NA on days following supportprovision to parents with health problems. These finding are consistent with the notion thatgiving support to aging parents has negative daily implications for middle-aged children(Fingerman et al., 2016). However, givingsupport to parents with ADL needs was associated with higher same-day PA and lower next-dayNA, mirroring the notion that social support has positive implications for those who give it(Liang et al., 2001). These results parallelthemes from caregiving literature, specifically that caregivers experience a variety ofpositive gains as a result of providing care and support. Such gains include building asense of purpose, increased gratification, and developing a closer relationship with theperson receiving care ().

Our results indicate different patterns between giving support when parents have ADL needsverses health problems. In circumstances where a parent has ADL needs, middle-aged childrenare likely burdened with the reality of parental disability and may anticipate furtherdecline, thus exhibiting a more pronounced biological response to support provision. Incontrast to ADL needs, many injuries are brief (e.g., a fall resulting in a broken hip) andchronic health problems may be treatable and manageable thanks to modern science andtechnology. Thus, it is feasible that parent ADL needs and health problems do in fact takeon a different meaning for middle-aged children, thereby posing diverse implications forhealth and well-being.

Although participants exhibited some positive gains in daily mood through assisting parentswho need help with ADL, these gains occurred simultaneously with heightened biologicalstress response as exhibited in the highest next-day AUC-G. Our study suggests that givingsupport to parents with ADL needs is perhaps best characterized as a psychologically andemotionally conflicting experience with some positive associations with daily mood, but alsosome negative biological stress implications. For example, helping a parent by providing aride to the grocery store may serve as a pleasant interaction that could enhance PA. On theother hand, this same act of support may also cause the middle-aged child to miss out onother important obligations or tasks, and may therefore account for an increased biologicalstress response the following day. Thus, it is important to consider these results withinthe context of challenges and obligations of midlife. In some cases, middle-aged adultssimultaneously give support to, and are “sandwiched” between aging parents and dependentchildren (). Thus, it maybe that giving support to an aging parent with ADL needs is not particularly taxing, butthis support is often provided amidst other obligations and demands, which in turncontribute to a biological stress response. A biopsychosocial approach captures the ideathat support to aging parents truly has dual implications for the health and well-being ofmiddle-aged children.

This study has several limitations. Past research suggests that the mental health effectsof giving family support are moderated by the appraisal of giving support as stressful orrewarding (). Perceptions of the support that an individual’s give, and notnecessarily the amount of support, may play an important role in biological stress responsesassociated with giving support. We did not gather appraisals of everyday support and werenot able to test this theory. Next, support was given to parents rather minimally, only 29%of study days were support days, and it is therefore difficult to estimate if findings are afunction of limited frequency of support provision. Moreover, we did not examine outcomes asa function of the type of support given, it is likely that giving different types of supportand different combinations of support (e.g., practical, emotional, advice) may havedifferential associations with diurnal cortisol and daily mood. The present study did notclosely examine these different types of support, or the potential overlap between theseforms of support. Though our sample is not, nor is it intended to be, a caregiving sample,it is plausible that some of the participants in our sample do in fact engage in caregivingfor their parents. Caregiving duties are likely embedded within practical support andpersonal ADL needs; however, our sample indicated that parent ADL needs were mostly intransportation and housekeeping, with personal needs reported least frequently. Participantsalso reported providing practical assistance least frequently, indicating that caregivingwas not likely taking place. However, we did not measure daily caregiving (i.e., supportwith ADL) provided to parents and therefore could not estimate the association between dailycaregiving and diurnal cortisol. Likewise, it is possible that parents were receivingsupport from other formal services (e.g., assisted living facilities, social services) orinformal sources (e.g., other friends and family members); however, we did not consideralternative sources of support in our analyses. Finally, although we collected data across 4days, this short period of data collection provides a mere snapshot of what supportexchanges may look like for participants. Support is likely to ebb and flow across time,changing with needs, resources, and life events; it is difficult to capture the naturalprogression of support in the limited time period allotted for data collection in thisstudy.

Future efforts toward understanding at what point support provision to aging parents beginsto show consequences for biological stress is crucial for the development of resources,services, and interventions. Likewise, identifying the positive and potentially beneficialaspects of providing support to aging parents is essential. Our study highlights theambiguity of support provision in that we highlight both positive implications (e.g., dailymood) and biological consequences (e.g., next-day AUC-G) and therefore provides an essentialstep toward understanding the seemingly ubiquitous process of giving support to agingparents in need, a task which, for centuries, adult children have fulfilled. Future researchthat identifies both the positive aspects and consequences of support provision will aid indeveloping an enhanced understanding of how support can be provided to aging parents ineffective, sustainable, and viable ways.

Supplementary Material

Supplementary data are available at The Gerontologist online.

Supplementary Material

Supplementary Appendix A

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Supplementary Materials

Supplementary Appendix A

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