Self-, Informal and Formal Care: Partnerships in Community-Based and Residential Long-Term Care Settings

Heterogeneity in informal care intensity and its impact on employment

Working-age individuals are under growing pressure to contribute unpaid time to the care of elderly family members and friends. Existing work has generally found informal care to negatively impact labor market outcomes, an effect that varies considerably by caregiving intensity, as defined by average hours of care or co-residence with the care receiver. I construct a new measure of caregiving intensity based on the length of caregiving spells. To do so, I use the Longitudinal and International Study of Adults, which provides data on the monthly caregiving status of respondents over a six-year period. I investigate how this dimension of caregiving intensity intersects with better-known measures, and show that results relying on the latter conceal substantial heterogeneity in the impact of caregiving on employment. These differences are particularly important to understand disparities in the impact of caregiving on female and male employment.

Like an extended family: Relationships that emerge when older caregivers use written messages to communicate in an ICT-based healthcare service

OBJECTIVE

To explore the relationships that emerge amongst caregivers of persons with dementia and stroke when caregivers use written messages as their communication tool in a closed information and communication technology (ICT)-based support group.

METHODS

An explorative design with a qualitative approach was used that applied systematic text condensation (STC) to analyse 173 written messages extracted from a web forum.

RESULTS

Empathetic, empowering and familiar relationships emerged amongst peers of older caregivers when the caregivers used written messages as their communication tool. The empathetic relationship was characterised by sincerity and openness when the caregivers shared emotions related to caregiving. The empowering relationship reflected a fellowship based on solidarity influenced by a sense of optimism and a willingness to share knowledge to support one another in overcoming challenges. In the familiar relationship, the caregivers were thoughtful and good-humoured with one another and displayed an attitude of consideration towards one another, as in an extended family.

PRACTICE IMPLICATION

The use of computer-mediated communication in health care service will change the context of establishing and maintaining interpersonal relationships. Therefore, greater knowledge regarding how the peers of caregivers interact with one another is vital so nurses may better support and educate ICT-based support groups.

Recommendations of Common Data Elements to Advance the Science of Self-Management of Chronic Conditions

PURPOSE

Common data elements (CDEs) are increasingly being used by researchers to promote data sharing across studies. The purposes of this article are to (a) describe the theoretical, conceptual, and definition issues in the development of a set of CDEs for research addressing self-management of chronic conditions; (b) propose an initial set of CDEs and their measures to advance the science of self-management; and (c) recommend implications for future research and dissemination.

DESIGN AND METHODS

Between July 2014 and December 2015 the directors of the National Institute of Nursing Research (NINR)-funded P20 and P30 centers of excellence and NINR staff met in a series of telephone calls and a face-to-face NINR-sponsored meeting to select a set of recommended CDEs to be used in self-management research. A list of potential CDEs was developed from examination of common constructs in current self-management frameworks, as well as identification of variables frequently used in studies conducted in the centers of excellence.

FINDINGS

The recommended CDEs include measures of three self-management processes: activation, self-regulation, and self-efficacy for managing chronic conditions, and one measure of a self-management outcome, global health.

CONCLUSIONS

The self-management of chronic conditions, which encompasses a considerable number of processes, behaviors, and outcomes across a broad range of chronic conditions, presents several challenges in the identification of a parsimonious set of CDEs. This initial list of recommended CDEs for use in self-management research is provisional in that it is expected that over time it will be refined. Comment and recommended revisions are sought from the research and practice communities.

CLINICAL RELEVANCE

The use of CDEs can facilitate generalizability of research findings across diverse population and interventions.

Formal and informal care in relation to activities of daily living and self-perceived health among older care-dependent individuals in Norway

Background.  Research about formal care of older home-dwelling people in the Nordic countries is comprehensive, while research on informal care has been less inclusive. Aim.  To describe self-reported activities of daily living and perceived health, and to relate them to amount and types of formal and informal care received by a group of care-dependent, home-dwelling older individuals in Norway. Design and methods.  A sample consisting of 242 persons aged 75+ years receiving home nursing services. Data were collected by means of structured interviews with questions about activities of daily living (ADL), amount and types of formal and informal care and demographic variables. Descriptive statistics, chi-square test, Mann-Whitney U-test and multiple stepwise regression were used in the analyses. Results.  ADL dependency was the only predictor for explaining quantity of home nursing received. Those who received a generous amount of formal care also received a lot of care and support from informal networks. The type of care from the two sources differed. The home nurses performed PADL tasks. While the informal caregivers offered help with IADL tasks. Conclusion.  This study of receiving help in this group of older people in Norway shows that formal and informal care resources complement one another.

The experiences of neighbour, volunteer and professional support-givers in supporting community dwelling older people

Public policy increasingly emphasises the importance of informal support networks to meet the needs of the ageing population. Evidence for the types of support neighbours provide to older people and how neighbours collaborate with formal support-givers is currently insufficient. Our study therefore explored (i) types of informal neighbour support and (ii) experiences of neighbours, volunteers and professionals providing support. Interviews with nine Dutch neighbour support-givers, five volunteers and 12 professionals were conducted and subjected to latent content analysis. Findings indicate that commitment occurred naturally among neighbours; along with providing instrumental and emotional support, neighbour support seems to be a matter of carefully 'watching over each other'. Neighbour support-givers, however, are often frail themselves and become overburdened; they furthermore lack support from professionals. Neighbour, volunteer and professional support-givers seem to operate in distinct, non-collaborative spheres. Findings suggest that policy-makers should consider the opportunities and limitations of neighbour and volunteer support. Professionals have an indispensable role in providing back-up and accountable, specialised support. They may be trained to adopt a visible and proactive attitude in neighbourhoods to facilitate, cooperate with and mediate between neighbour and volunteer support-givers.

Social Support, Caregiving, and Aging

Cet article examine la littérature internationale rédigée en anglais sur le thème du soutien social et des soins gérontologiques depuis le début des années 1990. La littérature s’est développée, mais il manque de consensus sur le sens des termes et sur la mesure. L’intérêt reste une constante pour l’aide pratique, les prestations de soutien social, et la demande et les résultats négatifs pour les aidants, avec de plus en plus de questions plus théoriques, auxquelles on accorde de moins en moins d’importance, sur les résultats négatifs du soutien reçu, ainsi que sur les conséquences positives de la prestation de soins. Le soutien social, néanmoins, est dûment reconnu comme un déterminant social de la santé et reçoit l’attention au niveau des politiques—qui sont tous deux d’importants changements à partir de deux décennies—et ajoutent a l’intérêt ce domaine recevra de chercheurs dans les décennies à venir. Il reste de nombreuses questions sans réponses quant à l’évolution du contexte sociétal, mais il est clair que le soutien social des personnes – y compris la vieillesse et tout au long de la vie – se poursuivra dans l’avenir, quoique dans des formes toujours renouvelées.

Bridging the Knowledge Gap: From Evidence to Policy and Practice that Fosters Seniors' Independence

Cette synthèse vise à mettre en relief certaines conclusions des autres articles de ce numéro et à démontrer de quelle façon on peut les utiliser dans la conception de politiques et de soins de santé qui mettront de l'avant une réforme assurant l'autonomie des aîné(e)s. L'article examine d'abord la réforme de santé et s'y appuie pour commenter les principales conclusions des études du présent numéro. Le débat porte ensuite sur l'importance de la preuve présentée pour l'élaboration des politiques, la planification et les pratiques dans le contexte actuel. Chaque section se termine par la présentation de l'écart pour lequel il faudra faire un examen plus approfondi de la documentation ou sur lequel il faudra pousser la recherche.

Services Provided by Informal and Formal Caregivers to Seniors in Residential Continuing Care

Au chapitre des nouvelles approches pour le soin des aînés fragiles en établissements figure l'adoption de modèles de soins sociaux qui se traduit par l'embauche de travailleurs polyvalents et la participation des membres de la famille à la prestation des soins. On a utilisé les méthodes de rappel et d'emplois du temps pour évaluer les types de tâches et la quantité de services fournis par la famille et le personnel soignant dans trois modèles de soins. Les résultats indiquent que les membres de la famille accordent environ 30 pour cent des soins sur place. Ils consacrent la plupart de leurs efforts au bien-être des patients alors que le personnel se charge plutôt des travaux domestiques. Les modèles de soins diffèrent entre les milieux familiaux pour adultes, les logements avec assistance et ceux où il faut donner des soins reliés à la démence. La durabilité des modèles dépend de la saffisance du personnel et des attentes raisonnables à l'égard des ressources familiales.

Sociology of Aging in Canada: Issues for the Millennium

This paper presents a selective review of sociological gerontology in Canada, examining where it has been, where it is, and where it could go in the future in four general areas: inequality, population aging and the social construction of crisis; family relations and caregiving; work, retirement and income security; and health, health care systems, and health policy. This review suggests that the sociology of aging has not differentiated itself by the topic studied or by its applied and empirical focus, but rather in its unique perspective that reveals the importance of social structures for the personal and private experience of aging. In doing so, sociological gerontology rejects deterministic assumptions ofinevitability. The importance of relating the personal to the public and of continuing a critical examination of existing trends will continue into the future. An additional challenge will be the generation ofnew knowledge on how to transform institutions so that they better enhance the quality oflife ofseniors, including the identification of support of family structures and community environments, as well as more appropriate health and income security policies. This also includes research on effective and appropriate means of introducing new structures and implementing new policies and programs within the context of current social institutions.

Medical Services Utilization Patterns by Seniors

Cette analyse documentaire vise à déterminer les principaux éléments du mode d'utilisation des soins médicaux chez les aînés dans le cadre du Consensus national sur la conception et la prestation d'une réforme des soins de santé visant à promouvoir l'autonomie des personnes âgées (Shapiro & Havens, 2000). On y présente une stratégie de recherche de la documentation pertinente depuis 1985 portant principalement sur des articles de revuses révisés par les pairs et on résume les conclusions de la recherche. On souligne les principaux articles, lesquels sont analysés et synthétisés à partir de modalités américaines ou canadiennes de fonctionnement institutionnel, de recours aux médecins, aux soin ambulatoires et sur des déterminants de l'utilisation de ces services.

We share the care: family caregivers' experiences of their older relative receiving home support services

Although both family care and home support are considered essential components of home-based health-care, the experiences of family caregivers who have a relative in receipt of home support services are not well understood. Little is known about what aspects of home support services assist family caregivers or hinder them in their caregiving. This study examines family member's experiences of the home support services received by their elderly relatives. Based on a previous Canadian study of contributions in family caregiving, we developed a conceptual model for understanding multiple contributions in caregiving. The present study used this conceptual model to guide the analysis of data from in-depth interviews with family caregivers (N = 52), completed August 2007-April 2008, who have or had an older relative in receipt of home support services in British Columbia, Canada, in the previous 12 months. Verbatim transcripts were read, re-read and independently coded by three members of the research team to identify common themes. Themes relating to direct care (care provided directly to the elderly person) and assistive care (care provided to one caregiver by another) were identified. In discussing the direct care provided by workers, family members emphasised dissatisfaction with instrumental assistance provided by home support workers while also stressing the importance of affective assistance. In commenting about assistive care there were three key themes: caring together, care management, and quality assurance and monitoring. In conclusion, the important role of home support in providing relief for caregivers is highlighted and implications for caregiver policy are discussed.

Caregiving Networks in Later Life: Does Cognitive Status Make a Difference?

This study examines the caregiving networks of older adults, with particular emphasis on differences according to cognitive status (n = 303). Individuals with cognitive impairment were significantly more likely than those who were cognitively intact to receive assistance with personal care, linking with the outside world, and mobility. The types of network were generally similar for care receivers with cognitive impairment and those who were cognitively intact, although the percentage of networks comprised solely of the identified caregiver varied depending on the tasks. Coresidence of the caregiver and care receiver was more important than the care receiver's cognitive status for exclusive care by the identified caregiver. Having more ADL/IADL limitations was associated with a reliance on a network of the identified caregiver, in conjunction with other caregivers in several task areas. The findings highlight the complexity of sources of help in later life and the need for future research to consider the caregiving network as a whole.

Health Service Utilization among Older Adults in British Columbia: Making Sense of Geography

The utilization of health services by older adults has received increased attention over the past decade, but little is known about how service utilization varies between rural and urban areas. In an era of restructuring and downsizing within the Canadian health care system, there are concerns that rural older adults may be increasingly disadvantaged when it comes to accessing health care. This article examines the utilization of a range of health services by older adults living in urban and rural communities in British Columbia. A major strength of this article is its concurrent focus on a continuum of geographic communities and a broad range of services needed and used by older populations. The research utilizes provincial administrative health data from 48,407 older residents of British Columbia who used services in 1998–1999. Multivariate analyses of co-variance reveal some unique service utilization patterns by geographical area and population.

The interpretive dynamics of filial and collective responsibility for elderly people

Drawing on accounts from 28 adult children, I explore the interpretive dynamics of filial and social responsibility for elderly people. Participants tended to characterize individualistic, voluntary motivations positively in talk about personal filial responsibility, yet when speaking about other Canadians, criticized individualistic values as promoting irresponsibility. Others were assessed negatively in contrast to an idealized past and non-Western cultures; "Canadian society" was used as a contrast against which to define self as filially responsible. In this process, participants also reproduced conceptual opposition between filial and societal responsibility; rarer was an alternative, "solidarity" paradigm utilized.

The inter-relationship between formal and informal care: a study in France and Israel

This study examined whether formal care services delivered to frail older people's homes in France and Israel substitute for or complement informal support. The two countries have comparable family welfare systems but many historical, cultural and religious differences. Data for the respondents aged 75 or more years at the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. Regressions were examined of three patterns of care from outside the household: informal support only, formal support only and both formal and informal care, with the predictor variables including whether informal help was provided by a family member living in the household. The results revealed that about one-half of the respondents received no help at all (France 51%, Israel 55%), about one-tenth received care from a household member (France 8%, Israel 10%), and one-third were helped by informal carers from outside the household (France 34%, Israel 33%). More French respondents (35%) received formal care services at home than Israelis (27%). Most predictors of the care patterns were similar in the two countries. The analysis showed that complementarity is a common outcome of the co-existence of formal and informal care, and that mixed provision occurs more frequently in situations of greater need. It is also shown that spouse care-givers had less formal home-care supports than either co-resident children or other family care-givers. Even so, spouses, children and other family care-givers all had considerable support from formal home-delivered care.

Self-care as a health resource of elders: an integrative review of the concept

AIM

To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource.

BACKGROUND

Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care.

METHOD

In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We interactively compared data and display matrices to describe self-care as a health resource.

RESULTS

Fifty-seven articles addressed health self-care and were integrated into a framework of self-care as a health resource of elders. Self-care was identified as a two-dimensional construct including action capabilities and processes for health in self-care practice. The capabilities consisted of fundamental capabilities, power capabilities and performance capabilities. The action processes included a process of life experience, a learning process and an ecological process.

CONCLUSION

This review offers insight into self-care as a significant health resource of elders with different health status. It suggests that an elder's self-care ability is determined by the interaction of various sub-resources and conditions and emphasizes the constantly evolving nature of self-care. The framework may be of use in clinical practice, policy-making and research into health care of frail or robust elders.

A new typology of home-care helpers

PURPOSE

The formal-informal dichotomy of home care, which has been a theoretical framework in quantitative and qualitative research, might not be descriptive of older persons' views about their home-care providers. This qualitative study explores the perspectives of older women about the characteristics of their home-care providers.

DESIGN AND METHODS

Three interviews were conducted with each of 25 women (aged 80-94 years) during the first 4 months of participation in a 3-year phenomenological study. The women described their helpers. We differentiated helper types on the basis of the nature of the help, and we explored variations in compensation arrangements.

RESULTS

We delineated a new typology of home-care helpers: regular helpers, on-call helpers, can-will doers, and mainstays.

IMPLICATIONS

When home-care helpers are categorized by type of assistance provided, the potential value of their efforts is more evident. The association of formal care with paid help and informal care with nonpaid help limits the effectiveness of the dichotomy as a basis for home-care-payment policies. The new home-care-helper typology cuts across the dimensions of the dichotomy, providing an alternative theoretical framework for further research.