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*. The authors thank Norah Keating for guidance, and they appreciate the technical assistance provided by Emma Potter and Katherine Williams.
The aging of the population in the United States and elsewhere presents a number of macro-level issues and challenges for families. Declining fertility rates, and perhaps to a greater extent, decreasing mortality rates have influenced the size, age structure, and gender mix of families (Wolf, 1994). These demographic trends present care challenges as there are more family members in ages when care needs are relatively common and fewer in care-providing ages (Uhlenberg & Cheuk, 2008). At the same time, a host of social trends (serial marriages, co-habitation, delayed childbearing, non-marital parenthood, ubiquity of women in the labor force) and growth in racial, ethnic, and sexual minority populations have added complexity to American family life. In addition, the intensity of demands placed on family caregivers has increased as a result of government efforts to shorten hospital stays and the escalation of expenses associated with the long-term care of older adults with Alzheimer's disease and other debilitating health conditions. What is not clear is if and how these macro-level population patterns actually mirror changes in micro-level family structures and influence the ways in which contemporary families care for their older members.
In this article, we address the diversity of contemporary family structures and implications for the care of older people in the United States. We begin with a critique of assumptions about conventional family membership and the provision of care for older relatives. We focus primarily on the need for care that occurs when older adults experience changes in their physical, cognitive, or emotional status that require frequent or substantial amounts of assistance with instrumental activities of daily living (IADLs: e.g., managing finances, preparing meals, monitoring medications) and personal care (ADLs: e.g., feeding, bathing, dressing). Our intent is not to provide a comprehensive review of the massive family caregiving literature, but to highlight select findings about the structure and demographic features of family caregivers that are fairly consistent across this body of research. Next, we present common variations in family structures and discuss how these pluralistic family formations influence caregiving roles, responsibilities, and relationships with older family members within...