Aging & Mental Health Men caring for wives or ...

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Men caring for wives or partners with dementia: Masculinity, strain and gain Kevin L. Baker

a b c

a

, Noelle Robertson & David Connelly

a b

a

Department of Psychology , University of Leicester , 104 Regent Rd, Leicestershire, LEL 7LT, UK b

Department of Psychology , Nottinghamshire Healthcare NHS Trust, Highbury Hospital , Nottingham, NG6 9DR, UK c

Birmingham & Solihull Mental Health NHS Trust, The Barberry, Vernon Drive , Birmingham, B15 2FG, UK Published online: 27 Apr 2010. To cite this article: Kevin L. Baker , Noelle Robertson & David Connelly (2010) Men caring for wives or partners with dementia: Masculinity, strain and gain, Aging & Mental Health, 14:3, 319-327, DOI: 10.1080/13607860903228788 To link to this article: http://dx.doi.org/10.1080/13607860903228788

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Aging & Mental Health Vol. 14, No. 3, April 2010, 319–327

Men caring for wives or partners with dementia: Masculinity, strain and gain Kevin L. Bakerabc*, Noelle Robertsona and David Connellyab a

Department of Psychology, University of Leicester, 104 Regent Rd, Leicestershire, LEL 7LT UK; bDepartment of Psychology, Nottinghamshire Healthcare NHS Trust, Highbury Hospital, Nottingham, NG6 9DR, UK; cBirmingham & Solihull Mental Health NHS Trust, The Barberry, Vernon Drive, Birmingham, B15 2FG, UK

Downloaded by [Liverpool John Moores University] at 12:24 27 October 2013

(Received 12 March 2009; final version received 30 July 2009) Over the last three decades, demographic changes in the developed world have meant more older men find themselves in caregiving roles. Little research has been undertaken with male caregivers in dementia care. Although there is general consensus that men construe care differently to women, gender has seldom been treated as an independent variable that can inform supportive interventions. This study, underpinned by an assumption of the benefits of men’s differential response to managing illness, sought to explore how facets of masculinity might relate to male caregivers’ appraisals of strain and gain in dementia care. Seventy men, currently caring for a partner with dementia, completed questionnaires exploring their gender identity (Personal Attributes Questionnaire), gender role conflict (Gender Role Conflict Scale), and appraisals of carer strain and gain (Brief Zarit Burden Interview and Caregiving Satisfaction Scale). They were also asked to provide demographic information and, since caregiver strain is significantly affected by a care-receiver’s cognitive and behavioural difficulties, to complete the revised Memory and Behaviour Problems Checklist. Carers’ age and duration of caregiving was broadly representative of previous studies. A series of regression analyses revealed contrasting findings to previous studies. Gender identity did not appear important in carer’s evaluations of strain or gain, and only the ‘restrictive affectionate behaviour between men’ subscale of gender role conflict had explanatory power in analyses with all strain and gain variables. Findings are discussed with regard to response bias and defended masculinity. Consideration is made about how men can successfully access services. Keywords: dementia care; male caregiver; masculinity; burden

Introduction As demographic changes have transformed the constituency of most Western societies, more men have adopted caring roles than previously (Hirst, 2001; Kaye & Applegate, 1990), making up nearly 40% of caregivers in Canada (Frederick & Fast, 1999) and 44% in the United States (National Family Caregivers Association, 2000). Men have been reported to spend more hours providing care than other caregiver groups (Chang & White-Means, 1991; Office of National Statistics, 2005). Yet, gender as a feature of dementia care has been relatively little examined, arguably assuming that caring is a feminised activity (Kaye & Applegate, 1990; Kramer, 2000; Zarit, Todd, & Zarit, 1986) and often focused on comparing gender differences rather than treating gender as a mediating variable for carers’ stress (Baker & Robertson, 2008; Crocker Houde, 2002). There is a general awareness that men may construe care in different ways to women (Miller & Caffasso, 1992; Garity, 1997). However, there have been very few studies to investigate how carers’ constructions of their gender interact with their constructions of caring. Preliminary qualitative research has explored men’s perceptions of their caring role as a duty or ‘labour of love’, with some men discussing the emotional impact

*Corresponding author. Email: [email protected] ISSN 1360–7863 print/ISSN 1364–6915 online ! 2010 Taylor & Francis DOI: 10.1080/13607860903228788 http://www.informaworld.com

but others only focusing on instrumental aspects and the demands of the role (Harris, 1993, 1995, 1998). Kramer (1997, 2000) explored differential predictors of strain and gain in husbands caring for wives with dementia. She described more highly educated husbands appraising less gain than husbands with lower educational attainment, suggesting the former may perceive tasks of caring as lower status, intellectually unimportant, or less pressing than financial burdens. Interestingly, for this male sample, stressors were one of the strongest predictors of strain but displayed no relationship with gain. More recently, Pearlin’s model of carer stress has enabled analysis of why some men relinquish caregiving and decide to institutionalise their wives (Ducharme et al., 2007), reinforcing suggestions that men’s subjective stressors are an important part of the carer process (Alspaugh, Stephens, Twonsend, Zarit, & Green, 1999; Aneshensel, Pearlin, Mullan, Zarit, & Whitlach, 1995). This conclusion is in keeping with several calls for carers’ research to investigate individual responses to the strain of caring in order to inform successful interventions (Brown & Chen, 2008; Ulstein, Sandvick, Bruun Wyller, & Engedel, 2007). Nevertheless, research on elder male caregivers in dementia care has long been criticised for relying on


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a stereotyped view of gender (Miller & Kaufman, 1996). The majority of studies exploring how men think about their caring role have tended to use interview-based methodologies, generating only broad typologies rather than informed psychological models of stress and coping (Baker & Robertson, 2008). Some studies have assessed male-carers’ gender identity in an attempt to explore how it may mediate appraisals of stress, coping and help-seeking behaviour (e.g. Ducharme, et al., 2007; Kramer, 2000). However, gender role conflict may be a more useful construct than gender identity (Baker & Robertson, 2008). Gender identity is often operationalised through self-report questionnaires asking a person how much they identify themselves with adjectives considered to be stereotypical of men or women, such as the Bem Sex Role Inventory (Bem, 1974) or the Personal Attributes Questionnaire (PAQ) (Spence & Helmreich, 1978). The resulting cluster of adjectives are considered to be socially desirable traits that individuals select to be concordant with how they view themselves as masculine or feminine (Spence & Buckner, 2000). However, it is unclear how gendered self-identities relate to appraisals of coping (Heppner, Walther, & Good, 1995; Whitley, 1983). Gender role conflict is a more recent approach used to investigate the negative consequences of traditional masculine roles (O’Neil, Helms, Gable, David, & Wrightsman, 1986), and is based on the observation that these roles tend to lead to behavioural and emotional conflict with the self and others (O’Neil, 1995). Gender identity and gender role conflict appear to be independent constructs (Sharpe, Heppner, & Dixon, 1995). Gender role conflict may have some link with help-seeking behaviours. From their study of men over the age of 40, Hill and Donatelle (2005) found that gender role conflict in older men may limit perceptions of the availability of social support, and is predictive of men’s negative attitudes towards psychological helpseeking (Wisch, Mahalik, Hayes, & Nutt, 1995). How caregiving men appraise themselves and the stress of caregiving can help inform service delivery and interventions (Brown & Chen, 2008; Lauderdale & Gallagher-Thompson, 2002). The current study attempts to assess the utility of gender role conflict, alongside gender identity, in investigating appraisals of strain and gain in male caregivers of partners with dementia.

Method A survey approach via postal and internet questionnaires was used to investigate whether measures of gender identity and gender role conflict contributed to prediction of husband caregiver strain and gain. Gender identity and gender role conflict were assessed, with measures previously known to predict variance in strain and gain, using hierarchical multiple

regression analyses. Ethical approval for the study was granted by Nottingham NHS Research Ethics Committee, in September 2005. The study was completed in August 2006.

Participants Participants comprised men caring for wives or partners with a diagnosis of a dementia, recruited via two routes: proximally through UK National Health Service day hospitals and community teams in Nottinghamshire and Leicestershire, as well as voluntary sector carers’ groups; and, distally, through internet bulletin boards run by the Alzheimer’s Society (UK) and the Alzheimer’s Association (USA). Inclusion criteria specified that potential participants should be husbands caring for their wives or lifepartner with a diagnosis of a dementia. Men who considered themselves as principal carers, despite their wife or partner living in residential care, were also included. Respondents were excluded if either carer or care-recipient experienced co-morbid health problems. Forty-two participants returned questionnaires, representing a response rate of 89% of those approached local to the research team. Thirty-three respondents completed the questionnaire through the internet. In total, seventy participants’ data were used in the analysis. Five participants returned incomplete responses or consent forms and were excluded from analysis.

Measures The questionnaire comprised six sections, first piloted and then adapted for brevity to encourage completion of all items.

Caregiver characteristics and caregiving situation Respondents provided information about their age, years of education and self-rating of health, as well as their situation, such as length of marriage/cohabitation, duration of suspected dementia, the amount of support used by the couple and the number of services used.

Gender identity The short form of the PAQ (Spence & Helmreich, 1978) was incorporated to assess how people view themselves on traditional masculine/instrumental and feminine/expressive traits. Responses are recorded on a five-point Likert-scale for eight items on each subscale. Factor analysis supports the validity of the masculine/ instrumental (M) (! ¼ 0.85), feminine/expressive (F) (! ¼ 0.82) (Helmreich, Spence, & Wilhelm, 1981; Wilson & Cook, 1984), with validity shown to be preserved across various socio-economic and age groups (Spence & Helmreich, 1978).

Aging & Mental Health Appraisals of burden/strain


The 12-item Brief Zarit Burden Interview (B-ZBI) (Be´dard et al., 2001) was used to assess caregiver strain. Internal consistency is reported as ! ¼ 0.85 (O’Rourke & Tuokko, 2003). The B-ZBI assesses role strain (relating to the demands of the caregiving role) and personal strain (relating to the caregiver’s sense of adequacy about being a carer). The response scale uses a five-point Likert rating from 0 to 4, with higher scores indicating higher perceived burden. Gender role conflict An adapted version of the 37-item Gender Role Conflict Scale (GRCS) (O’Neil et al., 1986) was included. Originally designed to assess gender role conflict in men founded in a fear of femininity, the scale uses a six-point Likert scale ranging from ‘strongly disagree’ (1) to ‘strongly agree’ (6) to elicit four factors of: success, power, and competition (SPC) (! ¼ 0.85); restrictive emotionality (! ¼ 0.82); restricted affectionate behaviour between men (RABBM) (! ¼ 0.83); and conflict between work and family relations (! ¼ 0.75). Higher scores indicate more gender-role conflict. The work–family factor was omitted as it was irrelevant to the participants’ life situations (Gold, Franz, Reis, & Senneville, 1995). Memory and behaviour problems Memory and behaviour problems in the care-receiver contribute a significant main effect to caregiver strain (Kramer, 1997). Consequently the revised Memory and Behaviour Problems Checklist (MBPC) (Teri et al., 1992) was incorporated: a 24-item caregiver report measure of observable behavioural problems (! ¼ 0.78) and the caregiver’s reaction to these (! ¼ 0.87) (Roth et al., 2003). Appraisals of gain The final section comprised items relating to perceptions of gain, concluding the questionnaire with a positive outcome measure. There are few standardised measures of gain widely available (Rapp & Chao, 2000); therefore the measure used in the current study consisted of five items from the unpublished Caregiving Satisfaction Scale (Strawbridge, 1991, cited in Kramer, 1997), using a five-point Likert scale, 1 – disagree to 5 – agree. Higher scores indicate more perceived gain. Measures of the Caregiving Satisfaction Scale’s reliability are not given, but were assessed during data collection in the current study (! ¼ 0.84). Procedure Local health and voluntary services for dementia carers were contacted and asked to invite male carers fulfilling criteria for study participation.

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Table 1. Demographic variables describing the sample (N ¼ 70).

Age (years) Length of marriage (years) Duration of caregiving (years) Number of helpers Number of different services used

Mean (SD)

Range

68.6 42.9 5.6 1.0 1.5

43–83 5–62 1–24 0–9 0–5

(9.7) (13.2) (3.9) (1.6) (1.2)

Participants were given information about the research and asked permission for their names and address to be forwarded to the lead researcher. They were then posted a questionnaire, a consent form, a postage-paid return envelope and a £5 voucher to acknowledge participation. Internet recruitment was achieved by converting the questionnaire for web-page completion and extensive effort made to answer any questions the participants may have had about the research by email. Ethical standards for internet research were rigorously followed to ensure adequacy of information provision, and preservation of informed consent with anonymity (Kraut et al., 2004; Reips, 2002). Integrity of the data collection was preserved procedurally by preventing repeated submissions (Reips, 2002).

Results The demographic information is displayed in Table 1. The mean age of the carers and duration of caregiving was broadly representative of other studies (Kramer, 1997; Lutzky & Knight, 1994). Just over half the sample (53.9%) cared for their wife or partner on their own without any assistance, and over half used only one service or less (51.4%). Spread of education in the current sample was similar to that of other studies on male caregivers (Bowers, 1999; Kramer, 1997). Differences were found in the educational background of the two samples with the sample recruited from the internet reporting more years of education.

Inter-correlations of variables Only variables showing a significant relationship with the dependent variables were used for subsequent multiple regression analyses. The correlation matrix of the remaining variables is shown in Table 2. Given the number of independent variables and circumscribed sample size, it was necessary to constrain variables entered into the regression analyses. The carers’ reaction to memory and behaviour problems, rather than total score from the MBPC was used as a source of stress for caregivers given its more direct relationship to strain and depression than objective measures such as activities of daily living (Kramer, 1997; Zanetti et al., 1998). The carer’s reaction is also more strongly

– 0.104 0.304** 0.031 "0.138 0.114 "0.060 "0.119 "0.292** 0.015 "0.072 "0.247*

1

– 0.171 0.079 0.138 "0.277* 0.082 "0.058 0.084 0.211* 0.136 "0.021

2

– "0.014 "0.398*** 0.145 0.164 0.055 "0.034 "0.214* 0.009 0.087

3

– "0.009 "0.131 "0.166 0.006 0.121 0.208* 0.208* 0.024

4

– "0.186 "0.302** 0.159 0.047 0.517*** 0.441** "0.056

5

– 0.327** 0.148 "0.015 "0.274* "0.261* 0.163

6

– "0.168 "0.089 "0.125 "0.251* 0.166

7

– 0.252* "0.104 0.023 0.269*

8

– "0.189 0.214* 0.404**

9

– 0.614* "0.146

10

– "0.071

11

–

12

Notes: MBPC ¼ Memory and Behavioural Problems Checklist; PAQ ¼ Personal Attributes Questionnaire; GRCS ¼ Gender Role Conflict Scale; SPC ¼ success, power and competition; RABBM ¼ restrictive affectionate behaviour between men. *p50.05; **p50.01; ***p50.001.

1 Years education 2 Number of helpers 3 Self-rated health 4 Duration of caring 5 Carers’ reaction to MBPC 6 PAQ – M/instrumentality 7 PAQ – F/expressiveness 8 GRCS – SPC 9 GRCS – RABBM 10 Role strain 11 Personal strain 12 Gain

Variable

Table 2. Inter-correlations of independent and dependent variables used in the regression analyses (N ¼ 70).


322 K.L. Baker et al.

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Table 3. Hierarchical multiple regression predicting role strain among husband caregivers (N ¼ 68). Betas Step 1


Caregiver characteristics Self rating of health Caregiving situation characteristics Number of helpers Duration of caring Reaction to memory and behaviour problems Gender identity M/instrumentality F/expressiveness Gender role conflict Success, power, and competition Restrictive affectionate behaviour between men

"0.183

Step 2

Step 3

Step 4

0.000

0.035

0.054

0.108 0.213* 0.504***

0.037 0.211y 0.516***

0.055 0.235* 0.534***

"0.200y 0.079

"0.157 0.008 "0.129 "0.269**

Total R2 R2 change F for R2 change

0.033 0.033 2.277

0.325 0.291 9.056***

0.355 0.030 1.454

0.456 0.101 5.482**

Total F

2.277

7.570***

5.604***

6.191***

Note: yp50.10; *p50.05; **p50.01; ***p50.001.

related to strain, as indicated in the correlation matrix, and was more appropriate in the regression analysis. Although the two PAQ variables and the two GRCS variables of SPC and RABBM displayed a significant positive correlation with each other, the strength of the relationship was not strong enough to produce any confounding collinearity. Three hierarchical regression analyses were carried out on each of the appraisal outcomes of role strain, personal strain and gain. Role strain Previously identified predictors of strain (Kramer, 1997) were entered into the regression analysis first: caregiver characteristics at step 1, and caregiving situation characteristics at step 2. The gender identity variables were entered in at step 3, and the gender role conflict variables at step 4. The analysis is presented in Table 3. Consistent with Kramer (1997), carers’ reaction to memory and behaviour problems, together with duration of caring, were strong predictors of role strain in husband caregivers. The addition of gender identity and gender role conflict into the analysis increased the amount of variance accounted for. However, this was significant only for the addition of the gender role conflict measure of restrictive affectionate behaviour between men (RABBM) which contributed a unique source of variance to the model. Given the negative relation between variables, the more traditionally a man considered being emotionally close to other men, the less strain they reported regarding caregiving. Personal strain The hierarchical regression analysis was repeated to determine the predictor variables’ relationship with personal strain displayed in Table 4. The results were

similar to the role strain analysis, with carers’ reaction to the memory and behaviour problems of their partner the strongest predictor. Self-rating of health and duration of caregiving also contributed to personal strain to a lesser but still significant extent. Again both sets of gender variables increased the predictive value of the regression equation, but did not reach significance. The GRCS measure of RABBM was again the only gender variable to contribute a significant and unique source of variance to the regression. Interestingly, the direction of the relationship between the RABBM measure and the appraisals of personal strain was positive, in contrast to its negative relationship with role strain.

Gain The third regression analysis explored the relationship between potential predictors and the outcome measure of gain. The current study recorded only years of education and a self-rating of health as significant contributors. The latter and all remaining caresituation variables were not entered into the regression analysis because of weak non-significant relationships with gain. Table 5 shows the results of the hierarchical multiple regression analysis. The final regression equation explained 30.2% of the total variance in the appraisals of gain to a high level of significance. The addition of the gender identity variables increased R2 by a small but nonsignificant amount. However, in step 3, both the GRC measures added a significant increase in the prediction of variance in appraisals of gain. It was not until these variables were entered into the regression hierarchy that the model reached significance. Both the SPC and RABBM variables accounted for the largest proportion of variance in the final

324

K.L. Baker et al. Table 4. Hierarchical multiple regression predicting personal strain among husband caregivers (N ¼ 69). Betas


Caregiver characteristics Self rating of health Caregiving situation characteristics Number of helpers Duration of caring Reaction to memory and behaviour problems Gender identity M/instrumentality F/expressiveness Gender role conflict Success, power, and competition Restrictive affectionate behaviour between men

Step 1

Step 2

Step 3

Step 4

0.018

0.208y

0.236*

0.265*

0.153 0.248* 0.511***

0.112 0.223* 0.487***

0.101 0.204* 0.517***

"0.166 "0.032

"0.148 "0.038 "0.147 0.220*

Total R2 R2 change F for R2 change

0.000 0.000 0.022

0.328 0.328 10.404***

Total F

0.022

7.811***

0.356 0.028 1.359

0.407 0.051 2.588y

5.718***

5.155***

Note: yp50.10; *p50.05; **p50.01; ***p50.001. Table 5. Hierarchical multiple regression predicting gain among husband caregivers (N ¼ 69).

predictors of strain and gain in comparison to established predictors. The findings offered varying levels of support.

Betas Step 1

Step 2

Step 3

Caregiver characteristics Education "0.237y "0.249* "0.086 Gender identity M/instrumentality 0.171 0.095 F/expressiveness 0.111 0.224y Gender role conflict Success, power, 0.228* and competition Restrictive affectionate 0.375** behaviour between men Total R2 R2 change F for R2 change

0.056 0.056 3.931y

0.110 0.054 1.937

0.302 0.192 8.542**

Total F

3.931y

2.639y

5.373***

Note: yp50.10; *p50.05; **p50.01; ***p50.001.

regression equation at 19.2%. Its relationship with appraisal of gain was positive: the more gain a man reported as a result of caring, the more traditional were his responses about emotional closeness to other men and about success, power, and competition. One can conclude that gender identity, as measured by the PAQ, does not have an important association with appraisals of gain in male caregivers. However, both the GRC constructs of SPC and RABBM had a significant positive association with gain.

Discussion This study examined whether gender identity and gender role conflict could be considered significant

Gender identity The gender identity measures, using the PAQ’s scales of masculinity/instrumentality and femininity/expressiveness, did not seem important in determining male caregivers’ appraisals of strain or gain in comparison with other variables. Whilst the correlation matrix suggested that both M/instrumentality and F/expressiveness were significantly negatively related to personal strain, and M/instrumentality was significantly negatively related to role strain, neither were associated with the appraisals of gain made by the caregivers. Gender identity can be an important determinant in men making positive and negative appraisals of their caregiving. Previous studies have suggested that instrumental coping has been related to positive affect in caregiving (Rose, Strauss, & Neundorfer, 1997; Saad et al., 1995). M/instrumental identity has been associated with positive affect in male caregivers who were later widowed (Bowers, 1999). However, in the present study, no relationship between either sub-scale of the PAQ was significantly related to any outcome measure. This suggests that, for older husbands, gender identity does not predict how they adapt to becoming a caregiver.

Gender role conflict Of the gender role conflict measures, restrictive emotionality did not significantly correlate with any of the strain or gain measures and was not used in the regression analyses. This was surprising given previous evidence that restrictive emotionality is significantly


Aging & Mental Health negatively related to self-esteem (Cournoyer, 1994; Sharpe, 1993) and negatively with help-seeking (Berger Levant, McMillan, Kelleher, & Sellers, 2005). The GRC scale construct of SPC also did not contribute significantly to any of the regression analyses of role strain or personal strain. Since SPC has been defined as a pattern of beliefs connected with worries about achievement, competence, and dominance (O’Neil, 1995), and appears negatively associated with intimacy (Sharpe & Heppner, 1991) and seeking help (Robertson & Fitzgerald, 1992), it was expected to be important in the husbands’ appraisals of caregiving. It was not an important factor in male caregivers’ appraisals of strain, but had a significant positive relationship with gain. In contrast to all the gender variables, the GRC scale construct of RABBM was unique in its relationship with the outcome variables. It accounted for a significantly unique amount of variance in every hierarchical regression analyses with all the strain and gain variables. The RABBM contributed small but significantly unique amounts of variance to the appraisal of both role strain and personal strain which was secondary to the carers’ reactions to the memory and behaviour problems of their partner. The regression models revealed that some of the appraised strain may be determined uniquely by men with the RABBM. The RABBM was found to be negatively related to role strain and positively related to personal strain. Previous research has shown links between RABBM and low levels of self-esteem (Sharpe & Heppner, 1991), intimacy (Sharpe, 1993), and problem-solving (Chamberlin, 1994), and higher levels of anxiety (Sharpe & Heppner, 1991) and depression (Good & Mintz, 1990). But in the current study, we found that participants who indicated higher levels of RABBM, reported less strain related to the demands of the caregiving role, and more strain related to feelings of being an uncertain or inadequate carer. Regarding appraisals of gain, RABBM was a significant predictor in the regression analysis. The degree of variance accounted for by both SPC and RABBM exceeded that of all other variables. Thus, these measures of gender role conflict appear to play an important and independent role in explaining appraisals of gain in older male caregivers. This was a positive relationship that described men’s discomfort about being personal or expressing emotions to other men being associated with positive appraisals about being an older male caregiver. This again was unanticipated given the repeated assertions of negative links with traditional masculine roles outlined above.

Possible explanations for the findings The participants’ responses in this study suggest evidence of managing potential conflict between

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masculine and caring roles, so that appraisals of caregiving may be censored through a response bias. O’Rourke et al. (1996) described a response bias in caregivers’ descriptions of their relationship with their spouse with dementia. They found that caregivers who defensively monitored how they described their relationship with their spouse, reported significantly lower levels of burden. They suggested that self-reported burden may reflect only the amount of burden that caregivers are willing to report. In the current study, traditional beliefs about gender may be acting as a response bias, with male carers defending themselves against threats to their beliefs about their masculinity, such as appearing feminine to others (Mahalik, Cournoyer, DeFranc, Cherry, & Napolitano, 1998). For some older male carers, reporting that they feel inadequate as a carer may be a way of asserting themselves as masculine. Reporting high levels of personal strain for a man is congruent with societal beliefs that caring is women’s area of competence. Paradoxically, these men may feel that disclosing an inability to cope with caregiving may imply that they are weak, or not ‘man enough’ for the job. This would lead these men to under-report role strain when questioned about the demands of the role. For, appraisals of gain, some men with traditional views about masculinity may appraise caregiving as an opportunity to be a better carer or person. They may tend to report more gain than men with less traditional views about masculinity. Likewise, men with less traditional beliefs may have previously experienced dealing with domestic and caring situations, and so will not necessarily appraise high levels of gain.

Limitations and conclusions As a cross-sectional study with a small sample size, the explanations offered for the link between gender role conflict and the participants’ appraisals are necessarily speculative. Causality cannot be determined as appraisals of strain and gain may influence how male carers cope, construe memory and behaviour problems, and their beliefs about gender roles. A longitudinal study should clarify the process and relationship between the variables. Also the sample used may not have been representative of the population of male carers of partners with dementia. Recruiting through the internet and through local health and social services was purposefully used to access both men who typically do not use services and those who do. But this strategy was not employed systematically and may not represent the proportions or variance representative of the male carer population. Some measures may not have been optimally sensitive to the concerns of older male caregivers. The GRCS was adapted for use with older men, without any further analysis of the adapted measures’ factor structure. Similarly the PAQ, first developed using American college students has been shown to


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lack some validity in British populations (McCreary & Steinberg, 1992). An improved and more detailed measure of positive appraisal may have offered more understanding about gain in caregiving. Our study suggests that male caregivers with traditional beliefs about masculinity are more likely to say that (a) they are not feeling burdened, (b) they feel uncertain about caring and (c) they are more likely to articulate positive aspects to being a spousal carer than men with less traditional beliefs about masculinity. We have also shown that gender role conflict is more revealing than gender identity. Some men may connote ‘care’ as feminised activity and may struggle to construe themselves in the caring role. This may explain why some men are reluctant to access services. Previous research suggests that gender role conflict is negatively associated with help-seeking behaviours (Berger et al., 2005) and social support (Hill & Donatelle, 2005), and is key in considering how to engage men with services (see Addis & Mahalik, 2003 for a review). Caregivers of people with dementia often do not use services and the decision to take up services is complex (Brodaty, Thomson, Thompson, & Fine, 2005) with gender being only one factor. Understanding how men think about themselves as caregivers and how they perceive possible supports may contribute to strategies that will optimally engage older male carers and reduce their burden (Brown & Chen, 2008).

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