Help from spouse and from children among older people with functional limitations: comparison of England and Finland

Unmet Needs for Support in Activities of Daily Living among Older Persons: The Effects of Family and Household Structures in a Low- and Middle-Income Context

The unmet need for assistance in activities of daily living (ADLs) accentuates older persons' risk of falls, ill health, hospitalisation, and mortality. In Nigeria, the family arrangements through which older persons derive support are changing due to modernisation, migration, and economic challenges. How the family dynamics explain the unmet needs is poorly understood. This study investigates the influence of family and household structures on older persons' unmet needs in ADLs in southwestern Nigeria. The study analysed the data of 827 older adults aged ≥65 years selected from Oyo State, southwestern Nigeria, using a multi-stage sampling design. Associations were examined using the Poisson-logit hurdle regression model. From the results, 65% of older persons with difficulties had unmet needs in instrumental ADLs and 59% in basic ADLs. Increased unmet needs were associated with older persons living with non-family members (β = 0.19; p < 0.01; 95% C.I. = 0.05-0.32) and widows (β = 0.27; p < 0.01; 95% C.I. = 0.13-0.42). Conversely, unmet needs decreased with higher family size (β = -0.06; p < 0.001; 95% C.I. = -0.08--0.03), living in rich households (β = -0.29; p < 0.001; 95% C.I. = -0.42--0.17), not being the household head (β = -0.27; p < 0.001; 95% C.I. = -0.40--0.15), close family bonds, and proximity to children/caregivers. The study recommends alternative or complementary home-based support mechanisms for seniors with vulnerable family settings in southwestern Nigeria.

Inequities in home care use among older Canadian adults: Are they corrected by public funding?

BACKGROUND

Although care use should parallel needs, enabling and predisposing circumstances including the socio-demographic inequities of socioeconomic status (SES), gender, or isolation often intervene to diminish care. We examine whether availability of state-funded medical and support services at home can rebalance these individual and social inequities, and do this by identifying if and how intersecting social identities predict homecare use among older Canadian adults.

METHODS

Using the Canadian Longitudinal Study on Aging (CLSA) of 30,097 community-dwelling adults aged 45 to 85, we performed recursive partitioning regression tree analysis using Chi-Squared automatic interaction detection (CHAID). Combinations of individual and social characteristics including sociodemographic, family-related, physical and psychological measures and contextual indicators of material and social deprivation were explored as possible predictors of formal and informal care use.

RESULTS

Diminished function i.e. increased need, indicated by Activities of Daily Living, was most strongly aligned with formal care use while age, living arrangement, having no partner, depression, self-rated health and chronic medical conditions playing a lesser role in the pathway to use. Notably, sex/gender, were not determinants. Characteristics aligned with informal care were first-need, then country of birth and years since immigration. Both 'trees' showed high validity with low risk of misclassification (4.6% and 10.8% for formal and informal care, respectively).

CONCLUSIONS

Although often considered marginalised, women, immigrants, or those of lower SES utilised formal care equitably. Formal care was also differentially available to those without the financial or human resources to receive informal care. Need, primarily medical but also arising from living arrangement, rather than SES or gender predicted formal care, indicating that universal government-funded services may rebalance social and individual inequities in formal care use.

Complementary support in later life: investigating the gender disparities in patterns and determinants among older adults in South-Western Nigeria

Old-age needs are multifaceted and require multiple support sources, yet caregiving roles for older Nigerians are largely shifted to adult children. However, the children also declining capacity to respond. The extent to which older adults access support from other sources remains under-researched. This study investigates the patterns and determinants of access to complementary supports among older adults in South-Western Nigeria, taking Oyo State as the case study. The study is cross-sectional and utilized primary data of 827 older adults aged ≥ 65 years selected using a multi-stage sampling design. Box plot was used to determine the patterns while multiple ordinary least square regression was used to predict the determinants of access to complementary support. Expressed in percentage, the median complementary support score of older adults in Oyo State was 30 (interquartile range [IQR] = 24) with a slightly higher score for men (median = 32, IQR = 24) compared to women (median = 28, IQR = 20). Access to complementary support was lower for the widow(er)s, the lower socioeconomic group and self-dependent older adults across genders, and for urban women with secondary/higher education compared to the otherwise groups. Increased access to complementary support was significantly associated with primary/no education (β = 4.365; p < 0.01 95% C.I. = 1.511–7.218), affiliation to Islamic/Traditional religion (β = 5.100; p < 0.001; 95% C.I. = 3.000–7.200), rich wealth status (β = 3.315; p < 0.05; 95% C.I. = 0.667–5.963) and depending on both self and children/family for income (β = 5.510; p < 0.05; 95% C.I. = 1.710–9.309) with some gender disparities. However, reduced complementary support was associated with ages 80 years or over (β = -3.649; p < 0.05; 95% C.I. = -6.460 – -0.838) and widowhood (β = -6.285; p < 0.001; 95% C.I. = -8.556 – -4.015). The study suggests the need for welfare plans among professional, social, and religious groups, institutionalised social support systems, and community engagement to escalate welfare support for older adults. It also recommends intensified attention on the more vulnerable groups, especially the widows, childless and lower socioeconomic groups.

Patterns of help and care by adult only children and children with siblings

Adult children with siblings can share caring for older parents but adult only children face this responsibility alone. Given increased longevity and reliance on informal care-giving, as well as an increase in one-child families, there is a need to investigate only children's care-giving further. Using data from three large-scale British birth cohorts, this paper investigates patterns of parent-care, care intensity and wellbeing at ages 38 and 42 (N = 17,255, N = 16,703; born 1970), 50 and 55 (N = 12,775, N = 11,339; born 1958) and 63 (N = 2,364; born 1946), how sibling composition intersects with gender in relation to care-giving and whether different care-giving patterns are associated with wellbeing. Only children are more likely to provide parent-care and the pattern is consistent with an interpretation that differences by sibling status might increase with age. Provision is gendered, and the sibling group composition matters for involvement. Although care-giving is related to wellbeing, we found no evidence that this differs between only children and those with siblings. The literature on only children has hitherto focused largely on childhood, suggesting that on some outcomes they benefit from a concentration of parental resources. Our results suggest that in middle adulthood parental care needs may instead be concentrated for the only child without the ‘resource’ of siblings. This indicates a need to develop further our understanding of this growing demographic subgroup.

Does Gender Matter in the Receipt of Informal Care Among Community-Dwelling Older Adults? Evidence from a Cross-National Comparative Study Across the United States, South Korea, and China

OBJECTIVES

This study compares patterns of gender difference in the receipt of informal care among community-dwelling older adults across the United States, Korea, and China where family-oriented systems for providing care to older adults are emphasized.

METHOD

Data came from the 2014 Health and Retirement Study, the 2014 Korea Longitudinal Study of Aging, and the 2015 China Health and Retirement Longitudinal Study. Logistic regression models were used to predict the receipt of informal care by gender. We also examined how the effects of health and living arrangement on the receipt of informal care differ depending on gender.

RESULTS

In the United States and China, older women were more likely to receive informal care than men. However, older Korean women were less likely to receive informal care than men. The effects of health and living arrangement on the use of informal care were moderated by gender in different ways across countries.

DISCUSSION

This study provides evidence that patterns of gender differences in the receipt of informal care vary across the three countries. More attention needs to be paid to the design and implementation of long-term supports and services to address the unique patterns of gender difference in care arrangement in each country.

Within-couple dissimilarities in functional impairment as determinants of spousal care arrangement among older married couples

Existing research on spousal care focuses on one spouse receiving care from the other, which fails to address the complexity that is created when both spouses experience some impairments. Our study included situations in which one or both spouses have functional impairments when examining the extent to which spouses from the same couple hold a (dis)similar level of functional impairment and whether such within-couple (dis)similarity has an impact on the spousal care arrangement. A subsample of 1170 older married couples was selected from the 2014 Health and Retirement Study. Descriptive statistics were used for describing the level of each spouse's functional impairment regarding the number of limitations in activities (activities of daily living [ADL]) or instrumental ADL (IADL). Logistic regressions were used to examine whether spousal dissimilarity in functional impairment (dissimilar, similarly low, similarly high) was associated with spousal care arrangement. Within couples with one functionally impaired spouse, the impaired spouse was more likely to receive spousal care when reporting a higher level of ADL/IADL impairment. Within couples with two functionally impaired spouses, the more impaired person was more likely to receive spousal care (without giving back) when spouses reported dissimilar level of IADL impairment; spouses were more likely to report mutual care when they had similarly high levels of IADL impairment. By documenting the role of spousal dissimilarities in functioning for determining spousal care arrangement, our study can inform couple-based interventions that capitalize on each spouse's capabilities and resources.

Navigating the choppy waters to Nirvana: A critical reflective account of caring for ageing parents in the fourth age

This article revisits a paper and from an autoethnographic/critical reflective biographical approach re-examines seven cultural notions or myths, which may encourage ageism. It is framed within my experiential knowledge of caring for my ageing parents, with the tensions and challenges around problematising the value of expertise based on experience, communication, grief, and autonomy and freedom versus safety. The commentary emphasises that by analysing the impact of our personal life experiences, we can start to understand both the intended and unintended consequences of policy and practice affecting those in the fourth age. As a social work educator, I wanted to reflect upon how my tacit experiential knowledge, if made explicit, could impact upon my own and others’ learning. The recent death of my father has allowed for a period of reflection on my own caring and indeed my professional social work experience, knowledge, skills and practice. It is argued that the ageing process is unequal as class and socio-economic factors, i.e. geography, age, gender, religion and ethnicity, all play parts in determining how someone ages, and indeed upon the care an individual older person receives. A fuller understanding of negotiating the role of one stakeholder, that of a family carer in the ageing process, is elicited in this paper.

Does long-term care coverage shape the impact of informal care-giving on quality of life? A difference-in-difference approach

The impact that providing care to ageing parents has on adult children's lives may depend on the long-term care (LTC) context. A common approach to test this is to compare whether the impact of care-giving varies between countries with different LTC coverage. However, this approach leaves considerable room for omitted variable bias. We use individual fixed-effects analyses to reduce bias in the estimates of the effects of informal care-giving on quality of life, and combine this with a difference-in-difference approach to reduce bias in the estimated moderating impact of LTC coverage on these effects. We draw on longitudinal data for Sweden and Denmark from the Survey of Health, Ageing and Retirement in Europe (SHARE) collected between 2004 and 2015. Both countries traditionally had generous LTC coverage, but cutbacks were implemented at the end of the 20th century in Sweden and more recently in Denmark. We use this country difference in the timing of the cutbacks to shed light on effects of LTC coverage on the impact care-giving has on quality of life. Our analyses show that care-giving was more detrimental for quality of life in Sweden than in Denmark, and this difference weakened significantly when LTC coverage was reduced in Denmark, but not in Sweden. This suggests that LTC coverage shapes the impact of care-giving on quality of life.

Spousal care-giving arrangements in Europe. The role of gender, socio-economic status and the welfare state

Spouses (and partners) are the most important source of care in old age. Informal care for frail spouses is provided by both sexes and across all socio-economic backgrounds and welfare policy contexts. There are, however, interesting differences as to whether spouses care alone, receive informal support from other family members or formal support from professional helpers, or outsource the care of their spouse completely. The present article contributes to the literature by differentiating between solo spousal care-giving and shared or outsourced care-giving arrangements, as well as between formal and informal care support. Moreover, we show how care-giving arrangements vary with gender, socio-economic status and welfare policy. Adding to previous research, we compare 17 countries and their expenditures on two elder-care schemes: Cash-for-Care and Care-in-Kind. The empirical analyses draw on the most recent wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 2015. Our results show that men have a higher propensity to share care-giving than women, albeit only with informal supporters. As expected, welfare policy plays a role insofar as higher expenditure on Cash-for-Care schemes encourage informally outsourced care-giving arrangements, whereas Care-in-Kind reduce the likelihood for informally shared or outsourced care-giving arrangements. Moreover, the influence of these welfare policy measures differs between individuals of different socio-economic status but not between men and women.

The mediating roles of functional limitations and social support on the relationship between vision impairment and depressive symptoms in older adults

Vision impairment is prevalent and it is strongly associated with depressive symptoms in older adults. This study aimed to investigate the mediating roles of functional limitations and social support on the relationship between vision impairment and depressive symptoms in older adults. This study used data from a probability-based sample of 1,093 adults aged 60 and older in Shanghai, China. Structural equation models were used to examine the structural relationships among sets of variables simultaneously, including vision impairment, activities of daily living ADLs, instrumental ADLs (IADLs), friends support, family support, relatives support and depressive symptoms. The bootstrapping method and the program PRODCLIN were used to test the indirect effects of these variables. This study found that vision impairment was directly associated with a higher level of depressive symptoms, and the association was partially mediated by functional limitations (IADLs) and social support (friends support). The study demonstrates that improving social support from friends and enhancing social participation for visually impaired older adults can reduce depressive symptoms. More importantly, this study contributes to the knowledge of mediating mechanisms between vision impairment and depressive symptoms.

Adult Children and the Transition of Aging Parents

This study explores the experiences of adult children as they transition their functionally and/or cognitively declining aging parents from independent living to supervised housing. A qualitative grounded theory approach was used to chronicle the experiences of adult children as their caregiving responsibilities intensified and their parents' health declined. Purposive, snowball sampling was used to enlist adult children (n = 16) who were in the process of transitioning an aging parent from an independent living situation to one providing assistance with everyday care and tasks. Semi-structured telephone interviews were conducted and designed to follow a pattern of increased frailty of the parent(s) and escalating involvement of the adult child. Two major themes emerged from the data: Changing places and everlasting love. Adult children began to intervene when cognitive or physical declines compromised the safety and well-being of the older adult and began to assume responsibility for day-to-day needs. As disabilities intensified, adult children relied on siblings, friends, social services, and health care providers to assist in planning and implementing caregiving responsibilities. Deep respect and abiding love of the aging parent(s) sustained the adult child throughout the caregiving experience.

Parental health limitations, caregiving and loneliness among women with widowed parents: longitudinal evidence from France

We investigate how daughters' feelings of loneliness are impacted when widowed parents develop health limitations, and when daughters take on personal care tasks in response. Using longitudinal data from daughters of widowed parents drawn from the French Family and Intergenerational Relationships Study (ERFI, 1485 observations nested in 557 daughters), we assess (a) whether health limitations of widowed parents are associated with daughters' feelings of loneliness regardless of whether or not daughters provide personal care and (b) whether there is an effect of care provision on loneliness that cannot be explained by parental health limitations. Fixed effect regression analyses show that widowed parents' health limitations were associated with raised feelings of loneliness among their daughters. No significant additional effect of providing personal care to a widowed parent was found. Prior research on the impact of health limitations of older parents on the lives of their adult-children has focused mostly on issues related to informal caregiving. Our findings suggest that more attention to the psychosocial impact of parental health limitations-net of actual caregiving-on adult children's lives is warranted.

Adult children stepping in? Long-term care reforms and trends in children's provision of household support to impaired parents in the Netherlands

Recent long-term care (LTC) reforms in the Netherlands are illustrative of those taking place in countries with a universalistic LTC model based on extensive provision of state-supported services. They entail a shift from de-familialisation, in which widely available state-supported LTC services relieve family members from the obligations to care for relatives in need, to supported familialism, in which family involvement in care-giving is fostered through support and recognition for families in keeping up their caring responsibilities. Using data from four waves of the Netherlands Kinship Panel Study (N = 2,197), we show that between 2002 and 2014 the predicted probability that adult children provide occasional household support to impaired parents rose substantially. Daughters more often provided household support to parents than did sons, but no increase in the gender gap over time was found. We could not attribute the increase in children's provision of household support to drops in the use of state-supported household services. The finding that more and more adult children are stepping in to help their ageing parents fits a more general trend in the Netherlands of increasing interactions in intergenerational families.

Residential care and care to community-dwelling parents: out-selection, in-selection and diffusion of responsibility

Research suggests that adult children are less likely to provide care to community-dwelling parents when beds in residential care settings are more widely available. The underlying mechanisms are not well understood. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE) on 1,214 impaired parent–child dyads from 12 countries, we find that adult children are less likely to provide care in countries where beds in residential care settings are more widely available because (a) parents’ care needs are less severe in such countries (out-selection hypothesis) and (b) adult children and impaired parents are less likely to share a household in such countries (in-selection hypothesis). Finally (c), after taking these two factors into account, adult children remain less likely to provide care in countries where beds in residential care settings are more widely available (diffusion of responsibility hypothesis). Plausibly, being able to rely on residential care undermines adult children's sense of urgency to step in and provide care to their parents.

Seniors' narratives of asking (and not asking) for help after a fall: implications for identity

Falls among community-dwelling seniors constitute a major public health concern because of the potential morbidity and mortality associated with the fall. This study examined the informal care networks accessed by Canadian seniors who had visited the Emergency Department as a result of a fall, and considered the implications of the processes of asking for and receiving help on the senior's identity. Four themes were identified. The first was valuing independence. The remaining three themes concerned threats to the participants' identities linked to the need to ask for or receive help from family and friends. They were: becoming indebted, feeling devalued and becoming a burden to others. Seniors were noted to excuse family members from the expectation of helping because of work and family commitments, and illness. Participants described a mutually beneficial relationship with friends wherein both parties valued their independence and provided assistance to the other when needed. Their comments suggested that assistance was viewed as a good to be traded among peers. Our findings indicate that seniors value their independence and may not seek help even when it appears to be available, if asking threatens valued identities. Health and social care practitioners and policy makers responsible for planning and delivery of services should take this into account in order to ensure the best possible care for injured community-dwelling seniors.

Freedom and imperative: mutual care between older spouses with physical disabilities

This article explores mutual caregiving between older spouses aging with physical disabilities. Nine older couples, where both partners had lived long lives with physical disabilities, were interviewed as dyads about mutual caregiving. The couples not only had access to different kinds and degrees of formal support but also provided mutual care to each other in a variety of ways. Interview coding using grounded theory led to two overarching categories from which motivation for mutual caregiving could be understood. These categories were Mutual care as freedom and Mutual care as imperative. The results extend understanding about how older couples with disabilities attached meaning to their mutual caregiving, and why mutual care was sometimes preferable, despite the availability of other sources of help and despite practical difficulties of providing this help. These findings suggest that health care professionals need to be sensitive to the dynamics of the couple relationship and carefully explore the couple's preferences for how formal support can best be provided in ways that honor and sustain the integrity of the couple relationship.