Healthy grandparenting: The impact of non-residential grandchild care on physical activity and sedentary behavior in people aged 50 years and over.

Onderzoeksoutput: PhD Thesis

Samenvatting

Today’s society faces an increasing life expectancy, an unprecedented growth of the aging population and corresponding rising healthcare costs. As a result, the share of middle-aged and older adults within contemporary populations is expanding. Additional trends in current society, such as the increase of female labor force participation, two-income households and higher workloads, inquire close intergenerational exchanges with grandparents who are becoming important providers of childcare in addition to more formal caregiving options. Compared to other European countries, Belgium has one of the highest prevalence rates of grandparents among people aged 50 years and older (i.e., around 62% of men are grandfathers and 70% of women are grandmothers), with approximately 53.2% looking after their grandchild(ren) (i.e., 9.4% almost daily, 21.9% every week, 10.5% every month and 11.4% less often).
In view of healthy aging in middle aged and older adults, the maintenance of functional independence and good quality of life is critical. It has been put forward that an increased duration, frequency and intensity of physical activity (PA) combined with a restriction of sedentary behavior (SB) is the most important strategy to reduce morbidity risk and to improve health in adults at a more advanced age. As grandchild care clearly comprises several physical tasks (e.g., lifting and carrying younger children, going for a walk, playing together, etc.), it may thus indirectly impact grandparents’ health through changes in lifestyle and associated changes in PA and SB levels. Although the physical and mental health of caregiving grandparents have been examined in multiple contexts, evidence on the relationship between providing non-residential grandchild care and grandparents’ energy-expenditure related behavior (i.e., PA and SB) as well as other health-related outcomes is lacking. Fully understanding this topic is needed to provide scientific evidence to promote healthy grandparenting in people on the threshold of old age in modern society.
Using a mixed methods approach, the present doctoral thesis aimed to fill a gap in the current knowledge on caregiving grandparents’ PA levels and SB patterns. To this end, an observational prospective cohort study was conducted to examine and compare both energy-expenditure related behaviors among caregiving grandparents, non-caregiving grandparents and non-grandparent peers over a one-year period. The additional purpose was to better understand the underlying factors and mechanisms of grandparents’ PA and SB levels as a result of providing care for their grandchild(ren). To this end, a qualitative study using focus group discussions was set up.
The first study (STUDY 1) compared the levels of PA and SB as well as health related outcomes (i.e., body composition and quality of life) of caregiving grandparents with both non-caregiving grandparents and non-grandparent peers as relevant control groups. This case-control study was based on data pooling from the three assessment time points and revealed that caregiving grandparents obtained significantly higher levels of light-intensity PA (LIPA) and lower levels of SB compared to both non-caregiving grandparents and non-grandparents across all time points. Levels of moderate-to-vigorous intensity PA (MVPA) did not differ between the three subgroups. Furthermore, concerning body composition, significantly lower values for waist-to-hip ratio and fat percentage were found for caregiving grandparents compared to non-grandparents across all time points. Regarding physical and mental health-related quality of life, significantly better outcomes for caregiving grandparents versus nongrandparents were only found at baseline.
Where this first study established that caring for one or more grandchildren in a non-residential context plays a stimulating role in being more physically active and being less sedentary, STUDY 2 investigated how the daily amount of care for grandchildren was related with the PA and SB levels of caregiving grandparents of the same day. This study was again based on data pooling from the three assessment time points and found that a higher amount of grandchild care was significantly associated with higher levels of LIPA and lower levels of SB in grandmothers, but not in grandfathers. Additionally, a higher number of grandchildren for whom care was provided at the same time was found to be a confounding factor for higher levels of LIPA and lower levels of SB. Grandparents’ sex was identified as a moderator for the relationship between the amount of grandchild care and levels of MVPA, but only at T1, with higher amounts of grandchild care corresponding to lower levels of MVPA in grandfathers, but not in grandmothers. At T0 and T2, a higher amount of grandchild care was related to lower levels of MVPA, regardless of grandparents’ sex. Furthermore, no characteristics of the grandchildren cared for were found to be confounding factors for the grandparents’ MVPA levels.
The third study (STUDY 3) focused on examining within-subject differences in grandparents’ PA and SB levels on a day of providing care (i.e., care day) versus a day without providing care (i.e., non-care day) as well as on a care moment versus a corresponding non-care moment within those respective days. Comparing the care day with the non-care day revealed significantly higher LIPA levels and lower SB levels for the care day, but only at T0 and T1. Similar results were even more pronounced when comparing the care moment with the non-care moment. In contrast, although no significant differences in MVPA levels on a care day compared to a non-care day were observed, significantly lower amounts of MVPA levels were found for a care moment compared to a non-care moment within grandparents.
In a qualitative part of the research project, grandparents regularly providing care for their grandchildren were interviewed during six online focus group discussions. Based on participants’ input and shared experiences, a framework was developed that provides an overview of the determinants of grandparents’ levels of PA and SB during grandchild care (STUDY 4). Caregiving grandparents’ levels of PA and SB were both influenced by personal determinants (e.g., physical health, grandparental perceptions and responsibilities), interpersonal determinants (e.g., characteristics of the grandchildren, such as their age-related physical/motor development, and family interaction) and physical environmental determinants (e.g., weather and seasonal circumstances). PA levels of caregiving grandparents, in itself, were further affected by additional personal determinants (e.g., age of the grandparent, planning and location of grandchild care) and interpersonal determinants (e.g., characteristics of the grandchild(ren), such as new experiences of the grandchildren). Additionally, some personal determinants (e.g., perception of educational value) and interpersonal determinants (e.g., characteristics of the grandchildren, such as the age-related cognitive development and health of the grandchildren) were strictly mentioned to influence caregiving grandparents’ SB. Overall, the interplay between the different determinants was deemed important to take into account in future interventions.
Altogether, the findings resulting from this PhD research project indicate that grandparents experience significant benefits regarding their levels of PA and SB in relation to their grandchild caregiving activities. These energy-expenditure related behaviors are influenced by several personal, interpersonal and environmental determinants. Grandparenthood and more specifically regular non-residential grandchild care can be seen as the ideal window of opportunity to foster health aging. The framework developed as part of STUDY 4 can be used by other researchers, healthcare providers, or policy makers involved in the development of healthy lifestyle interventions for grandparents (and their grandchildren).
Originele taal-2English
Toekennende instantie
  • Vrije Universiteit Brussel
  • Ghent University
Begeleider(s)/adviseur
  • D'Hondt, Eva, Promotor
  • Deliens, Tom, Promotor
  • Deforche, Benedicte, Promotor, Externe Persoon
Datum van toekenning16 jan 2024
Uitgever
Gedrukte ISBN's9789464948011
StatusPublished - 2024

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