The influence of autonomy and paternalism on communicative behaviors in mother-daughter relationships prior to dependency.

Parents and their adult children rarely have discussions regarding caregiving preferences, especially before the onset of dependency. Families develop decision-making practices during caregiving, ideally, ones that maintain the care recipient's autonomy. Maintaining autonomy is essential because limiting autonomy leads to potentially negative health consequences. This study examined the attitudes of older, independent mothers and their adult daughters (n = 36 dyads) as well as their communication behaviors during decision making. All the mothers and daughters (100%) held strong beliefs in shared autonomy. Mothers (55.6%) and daughters (58.3%) were about evenly split in their strength of belief in independent autonomy. More mothers (63.9%) held strong beliefs in paternalism than did daughters (36.1%). In their conversations, daughters talked more when the mother and daughter held stronger beliefs in paternalism. These findings suggest that an individual's attitudes toward paternalism influence who controls conversations between parents and their adult children regarding caregiving, even before the parent has begun to show any signs of dependency. Once caregiving begins, it can be too late to change already ingrained patterns of decision making. Although this study takes a step toward establishing an understanding of how families develop decision-making processes utilized during caregiving, the sample size and composition limit generalizability. Future studies should follow families, as the parents make the transition from independence to dependence, to develop a better understanding of the factors involved in successfully making such a critical transition in the family's life.

Physician-older patient communication during the transition from independence to dependence.

This article reviews recent research regarding the communication between physicians and their older patients who are passing from independence to dependence. Major findings from these studies are summarized with a discussion of how the context of the medical encounter, the physical, cognitive and language changes related to age, the amount of time permitted for a medical encounter, the managed care environment, and the presence of a companion can affect competent communication between a physician and an older adult. The article concludes with a comment about the need to educate current and future physicians on the complexity of communicating effectively with older patients.

Shared stories of the grandparent-grandchild relationship.

This research examined the storytelling that oftentimes characterizes interaction between grandparent and grandchild. Close to 120 individuals (college students) audiotaped an interaction with one of their grandparents. They were asked to have their grandparent first "tell a story that captures the meaning of life" for them. In addition, the grandparent was asked to complete the phrase, "To me, life is like ." the students were asked to tell their grandparent "a story that captured the essence of their life at this time in their life." Students were divided into similar numbers of same and mixed sex grandparent-grandchild relationships. The audiotaped interactions were content analyzed. A major assumption of this investigation is that the story which each individual chooses to share with their relational partner reveals to some extent the definitional nature of their relationship. Results of the storysharing interaction across relations revealed some gender differences in the types of stories grandparents share with their grandchildren. The implications of the shared stories upon the relational dynamics of the grandparent-grandchild relationship are discussed. In addition, the metaphors used by the grandparents to describe life in the presence of their grandchildren are analyzed.