Grandparent caregivers

Journal article citation:
Journal of Gerontological Social Work, 50(S1), 2008, pp.321-344.
Taylor and Francis
Place of publication:
Philadelphia, USA

There has been a dramatic increase in the number of households headed by grandparents in the USA in the past twenty years, and many grandparents are unprepared to take on the role of raising another generation. They are at risk of several physical, mental and emotional problems because of the stress and strain involved. This review looks at nine studies providing empirical evidence on psychosocial interventions for grandparents and covering interdisciplinary case management and group approaches. Both appear to be promising but very few projects have been systematically evaluated using rigorous methods. More research is required. The paper concludes with a ‘treatment resource appendix’ directed at American social workers. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street,  Binghamton, NY 13904-1580).

Extended abstract:



Grandparent caregivers.

Journal citation/publication details

Journal of Gerontological Social Work, 50(supplement 1), 2008, pp.321-344.


Despite the increasing volume of research on grandparent carers, only nine studies met the inclusion criteria for this review and these are of limited methodological quality. Case management and group approaches appear promising as a way of supporting grandparents and reducing the adverse mental and physical health effects that may attend caring for grandchildren. However, further and better conducted research studies are needed both with grandparents and with the children they care for.


It is estimated that in the USA one in ten grandparents will be the primary carer of at least one grandchild for at least six months before it reaches the age of 18. The number of grandparent carers has risen markedly in the last 20 years, and they are at risk of both physical and mental health problems, not just because of the direct effects of caring for children in mid- to late-life but because of feelings of loss or shame in relation to those children’s parents. Psychosocial interventions may help to relieve some of the burden they face.


What sources were used?
AgeLine, PsycINFO and Social Work Abstracts were searched for the period 1995-2005.

What search terms/strategies were used?
The search terms are given as: grandparent caregivers; grandparents as parents; skipped generation households. The first of these is used as a thesaurus term in AgeLine (and should thus retrieve all studies on grandparents caring for grandchildren) but it is not clear that the others are thesaurus terms in either of the other two databases. If used as free text search phrases, they are likely to have significantly reduced the retrieval of potentially relevant studies.

What criteria were used to decide on which studies to include?
Eligible studies reported on interventions designed to improve the health, mental health or quality of life of grandparents acting as carers.

Who decided on their relevance and quality?
No details of the yield from the searches, or subsequent relevance assessment are given. All reviews in this issue of the Journal of Gerontological Social Work judged the quality of evidence on the basis of a common framework: meta-analysis or systematic review of all relevant randomised controlled trials (RCTs) (Level I); at least one properly designed RCT (Level II); well designed controlled but non-randomised studies (Level III); non-controlled studies (Level 4a); and consensus reviews of expert opinion based on clinical experience or reports of expert committees (Level 4b).

How many studies were included and where were they from?
Nine studies were reviewed. These are summarised in Table 1 but no details of geographical locations are given.

How were the study findings combined?
The review is narrative, with findings presented according to intervention mode.

Findings of the review

Case management approaches
Four interdisciplinary case management interventions were identified. Two examined a strengths-based intervention, Project Healthy Grandparents, designed to reduce psychological stress, improve mental and physical health, strengthen social support systems and increase resources. Both showed positive results in areas such as hostility and interpersonal sensitivity, mental health, perceptions of social support and access to community resources. A third case management intervention provided an intensive range of assessment, counselling, education, advocacy, practical and other assistance through a dedicated case manager, together with access to a grandparents’ support group. This produced improvements in depression and ‘mastery’. The final intervention provided case management services to kinship foster carers, and delivered improved social support and caring competence as well as reduced resource needs.

Group interventions
Five group projects based in schools or other community locations focused on delivering education and information about medical, legal, educational and financial issues. In addition, they provided social support and, in some cases, components designed to boost empowerment or teach specific skills such as computer literacy. Positive outcomes included reduced depression, reduced loneliness, improved coping, increased self-efficacy, better communication with grandchildren, better social support and re-engagement with health services. Key to the successful delivery of support group interventions is the provision of practical help with child care and transport, and flexible timing that suits the needs of carers rather than professionals.

Authors' conclusions

Although many support programmes and pilot initiatives have been introduced for grandparent carers, very few have been systematically evaluated. Most of the studies reviewed used convenience samples and non-experimental research designs, used different measures and measured different outcomes. As a result ‘external validity is greatly compromised’. In addition, all the studies are cross-sectional and cannot provide information on whether the interventions had lasting effects. The author implies that future studies need to be better designed, and also calls for more research on interventions with grandchildren as well grandparents.

Implications for policy or practice

No specific implications are discussed. The paper concludes with a ‘treatment resource appendix’ directed at American social workers.

Subject terms:
kinship care, mental health problems, older people, outcomes, physical illness, psychosocial intervention, stress, grandparents;
Content type:
systematic review
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