Asia Pacific Journal of Social Work and Development

ISSN: 0218-5385 (Print) 2165-0993 (Online) Journal homepage: http://www.tandfonline.com/loi/rswd20

Caring for my wife: voices from Malay older

husbands in Singapore
Chang-Keun Han & Izarina Binte Jupri
To cite this article: Chang-Keun Han & Izarina Binte Jupri (2013) Caring for my wife: voices
from Malay older husbands in Singapore, Asia Pacific Journal of Social Work and Development,
23:3, 215-221, DOI: 10.1080/02185385.2013.818201
To link to this article: http://dx.doi.org/10.1080/02185385.2013.818201

Published online: 25 Aug 2013.

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Asia Pacific Journal of Social Work and Development, 2013

Vol. 23, No. 3, 215221, http://dx.doi.org/10.1080/02185385.2013.818201

RESEARCH NOTE
Caring for my wife: voices from Malay older husbands in Singapore
Chang-Keun Hana* and Izarina Binte Juprib

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a
Department of Social Welfare, Faculty of Arts & Social Sciences, Sungkyunkwan University,
Jongnogu Myeongnyundong, South Korea; bCare and Counselling Department, Medical Social
Worker, Tan Tock Seng Hospital, Singapore

(Received 13 February 2012; final version received 23 July 2012)

This study explores how Malay older husbands giving care to their wives in Singapore
respond to these roles through coping strategies and social support. This study uses indepth interviews with five Malay older husbands whose wives are homebound because
of dementia and kidney problems. Key findings suggest that husbands report low
caregiver burden or strain. However, all the participants report that they do not take
time off from their caregiving roles because they have no other immediate sources of
support. Services relieving their caregiving responsibilities would be helpful to reduce
stress and prevent future burnout.
Keywords: Malay older husbands; caregiving to wives; caregiving roles and strains;
in-depth interview

Introduction
While a considerable amount of research has examined the nature and levels of burden that
families have in caregiving, only a small number of studies have focused on older
husbands and their caregiving burden (Ducharme et al., 2007; Fuller-Jonap & Haley,
1995; Gurung, Taylor, & Seeman, 2003; Kramer & Lambert, 1999). This may be because
females (wives, daughters, and daughters-in-law) are considered to be natural caregivers
(Huang, 2004; Wong, Rong, Chen, Wei, & Lin, 2007). However, studies have emphasized
the pressing need for research on male caregivers, in particular those caring for their
wives, to understand the predictors and consequences of their caregiving (Ducharme et al.,
2007; Gurung et al., 2003). Research on older husbands caregiving to their older wives is
especially important given todays modern context, wherein there are a growing number of
male older adults who make a sizable contribution to care for their wives (Baker &
Robertson, 2008).
Although this study is exploratory, two theoretical perspectives are considered to
explain male caregivers activity and its impacts on health and mental health. First, gender
socialization theory was introduced to explain different perception of caregiving to their
spouses. One study finds that some men may equate care with feminized activity and may
struggle to adjust themselves to caregiving roles (Baker, Robertson, & Connelly, 2010).
A few other studies, however, have found that older men occupy less polarized gender
roles and hold a less stereotyped image of caregiving (Crocker Houde, 2002;
Parsons, 1997). Male caregivers may perceive their caregiving activities as a duty,
a labour of love, or a way of repaying what they received from their spouse before

*Corresponding author. Email: chkhan@skku.edu

q 2013 Department of Social Work, National University of Singapore, Singapore

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C.-K. Han and I.B. Jupri

her illness. In addition, they may consider caregiving of their sick wives as a primary
responsibility (Baker & Robertson, 2008; Ducharme et al., 2007). Second, the other
dimension of theoretical background is about impacts of husbands caregiving on their
health and well-being. However, the findings are mixed. Some researchers have found that
male caregivers are likely to have a higher rate of depression and lower levels of well-being
than male non-caregivers (Fuller-Jonap & Haley, 1995; Kramer & Lambert, 1999). These
findings suggest that caregiving is physically taxing and older male caregivers are at risk in
terms of health. These strains and complications may explain why some male caregivers
consider relinquishing their caregiving duties and institutionalizing their spouse (Ducharme
et al., 2007). The other group of researchers has found that husbands reported no negative
impacts of caregiving on their well-being or positive perceptions toward their caregiving
experience (Berg-Weger, Rubio, & Tebb, 2000; Chan, 2010).
Studies targeting caregiving by older husbands in Singapore are scarce. While informal
caregiving by family members is prevalent, the majority of caregivers for older adults are
female (Chan, 2010; Mehta, 2006; Teo, Mehta, Theng, & Chan, 2006). To address the
paucity of research on male caregivers of older spouses in Singapore, the current study
explores how Malay older husbands take care of their wives with dementia or health
limitations. The present study focuses on older husbands caregiving roles and how they
respond to these roles, such as coping strategies, social support and satisfaction. Cultural
factors may shape perceptions of familial responsibilities and thus, may also influence the
caregiving experience. This study uses in-depth interviews and a grounded theory approach
which may be useful to understand caregiving experiences of five Malay older husbands.
Since Malays are a minority in Singapore, findings of this study can provide empirical
evidence to develop culturally competent services for this disadvantaged population.
Methods
Participants
Participants in this study were conveniently and purposively selected through personal
invitation. Participants were selected according to the following selection criteria: (1)
Malay husbands aged 65 or above; (2) having wives with chronic illnesses (dementia or
kidney failure); (3) taking the primary caregivers role to their wives; (4) living
independently from other family members; (5) being physically competent tested with the
Activities of Daily Living (ADL) and the Instrumental Activities of Daily Living (IADL)
checklists. The final sample size was five. Key socio-economic characteristics of the
sample are presented in Table 1.
Interview and analysis
Semi-structured interviews were conducted with five participants in their respective homes
where they felt most comfortable. Before beginning the interview, we explained the purpose
of the research, and respondents signed informed consent forms. The interview guideline
consisted of five components: background of participant and his family, personal autonomy
(roles and activities), social support/network, coping, and expressed satisfaction. All of
them have 6 10 specific items which are open-ended. The interviews were conducted in
Malay. The interview duration ranged from 50 to 60 minutes. The interviews were
transcribed verbatim and analysed individually using thematic coding, allowing themes to
emerge. All ethical considerations on this research were approved by the Institutional
Review Board (IRB) at National University of Singapore (NUS IRB 11-127).

Asia Pacific Journal of Social Work and Development

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Table 1. Key characteristics of interview participants.

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Husbands
Husbands Wifes medical
age
age condition
P1

80

74

P2

65

62

P3
P4

65
68

P5

72

Wifes
medical
condition

Housing
type
(HDB)

Dementia

3 rooms

Kidney failure

3 rooms

65
62

High blood
pressure
High blood
pressure
Body ache
Body ache

Dementia
Kidney failure

2 rooms
2 rooms

65

Body ache

Dementia

2 rooms

Number of
children
8 (3 daughters,
5 sons)
7 (all daughters)
4 (all sons)
5 (3 daughters,
2 sons)
4 (all daughters)

Length of
years in
providing care
5
8
5
15
6

Note: P denotes participant.

Results
Caregiving roles and husbands perceptions
Participants help their spouses with daily basic needs like going to the toilet, preparing
meals and cleaning the house. Some statements are excerpted from the interviews below.
Ever since she was diagnosed with kidney failure and has been confined to the wheelchair, she
cannot do anything on her own anymore . . . .In short, everything in this house is done by me.
(P4)
I basically help her with her daily needs, like going to the toilet, preparing meals, and
everything. She doesnt leave the house alone now, most of the time if theres anything we
need, Ill hurry to the shop alone. (P3)

It is noteworthy that all participants considered taking care of wives as a responsibility.

Further, their perspective was that husbands and wives took turns caring for one another.
For me, caring for my wife is part of my responsibility as a husband. Besides I love my wife
for raising our children with me, so I guess its my turn to care for her now that she is sick. (P5)
When I was well she took care of our family without rest and tire, so now I see it as my turn to
fulfil my part of the deal. (P1)

Despite their heavy responsibilities and stresses of caregiving, all of the participants
displayed a high degree of independence and low reliance on others in their daily decision
making.
I try my best to manage on my own. You know, be independent. I also dont find the need to let
others know about my private matters. I think if I can do on my own, Id rather do it myself.
Why involve people unnecessarily? (P2)
Id rather live on my own actually. I can do my own things without feeling I am depending on
other people. More freedom, and I feel in control. (P3)

Challenges: caregiving strain and stress

Although husbands in this study expressed high levels of responsibility for and autonomy
in caregiving for their wives, it is inevitable that they faced many challenges and stresses
in their caregiving responsibilities. During interviews, three aspects of challenges were
identified.
Firstly, husbands are aged so that they suffered from physical strains. Most husbands
mentioned that physical strains were the primary challenge they had.

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C.-K. Han and I.B. Jupri

The main challenge is the physical, because it can get very tiring for me to take care of her
. . . . My strengths and ability are also limited. My back aches and I need lots of rest (P5)
When I am sick, my leg hurts or I have a fever, I cannot take MC [Medical Certificate] from
my caregiving role. (P1)

However, it is interesting that the caregivers were unable to state explicitly the
illnesses they had and often conveniently classified their condition as old peoples
illness. They do not take their health ailments and illnesses seriously.
Secondly, some participants experienced emotional strain or loneliness.
Sometimes it tests my patience, and when I am ill there is no one else I can depend on.
Basically it is the emotional strain, not other aspects that I am concerned about. (P3)

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I sometimes can get very lonely not talking to or meeting anyone. (P5)

Thirdly, uncertainty about the future is one of the major stresses. Since they were old,
they worried about who would care for their wives if something should happen to them.
I am old, too, so I am not sure of how long I can cope with the physical demands of caregiving
for my wife. (P4)
Its not that I cannot manage already, just that I dont know what will happen in the future.
I am getting old, dont know what will happen to my wife if anything happens to me first. (P5)

Coping
All the participants coped by relying on their religious faith, which centred on believing
that every difficulty they faced would become manageable through worship to God. They
exercised positive thinking, as demonstrated by the following examples:
We Malays, as you know, usually keep our issues to ourselves and find it hard to consult others
for help. So mostly, we rely on family . . . . As Muslims, we must always be grateful with what
we have. Every hardship and joy comes from God so we must accept it openly. (P1)
It helps to pray for strength and signs from God . . . . Its also part of our religious beliefs to
accept our fate and what God has created for us. (P5)
I guess thinking positively helps, and believing that everything comes from God. In times of
need, I think praying for strength and patience helps . . . by praying for strength I learn to cope
with my difficulties better. (P2)

Social support and networks

It is interesting to note that all the participants perceived family as their main source of
social support. The most regular form of communication was with their family members,
particularly their adult children and grandchildren, although the frequency of contact
varied. Respondents prioritized family and children in all circumstances.
Because now they have husbands whom they must be filial to and children to care for, like last
time, my wife dedicated her time to raising our children. Its even harder nowadays, because
my daughters have to balance outside work and taking care of their families. (P5)
My eldest son who lives nearby comes quite regularly to check on things, every month he
takes my wife for her medical check up. His wife is nice, too, often sends over cooked food for
us . . . . My children provide me with financial help monthly, so they contribute. Im grateful
because I still have filial children. (P1)

The participants generally were not receiving any formal assistance, such as support
from the Family Service Centres (FSC) or the community. The only form of assistance is

Asia Pacific Journal of Social Work and Development

219

emotional support provided mostly by their adult children. Participants did not receive any
help at all from anyone and relied mostly on themselves to meet their daily needs.
I dont think I need any help, and if other people can help me. I think there are others who are
worse off than me and need the help from all these sources. Let other people who deserve it get
the help. (P5)

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I ask for help from my daughters when I cannot cope. As a last resort, so called . . . . I dont
believe in telling outsiders because people will not understand my personal issues. I think
better keep family issues within the people you are close to. (P5)

Expressed satisfaction
Participants were generally satisfied with their current situation, which may be mainly
attributed to their religious beliefs and positive thinking as discussed at the coping section
above.
Well. I think I am rather satisfied. I have good health, for someone with my age. I have a big
family who respects me and many grandchildren to keep me entertained when they visit. I still
have a wife although she is not well. I have a place for shelter and enough money to continue
to survive day by day. What more can I ask for? (P3)
I would say I am satisfied, because my life could have been harder and I could be challenged
more in life. Right now, I have children who still care about me and I have enough food to eat
and shelter for myself and my wife, so I am happy. (P1)

Discussion and conclusion

This exploratory study has several limitations: a small sample size, no representativeness
of Malay older husbands, a possible self-selection bias, and a cross-sectional design. The
findings of this study should be understood with the limitations.
Despite the limitations, the findings of this study are noteworthy. Here, we summarise
several key themes that emerged from the interviews. First, contrary to a culturally
stereotyped perception where males may struggle to cope with caregiving to their spouse,
Malay older adults accept their caregiving roles as responsibilities and payback to what
they had received from their spouse. These findings suggest that Malay older adults do not
have stereotyped images of caregiving to their wives and consider the caregiving as their
primary responsibility (Baker & Robertson, 2008; Crocker Houde, 2002; Ducharme et al.,
2007). Second, accordingly, they have expressed a very low level of caregiving burdens.
These findings are consistent with studies where caregiving husbands report no negative
perceptions of giving care to their wives and no negative impacts on husbands well-being
(Berg-Weger et al., 2000; Chan, 2010). Third, the low caregiver burden experienced by the
male Malay caregivers can be attributed to the cultural values of the Malays who recognize
caregiving as a salient part of family life. They believed that they need to accept the
situations. In a collectivistic and communal culture like the Malays, the importance of
family bonds is heavily propounded. There is a strong connection and interdependence
amongst family members. For Malay husbands, they tried to promote the communal
nature of the relationships by caring for their sick wife (Clark & Monin, 2006; Dion &
Dion, 2006). In doing so, male older adults regarded caregiving to their wife as the paying
back of their wifes contributions when they were still well (Antonucci, 1990). Last, the
prevalent coping strategy used by the respondents was through spiritual faith that was
manifested in acts of worship to God. Religion is a salient psychosocial resource that
provides the caregivers with a way to deal with the strains of caregiving. In particular, the
concept of fate and predestination reduced difficulties associated with caregiving since
their responsibilities mean a test from God which should be embraced with optimism and

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C.-K. Han and I.B. Jupri

courage. Dismissing their caregiving obligations is akin to a rejection of Gods will.

Religious obligations may cement their unconditional caregiving responsibilities. Since
belief in God leads to positive thinking, they are in general satisfied with caregiving to
their spouse and their current situations.
However, these findings do not discount older husbands needs for social services to
enhance their quality of life. Despite no negative impacts on the well-being of husbands,
they are concerned about their physical health, emotional strain and worries about their
own death. All the participants reported that they do not take time off from their caregiving
roles because they have no other immediate sources of support. They also displayed a lack
of knowledge of the available support resources and showed heavy reliance on their
children to communicate with external parties such as medical professionals. Thus, it
would be helpful if they gain access to information and assistance in a language that they
are comfortable with (i.e. Malay) (Maslow & Selstad, 2001). Emotional and psychosocial
supports can be provided through social service sectors. The support can include in-home
or out-of-home respite programmes such as day care programmes. There is evidence that
out-of-home daytime respite reduces caregivers physical and emotional distress (Gaugler
& Zarit, 2001). In particular, in-home respite care may help delay institutionalization of
individuals with Alzheimers disease or other forms of dementia (Gaugler et al., 2000;
Kosloski & Montgomery, 1995; Sorensen, Pinquart, & Duberstein, 2002).
A wide variety of caregiver services exist nationwide in Singapore. However, it is
important to ensure that these services cater to the needs and abilities of older adults. This
is especially so for the minority groups in Singapore. It is understandable that programme
administrators may face various constraints in implementing caregiver services, such as
workforce shortage (e.g. Malay or Malay-speaking social workers), need for additional
outreach efforts, growing diversity among caregiver needs and limited collaboration
among service providers (Feinberg, Newman, Gray, Kolb, & Fox-Grage, 2004). However,
identifying the needs of older adults may be crucial to ensure better effectiveness and
utilization of the services provided. In an Asia-Pacific region where family caregiving is
prevalent and racial diversity is increasing, this study suggests that social services should
be initiated to meet different needs of caregiving considering diverse racial and cultural
contexts (Wood & Parham, 1990).
Notes on contributors
Dr Chang-Keun Han is an associate professor of the Department of Social Welfare, Sungkyunkwan
University in Korea.
Izarina Binte Jupri is a medical social worker at Tan Tock Seng Hospital in Singapore.

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