The prevalence of grandmothers as primary caregivers in a poor pediatric population.

In the wake of the HIV/AIDS and crack cocaine epidemics, poor urban communities face growing numbers of older adults, largely grandmothers, who have become surrogate parents to children orphaned by these epidemics. This study is the first in the United States to determine the prevalence of older surrogate parents among families registered at pediatric clinics. The three clinics selected were in low income neighborhoods of New York City with a high incidence of female HIV/AIDS and substance abuse. Using a 50% random sample of 1,375 records of registered families, data were obtained on the number and ages of relatives serving as surrogate parents. In 11% of these 1,375 families with children 12 years and under a parent was not the caregiver. In 8% the caregiver was a grandmother. Forty-seven percent of these women were 55 years or older, 25% were 60 years or older and 8% were 70 years or older. Most of these women were caring for more than one child. Ten percent of the total of 2,445 children, 12 years and under, lived in non-parent headed families. Eight percent lived with a grandmother, 1% with other parental generation relatives and 1% in foster care. Given the stresses associated with caregiving in late life and the greater risk of poor health among low income African-American and Hispanic elderly, older surrogate parents from these communities are a potentially high health risk population whose own needs may go unrecognized and unattended. The young ages of the children suggest that many grandparents may continue to be caregivers as they reach their sixties, seventies and even eighties. Clinical and longitudinal data are needed to determine how prolonged surrogate parenting in late life affects the health of older caregivers and the children in their care. Coordination between health and social services for the elderly and for children are needed to promote effective programs for these families.