1
|
Mobasseri K, Matlabi H, Allahverdipour H, Kousha A. Home-based supportive and health care services based on functional ability in older adults in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:124. [PMID: 38784273 PMCID: PMC11114482 DOI: 10.4103/jehp.jehp_422_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/22/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND Home-based care is affordable due to population aging, increased chronic disease, and higher hospitalization costs. The objective was to evaluate home-based supportive and health care services provided to older adults and identify possible associations between activities of daily living (ADLs), instrumental ADL (IADLs) classifications, sociodemographic variables, clinical characteristics, and perceived social support among older adults. MATERIALS AND METHODS In this cross-sectional study, 700 people aged 60 years and older were selected by stratified cluster sampling. Areas of Tabriz City were selected as clusters, and 55 comprehensive urban health centers were selected as stratifies. Chi-square, Pearson's and Spearman's tests, and multiple linear regression were used for statistical analyses. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS 24.0, SPSS Inc., Chicago, USA). The study instrument included demographic characteristics of older adults and caregivers, health services provided at home, and two valid questionnaires, including the KATZ index of independence in (instrumental) activities of daily living and a multidimensional scale of perceived social support. Scores on scales and demographic variables were collected during telephone interviews. The study lasted from April 25, 2022, to October 30, 2022. RESULTS A high level of perceived social support was 56.6%. The study found that 51.3% of participants had family caregivers. Most participants had ADL independence (85.4%), while 22.9% and 24.3% were dependent and needed assistance with IADL, respectively. Women had a lower ADL score and a higher IADL score than men (P < 0.05). The obtained results of multiple regression analysis revealed a negative and significant association between unemployment, illiteracy, increasing age, five and more medications, and ADL and IADL dependency (P < 0.05). CONCLUSION Empowering older adults to reduce dependency, and designing a formal home-based care system is recommended.
Collapse
Affiliation(s)
- Khorshid Mobasseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Geriatric Health, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Matlabi
- Department of Geriatric Health, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Kousha
- Department of Health Education and Promotion, Faculty of Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
2
|
Khalaila R, Vitman-Schorr A. Home care and quality of life among community-dwelling dependent older adults in Israel: a multiple mediator model. Qual Life Res 2024; 33:507-517. [PMID: 37955794 DOI: 10.1007/s11136-023-03541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To examine the association between home care provision (combined paid formal home care and non-paid family-only home care) versus non-paid family-only home care with quality of life (QoL) of older adults, as well as the mediating effects of loneliness, social isolation and satisfaction with family relationships and support. METHODS A convenience sample of 360 Israeli dependent adults aged 65 + responded to questionnaires. Using bootstrapping, we tested the strength and significance of the conditional indirect effects of the four simultaneous mediators. RESULTS Using combined home care provision (paid formal home care and non-paid family-only home care) versus non-paid family-only home care for older adults was associated with lower QoL of care-recipients (B = - 4.57, t = - 2.24, p = 0.001, 95% CI - 8.58, - 0.56; R2 = 0.37), and was fully and strongly mediated by feelings of loneliness (B = - 1.92, p = 0.001, 95% CI - 3.66, - 0.79), social isolation (B = - 0.54, p = 0.001, 95% CI - 1.47, - 0.07) and satisfaction with family support (B = - 1.09, p = 0.001, 95% CI - 2.57, - 0.16). However, the indirect effect through satisfaction with family relationships was not significant. The highest proportion of the indirect effect size was (B = 0.42, 95% CI 0.13, 1.97) for loneliness, followed by satisfaction with family support (B = 0.23, 95% CI 0.01, 1.07), and social isolation (B = 0.11, 95% CI 0.01, 0.66), respectively. CONCLUSIONS Using combined formal home care might reduce the QoL of care-recipients by increasing their feelings of loneliness, social isolation and reduced perceived family support. Practitioners should encourage family members to continue with family regular support and contact alongside the use of formal home care in order to maintain satisfaction and QoL of older relatives.
Collapse
Affiliation(s)
- Rabia Khalaila
- Zefat Academic College, 11 Jerusalem St, P.O.B 169, 13206, Zefat, Israel.
- University of California San Francisco, Global Brain Health Institute, San francisco, CA, USA.
| | - Adi Vitman-Schorr
- Shamir Research Institute, Haifa University and Tel-Hai College, 1290000, Kazrin, Israel
| |
Collapse
|
3
|
Boerner K, Kim K, Kim YK, Jopp DS. Support Exchanges Among Very Old Parents and Their Children: Findings From the Boston Aging Together Study. THE GERONTOLOGIST 2022; 62:375-384. [PMID: 33772286 PMCID: PMC8963138 DOI: 10.1093/geront/gnab043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Very old parents and their "old" children are a growing group in industrialized countries worldwide. Care needs of very old parents can be substantial, while children may also face their own age-related issues. Continued mutual support represents an important pathway to addressing emerging care needs. This study aimed to identify patterns of support exchanges occurring in very old parent-child dyads and to ascertain associated individual and relationship factors. RESEARCH DESIGN AND METHODS Participants were 114 very old parents (aged ≥90) and their children (aged ≥65) from the Boston Aging Together Study. Data were collected using comprehensive, semistructured in-person interviews with both dyad members, including standardized assessments of support exchanges, relationship quality, health, and perceptions of family norms. Actor-Partner Interdependence Models were used to predict upward and downward support reported by children and parents. RESULTS Both dyad members not only reported substantial upward support (child to parent) in all domains but also notable amounts of downward (parent to child) in the domains of emotional support, listening, and socializing. Findings showed significant associations of parent functional impairment, parent and child relationship quality, and child perceptions of family obligation with upward support and of relationship quality with downward support. DISCUSSION AND IMPLICATIONS Continued support exchanges among very old parents and their children indicated that intergenerational theories still hold up in very late-life relationships. Health care professionals should be aware that attention to relationship quality and family norms might be vital to ensure that support needs are met.
Collapse
Affiliation(s)
- Kathrin Boerner
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Massachusetts, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Yijung K Kim
- Texas Aging & Longevity Center, The University of Texas at Austin, Austin, Texas, USA
| | - Daniela S Jopp
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, Lausanne, Switzerland
| |
Collapse
|
4
|
Khalaila R, Vitman-Schorr A. Social support and loneliness among frail older adults attending daycare centers: A multicultural study in Israel. Arch Gerontol Geriatr 2021; 97:104486. [PMID: 34325329 DOI: 10.1016/j.archger.2021.104486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/20/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
AIMS To examine the link between intensity of use of formal support and loneliness among older adults, controlling for family support and covariates; and examine the moderating effect of contact frequency with family on this relationship. METHODS Cross-sectional data were collected from September 2016 - April 2017 through structured interviews with 360 older adults attending adult day care centers (ADCCs) and representing three different ethnic groups in Israel. Loneliness was assessed by the UCLA Loneliness Scale. Hierarchical regression was applied to the study variables with loneliness scores as dependent variable, and bootstrapping with resampling strategies tested a moderating effect. RESULTS Loneliness was linked negatively with contact frequency with the family network, frequency of ADCC attendance, and greater involvement in social activities at the ADCC. Significant negative correlation between ADCC attendance frequency and loneliness occurred only when family contact was at low-to-average frequency, but not in cases of high-contact frequency. CONCLUSIONS Frequent use of ADCCs emerged as a significant contributor beyond the contribution of family support for reducing loneliness in older age, particularly for those with insufficient family contact. Service providers should improve the accessibility and availability of formal community services for the older population.
Collapse
Affiliation(s)
- Rabia Khalaila
- Zefat Academic College, 11 Jerusalem St., P.O.B 169, Zefat 13206, Israel.
| | | |
Collapse
|
5
|
Shamsikhani S, Ahmadi F, Kazemnejad A, Vaismoradi M. Typology of Family Support in Home Care for Iranian Older People: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126361. [PMID: 34208269 PMCID: PMC8296177 DOI: 10.3390/ijerph18126361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 01/20/2023]
Abstract
The world population is rapidly aging. In older people, age-related biological decline in most body systems causes functional decline, an increase in dependence, and an increased need for support, especially by their family members. The aim of this study was to explore the main aspects of family support for older parents in home care. This qualitative study was conducted using a deductive qualitative content analysis approach. Participants were 21 older parents living in their own homes, as well as four family members of some participants. Data were collected using semi-structured interviews and then were analyzed using the primary matrix developed based on the existing literature. The main aspects of family support for older parents were grouped into five predetermined categories and one new category: "instrumental support", "financial support", "psycho-emotional support", "healthcare-related support", "informational-technological support", and "social preference support ". Family support for older people in home care is a multi-dimensional phenomenon. Family members can identify the needs of their older parents and provide them with appropriate support in collaboration with healthcare professionals to enhance their quality of life, autonomy, and satisfaction with life.
Collapse
Affiliation(s)
- Soheila Shamsikhani
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14155-4838, Iran; (S.S.); (A.K.)
| | - Fazlollah Ahmadi
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14155-4838, Iran; (S.S.); (A.K.)
- Correspondence: ; Tel.: +98-21-8288-3590
| | - Anoshirvan Kazemnejad
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14155-4838, Iran; (S.S.); (A.K.)
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, 8049 Bodø, Norway;
| |
Collapse
|
6
|
Pristavec T, Luth EA. Informal Caregiver Burden, Benefits, and Older Adult Mortality: A Survival Analysis. J Gerontol B Psychol Sci Soc Sci 2020; 75:2193-2206. [PMID: 31903481 PMCID: PMC7664316 DOI: 10.1093/geronb/gbaa001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Informal caregivers are crucial to maintaining older adults' health, but few studies examine how caregiving receipt is associated with older person longevity. In a nationally representative sample, we prospectively explore whether and how having an informal caregiver is associated with older adult overall mortality, and how caregivers' burden and benefits perceptions relate to care recipient mortality. METHODS We match six National Health and Aging Trends Study waves (2011-2016) with 2011 National Study of Caregiving data, conducting survival analysis on 7,369 older adults and 1,327 older adult-informal caregiver dyads. RESULTS Having an informal caregiver is associated with 36% (p < .001) higher mortality risk over 6-year follow-up, adjusting for demographic, economic, and health factors. Older adults whose caregivers perceive only burden have 38% higher (p < .05) mortality risk than those with caregivers reporting neither burden nor benefits. This risk is reduced from 38% higher to 5% higher (p < .001) for older adults with caregivers reporting benefits alongside burden, compared to those with caregivers reporting neither perception. DISCUSSION Having a caregiver may signal impending decline beyond known mortality factors. However, interventions to increase caregivers' benefit perceptions and reduce their burden may decrease mortality risk for older adults with declining health and functional ability.
Collapse
Affiliation(s)
- Teja Pristavec
- Social and Decision Analytics Division, Biocomplexity Institute and Initiative, University of Virginia, Arlington
| | - Elizabeth A Luth
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
| |
Collapse
|
7
|
Weaver RH, Roberto KA. Location Matters: Disparities in the Likelihood of Receiving Services in Late Life. Int J Aging Hum Dev 2020; 93:653-672. [PMID: 32830543 DOI: 10.1177/0091415020948205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Moving beyond typical dichotomous rural-urban categorizations, this study examines older adults' likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014-2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p = .003) and mostly urban (OR = 1.97, p = .024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults' ability to live.
Collapse
Affiliation(s)
- Raven H Weaver
- 6760 Department of Human Development, Washington State University, Pullman, WA, USA
| | - Karen A Roberto
- 1757 Institute for Society, Culture and Environment & Center for Gerontology, Virginia Tech, Blacksburg, VA, USA
| |
Collapse
|
8
|
Park E, Kim N, Ta Park VM, Rhee Y. Caregiving for Community-Dwelling Older Persons in South Korea: Current Formal and Informal Care Use and Expectation. J Appl Gerontol 2019; 39:398-403. [DOI: 10.1177/0733464819866360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The aim of this study is to examine formal and informal care use among community-dwelling older Korean adults. Older adults aged between 65 and 85 ( N = 516) in mid-size city, selected using the probability proportional sampling method, were interviewed in person. One third reported having at least one caregiver. Compared to respondents who did not use any informal/formal care, those who used any formal or informal care were older and were more likely to be prefrail or frail and experienced at least one hospitalization or emergency department use in the past year. Living alone or being experienced with any hospitalization was associated with formal care use. Most care recipients received informal care from families, specifically spouses. Among participants who received no formal/informal care, 19% of them expected to receive formal care support in the future. Substantial support programs for informal caregivers are needed to address the increase in demand and expectation for long-term care.
Collapse
Affiliation(s)
- Eunja Park
- Korea Institute for Health and Social Affairs, Sejong, South Korea
| | - Namsoon Kim
- Korea Institute for Health and Social Affairs, Sejong, South Korea
| | | | - YongJoo Rhee
- Dongduk Women’s University, Seoul, South Korea
- Northwestern University, Chicago, IL, USA
| |
Collapse
|
9
|
Sun Z, Guerriere DN, de Oliveira C, Coyte PC. Does informal care impact utilisation of home-based formal care services among end-of-life patients? A decade of evidence from Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:437-448. [PMID: 30307669 DOI: 10.1111/hsc.12664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/28/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
Understanding how informal care impacts formal care utilisation for home-based end-of-life patients is an important policy- and practice-relevant question. This paper aims to assess the relationship between informal and formal home care among home-based end-of-life patients and how this relationship has changed over the last decade and over the end-of-life trajectory. We focus on informal care provided by family members or friends, and three types of home-based formal care services: care by personal support workers, physician visits, and nurse visits. Using survey data collected in a home-based end-of-life care programme in Ontario, Canada from 2005 to 2016, we build a two-part utilisation model analysing both the propensity to use each type of formal care and the amount of formal care received by patients. The results suggest that informal care is a substitute for care by personal support workers, but a complement to physician visits and nurse visits. In the case of nurse visits, an increased complementary effect is observed in more recent years. For home-based physician and nurse visits, the complementary effect grows with patient's proximity to death. These results highlight the complexity of the relationship between informal and formal care among home-based end-of-life patients. Decision-makers need to take into account the relationship between informal care and different types of formal services when introducing future policies.
Collapse
Affiliation(s)
- Zhuolu Sun
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Denise N Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Center for Health Economics, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Center for Health Economics, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Family status and later-life depression among older adults in urban Latin America and the Caribbean. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractRapid fertility declines in Latin American and Caribbean countries since the 1960s have contributed to smaller family sizes among the current cohorts of older adults. This may have mental health implications in these societies as the family unit is highly valued as a source of social support. Utilising data from the 2000 Survey of Health, Well-being and Aging in Latin America and the Caribbean (SABE), this study examines the association between parental status, marital status and the likelihood of experiencing depressive symptoms among adults 60 years and older in seven cities within Latin America and the Caribbean (N = 9,756): Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. Results from multivariate logistic regressions indicate that parental status is not significantly associated with depressive symptoms. Nonetheless, unmarried older adults, both those living alone and those living with others, are more vulnerable to experiencing depressive symptoms than their married counterparts. Marriage is especially protective for older adults in Havana and Montevideo. Older adults’ perceived income adequacy significantly moderates the relationship between marital status and depressive symptoms. Other significant covariates, such as experiencing disability and comorbidity, showed positive associations with depressive symptoms. While families may still represent a critical component for the mental health of older adults, broader investments in health across the lifespan are needed to improve individual psychological wellbeing.
Collapse
|
11
|
Abstract
The study examined family relations and elder care, in light of the modernization processes that are taking place in the Arab sector. Interviews with 25 older adults, 27 family members, and 5 paid home care workers of an Arab origin were conducted. Qualitative analysis consisted of constant comparisons and contrasts of relevant themes. Most Arabs reported that intergenerational solidarity is very strong in the Arab sector. Whereas many older adults and a few of their family members tended to favor paid care, the majority of Arab family members and fewer older adults stated that family care is preferred. Finally, a third theme outlined the desired properties of care, which consists of a true mix between formal and informal care. The study points to two sources of tension between (a) older adults and their family members and (b) perspectives on care held by the National Insurance Institute and the Arab sector.
Collapse
Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
12
|
Lee Y, Barken R, Gonzales E. Utilization of Formal and Informal Home Care: How Do Older Canadians’ Experiences Vary by Care Arrangements? J Appl Gerontol 2018; 39:129-140. [DOI: 10.1177/0733464817750274] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigates how the receipt of formal, informal, and/or a combination of both types of care at home relates to older adults’ perceived loneliness, life satisfaction, and day-to-day lives. Quantitative analyses using the Canadian Community Health Survey ( n = 3,928) reveal that older adults who only received formal care reported lower levels of loneliness and higher levels of life satisfaction when compared with respondents who received informal or a blend of home care. Qualitative analyses of persons aged 65+ years receiving formal and informal home care in Ontario ( n = 34) suggest that formal care bolstered care recipients’ autonomy and reduced their sense of being a burden on family. In turn, receiving formal care served to improve these older adults’ social connectedness and well-being. Findings underscore older adults’ symbolic, functional, and emotional attachment to formal care services, as well as the limitations of a reliance on informal support.
Collapse
|
13
|
Weaver RH, Roberto KA, Blieszner R. Older Adults in Rural Appalachia: Preference and Expectations for Future Care. Int J Aging Hum Dev 2017; 86:364-381. [PMID: 28814109 DOI: 10.1177/0091415017720891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about how rural-dwelling older adults anticipate and plan for future care needs. Using a mixed-method explanatory design, structural equation modeling ( n = 535) revealed significant associations between concerns about using services on preference for type of help; preference was associated with likelihood of using future services. Content analysis of interview data from 19 older adults who needed but were not receiving help revealed how they conceptualize their need for assistance and anticipated future care arrangements. Nine older adults were not thinking about future care needs. While most older adults articulated preferences for informal help, they indicated some openness to formal assistance. Preferences did not always align with expectations for the future. Rather, concerns about burdening family and friends outweighed concerns about community services and influenced expectations of using formal services. Understanding rural older adults' expectations for future care arrangements is necessary for advancing policy and implementing successful services options.
Collapse
|
14
|
Liu X, Lu B, Feng Z. Intergenerational transfers and informal care for disabled elderly persons in China: evidence from CHARLS. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1364-1374. [PMID: 28276169 DOI: 10.1111/hsc.12441] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 05/23/2023]
Abstract
Aiming at 'ageing healthier and ageing better', a certain amount of high-quality informal care should be available for elderly persons with physical disability as formal care is barely accessible in China. The demographic transition and family structural changes have dramatically weakened traditional norms of filial piety and the structure of intergenerational transfers. This article employed nationwide representative data from the first wave (2011) of Chinese Health and Retirement Longitudinal Study (CHARLS) in order to identify the duration of informal care provision at home for frail elders (1122 in rural areas and 577 in urban areas, total 1699), measured in monthly hours, before estimating the associations between intergenerational transfers and the received time of informal care with Tobit Model analysis. Results showed that financial support from the younger generation was unexpectedly negatively associated with the monthly hours of care, implying a reduction of caring support along with increasing financial transfers towards older parents. The lack of informal care could not be compensated by having more children, co-residing with children, or increasing the parent-to-child/grandchild transfers. Spouses were shown to replace children as the major caregivers. In addition, the community-based long-term care system needs to be promoted to sustain and develop informal care, as the latter will become increasingly important with changing family dynamics. Finally, the received time of informal care, rather than the severity of physical disability measured by difficulty with ADLs or IADLs, was introduced to identify the actual demand for care by elders. The paper argues that it is important to reconceptualise and re-investigate the duration of care provision in the Chinese context in order to develop standards of payment as part of long-term care policies.
Collapse
Affiliation(s)
- Xiaoting Liu
- School of Public Affairs, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bei Lu
- ARC Centre of Excellence in Population Ageing Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Zhixin Feng
- Centre for Research on Ageing, Social Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
15
|
Jönsson M, Appelros P, Fredriksson C. Older people readmitted to hospital for acute medical care – Implications for occupational therapy. Scand J Occup Ther 2016; 24:143-150. [DOI: 10.1080/11038128.2016.1227367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
16
|
HLEBEC V, SRAKAR A, MAJCEN B. Determinants of Unmet Needs among Slovenian Old Population. Zdr Varst 2016; 55:78-85. [PMID: 27647092 PMCID: PMC4820185 DOI: 10.1515/sjph-2016-0011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Population ageing has significant effects on societies. The organization of care for dependent old people is one of the key issues for ageing societies. The majority of care for homebound dependent old people in Slovenia is still performed by informal carers, even though the use of formal services has been increasing over the last 20 years. The proportion and characteristics of people with unmet needs are important for the development of long term care social policy. METHOD The SHARE (Survey of Health, Ageing and Retirement in Europe) survey was used to assess the determinants of care arrangements and of unmet needs of the aging population in Slovenia. Multinomial regression analysis was used to evaluate individual and contextual determinants of care arrangements and unmet needs. RESULTS The proportion of older people with unmet needs is 4%. As expected, "needs" (Functional impairment OR=4.89, P=0.000, Depression OR=2.59, P=0.001) were the most important determinant, followed by the predisposing factor "age" (age OR 1.15, P=0.000) and two enabling factors, namely:"community setting and "availability of informal care within household" (Urban areas OR=.47, P=0.021; Household size 3+ OR=2.11, P=0.030). CONCLUSION This study showed that there are a proportion of older people in Slovenia with severe needs for care, which are being unmet. As shown by the importance of enabling factors, social policy should encourage the development of formal services in rural areas and elaborate policy measures for informal carers.
Collapse
Affiliation(s)
- Valentina HLEBEC
- University of Ljubljana, Faculty of Social Sciences, Kardeljeva ploščad 5, 1000 Ljubljana, Slovenia
| | - Andrej SRAKAR
- Institute for Economic Research, Kardeljeva ploščad 17, 1000 Ljubljana, Slovenia
| | - Boris MAJCEN
- Institute for Economic Research, Kardeljeva ploščad 17, 1000 Ljubljana, Slovenia
| |
Collapse
|
17
|
Schure MB, Goins RT. Association of depressive symptomatology with receipt of informal caregiving among older American Indians: the native elder care study. Am J Geriatr Psychiatry 2015; 23:579-88. [PMID: 24801609 PMCID: PMC4185302 DOI: 10.1016/j.jagp.2014.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/12/2014] [Accepted: 03/31/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our study objectives were to identify the primary sources of informal caregiving and to examine the association of depressive symptomatology with receipt of informal caregiving among a sample of community-dwelling older American Indians. DESIGN We conducted a cross-sectional study of older American Indians. PARTICIPANTS Community-dwelling adults aged 55 years and older who are members of a federally recognized American Indian tribe in the Southeast United States. MEASUREMENTS We collected information on the participant's primary caregiver, number of informal care hours received in the past week, depressive symptomatology, demographic characteristics, physical health status, and assistance need. RESULTS Daughters, spouses, and sons were the most common informal primary caregivers with distinct differences by sex of those receiving care. Compared with participants with lower levels, those with a high level of depressive symptomatology received substantially greater hours of informal care (33.4 versus 11.5 hours per week). CONCLUSION Older American Indians with higher levels of depressive symptomatology received more informal caregiving than those with lower depressive symptomatology. The burden of caregiving of older adults is primarily shouldered by spouses and children with those who care for older adults with depressive symptomatology likely experiencing an even greater burden of care.
Collapse
Affiliation(s)
- Marc B Schure
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA.
| | - R Turner Goins
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, and Center for Healthy Aging, Mountain Area Health Education Center, Asheville, NC
| |
Collapse
|
18
|
Wilson DM, Vihos J, Hewitt JA, Barnes N, Peterson K, Magnus R. Examining waiting placement in hospital: utilization and the lived experience. Glob J Health Sci 2013; 6:12-22. [PMID: 24576361 PMCID: PMC4825473 DOI: 10.5539/gjhs.v6n2p12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/23/2013] [Indexed: 11/12/2022] Open
Abstract
This mixed-methods study addressed the problem that although waiting placement is considered a major hospital utilization issue, minimal evidence exists to highlight the extent of it and the personal impact of waiting placement. An analysis of two years of complete hospital data for the Canadian province of Alberta was undertaken to examine waiting placement rates and describe waiting placement patients. Qualitative interviews and observations of elderly patients waiting in hospital for nursing home placement were also undertaken to gain an understanding of the lived experience of waiting for placement in hospital. Only 1.8% of all inpatients were waiting placement with an ALC (Alternative Level of Care) designation, 80% of ALC waits were less than 41 days (mean=29.85, median=14), and 2.2% of total hospital bed days in these two years were used by ALC patients. Three qualitative themes emerged: (a) coming to a realization of this significant move, (b) waiting is boring and distressing, and (c) hospitals are not designed for waiting placement. The findings of this study should raise awareness that although relatively few people wait placement in hospital, there are some major possible negative effects of waiting for placement in hospital for those who wait; with remedies to address waiting placement care deficits needed.
Collapse
|
19
|
Tsutsui T, Muramatsu N, Higashino S. Changes in perceived filial obligation norms among coresident family caregivers in Japan. THE GERONTOLOGIST 2013; 54:797-807. [PMID: 24009170 PMCID: PMC4163045 DOI: 10.1093/geront/gnt093] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose of the Study: Japan introduced a nationwide long-term care insurance (LTCI) system in 2000, making long-term care (LTC) a right for older adults regardless of income and family availability. To shed light on its implications for family caregiving, we investigated perceived filial obligation norms among coresident primary family caregivers before and after the policy change. Design and Methods: Descriptive and multiple regression analyses were conducted to examine changes in perceived filial obligation norms and its subdimensions (financial, physical, and emotional support), using 2-wave panel survey data of coresident primary family caregivers (N = 611) in 1 city. The baseline survey was conducted in 1999, and a follow-up survey 2 years later. Results: On average, perceived filial obligation norms declined (p < .05). Daughters-in-law had the most significant declines (global and physical: p < .01, emotional: p < .05) among family caregivers. In particular, physical support, which Japan’s LTC reform targeted, declined significantly among daughters and daughters-in-law (p < .01). Multiple regression analysis indicated that daughters-in-law had significantly lower perceived filial obligation norms after the policy introduction than sons and daughters (p < .01 and p < .05, respectively), controlling for the baseline filial obligation and situational factors. Implications: Our research indicates declining roles of daughters-in-law in elder care during Japan’s LTCI system implementation period. Further international efforts are needed to design and implement longitudinal studies that help promote understanding of the interplay among national LTC policies, social changes, and caregiving norms and behaviors.
Collapse
Affiliation(s)
- Takako Tsutsui
- National Institute of Public Health, Ministry of Health, Labour and Welfare, Saitama, Japan
| | | | | |
Collapse
|
20
|
Rodríguez M. Use of informal and formal care among community dwelling dependent elderly in Spain. Eur J Public Health 2013; 24:668-73. [PMID: 23813712 DOI: 10.1093/eurpub/ckt088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Faced with increased public spending for care, knowledge of the determinants of the choices between informal and formal care is of particular importance for estimating the need for care in the future. METHODS Using a representative sample of Spanish dependent elderly from the Disabilities, Independence and Dependency Situations Survey (DIDSS) 2008, we compare the factors associated with the reception of informal, formal and mixed care. The study included 10 703 dependent persons living at home aged ≥ 65 years. RESULTS Overall, the percentage of those receiving only informal care was high in Spain, 47.5%. Formal care was most often received in combination with informal care (9.8%) than alone (4.9%). Five out of the seven factors analysed were found to influence the reception of all types of care: age, gender, income, self-rated health and suffering a chronic condition. CONCLUSIONS There is a high coincidence among how factors affect the reception of care although some differences can be noted. Curiously, a high income level and the availability of informal care (as measured by living with a partner) can negatively affect the reception of only formal care. Living in a capital can also have an impact on the type of care a dependent elderly person receives.
Collapse
Affiliation(s)
- Mercedes Rodríguez
- Department of International and Spanish Economics, University of Granada, Spain
| |
Collapse
|
21
|
Dramé M, Lang PO, Jolly D, Narbey D, Mahmoudi R, Lanièce I, Somme D, Gauvain JB, Heitz D, Voisin T, de Wazières B, Gonthier R, Ankri J, Saint-Jean O, Jeandel C, Couturier P, Blanchard F, Novella JL. Nursing Home Admission in Elderly Subjects With Dementia: Predictive Factors and Future Challenges. J Am Med Dir Assoc 2012; 13:83.e17-20. [DOI: 10.1016/j.jamda.2011.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/11/2011] [Accepted: 03/11/2011] [Indexed: 11/28/2022]
|
22
|
Help from spouse and from children among older people with functional limitations: comparison of England and Finland. AGEING & SOCIETY 2011. [DOI: 10.1017/s0144686x11000729] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTFuture increases in need of old-age care warrant research on receipt of informal care among older people in different policy and cultural contexts. Separating informal care into help provided by spouse and by children may shed more light on dynamics of informal help, important in alleviating the demands on the formal sector. Using nationally representative data from England and Finland, we performed logistic regression analyses to study receipt of help from spouse and children among community-dwelling persons aged 70+ years with functional limitations. In both countries, women and those with more functional limitations had higher odds of receiving spousal and filial help. In England – but not in Finland – those receiving formal public help had lower odds of receiving spousal help than those with no formal help. Those with low education received more filial help in England, but no association was found between formal and filial help. In Finland, the effect of education was not significant but those receiving formal help had higher odds of also receiving filial help. The results suggest that in a liberal market-led state, the role of children may be to help their parents living alone and with low financial resources. In the context of a generous welfare state, children may function more as active agents bridging the gap between their parents and formal services.
Collapse
|
23
|
Woodward AT, Chatters LM, Taylor RJ, Neighbors HW, Jackson JS. Differences in Professional and Informal Help Seeking among Older African Americans, Black Caribbeans and Non-Hispanic Whites. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2010; 1:124-139. [PMID: 21666782 PMCID: PMC3111220 DOI: 10.5243/jsswr.2010.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study uses a national probability sample of older adults to examine racial and ethnic differences in the use of professional services and informal support for a stressful personal problem. Using data from the National Survey of American Life, this study focuses on African Americans, Black Caribbean immigrants, and Whites aged 55 years and older who experienced a personal problem that caused them significant distress (n=862). Multinomial logistic regression is used to estimate the association of race with the use of professional services only, informal support only, both professional services and informal support, or no help at all, while controlling for demographic and socioeconomic variables, characteristics of the informal support network, the type of problem experienced, and experiences of racial discrimination. Examining the use of professional services and informal support provides a more complete picture of racial and ethnic differences of help-seeking behaviors among older adults, and the factors associated with the sources from which these adults request help. Most respondents use informal support alone or in combination with professional services. Black Caribbeans are more likely than African Americans to rely on informal support only, whereas African Americans are more likely than Whites to not receive help. However, these findings are accounted for by differences in social support and experiences of discrimination.
Collapse
|
24
|
Kirby JB, Lau DT. Community and individual race/ethnicity and home health care use among elderly persons in the United States. Health Serv Res 2010; 45:1251-67. [PMID: 20662950 DOI: 10.1111/j.1475-6773.2010.01135.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with health-related home care use among elderly persons in the United States. DATA SOURCES A nationally representative sample of community-dwelling elders aged 65+ from the 2000 to 2006 Medical Expenditure Panel Survey (N=23,792) linked to block group-level racial/ethnic information from the 2000 Decennial Census. DESIGN We estimated the likelihood of informal and formal home health care use for four racial/ethnic elderly groups (non-Hispanic [NH] whites, NH-blacks, NH-Asians, and Hispanics) living in communities with different racial/ethnic compositions. PRINCIPAL FINDINGS NH-Asian and Hispanic elders living in block groups with ≥25 percent of residents being NH-Asian or Hispanic, respectively, were more likely to use informal home health care than their counterparts in other block groups. No such effect was apparent for formal home health care. CONCLUSIONS NH-Asian and Hispanic elders are more likely to use informal home care if they live in communities with a higher proportion of residents who share their race/ethnicity. A better understanding of how informal care is provided in different communities may inform policy makers concerned with promoting informal home care, supporting informal caregivers, or providing formal home care as a substitute or supplement to informal care.
Collapse
Affiliation(s)
- James B Kirby
- Agency for Health Care Research and Quality, Rockville, MD, USA
| | | |
Collapse
|
25
|
Chan N, Anstey KJ, Windsor TD, Luszcz MA. Disability and depressive symptoms in later life: the stress-buffering role of informal and formal support. Gerontology 2010; 57:180-9. [PMID: 20424429 DOI: 10.1159/000314158] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 02/04/2010] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite the increasing utilization of formal services by older adults in many nations, there is a paucity of research that has examined the relationships between disability, formal support and depressive symptoms in later life. OBJECTIVE We investigated whether support received for daily activities, either from formal and/or informal sources, weakened the deleterious relationship between disability and depression symptoms in later life and whether these stress-buffering effects were stronger in later years of older adulthood. METHODS Participants were 1,359 community-dwelling older adults drawn from Wave 1 of the Australian Longitudinal Study of Ageing. Hierarchical multiple regression was used. RESULTS Individuals receiving support from (1) informal sources only and (2) both informal and formal sources had weaker relationships between disability and depressive symptoms, relative to those receiving no support. The interaction between informal and formal support and disability also revealed that for individuals with above average functional limitations, receipt of this support type was associated with fewer depressive symptoms. However, for individuals with no functional limitations, receipt of both informal and formal support was not associated with depressive symptoms. The stress-buffer age variation hypothesis received no support. CONCLUSIONS Findings suggest that receiving a combination of informal and formal support may be sufficient to offset the harmful association between disability and depressive symptoms in later life. In addition, findings further emphasized the importance of informal support in later life. In contrast, formal support in isolation may not be sufficient to confer a protective effect. Given the expected increase in utilization of formal services among older adults in the coming decades, it is essential that future research investigates the possible factors that underlie this null result.
Collapse
Affiliation(s)
- Natalie Chan
- Centre for Mental Health Research, The Australian National University, Canberra, A.C.T., Australia
| | | | | | | |
Collapse
|
26
|
Ryburn B, Wells Y, Foreman P. Enabling independence: restorative approaches to home care provision for frail older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:225-234. [PMID: 19175428 DOI: 10.1111/j.1365-2524.2008.00809.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study reviews the 'real world' potential (i.e. efficacy and effectiveness) of restorative approaches towards home care for frail older adults. Such approaches aim to go beyond traditional home care goals of 'maintenance' and 'support' towards improvements in functional status and quality of life. Our review of the literature included searches of health and gerontology databases as well as 'grey literature' across Australia, the UK and the USA. We provide an initial overview of the efficacy of a range of single component restorative interventions, including occupational therapy, physical therapy, health education and social rehabilitation. In order to answer questions about the overall efficacy and cost-effectiveness of restorative home care provision, we also review the nature of in-house programmes across the three nations as well as the evidence base for such programmes, particularly when they have been compared to home care 'as usual'. A range of positive outcomes has emerged, including improved quality of life and functional status and reduced costs associated with a reduction in the ongoing use of home care services postintervention. Questions remain about which components are most beneficial, which clients are likely to receive the greatest benefit, and the appropriate intensity and duration of such interventions.
Collapse
Affiliation(s)
- Bridget Ryburn
- Lincoln Centre for Research on Ageing, Australian Institute for Primary Care, Faculty of Health Sciences, La Trobe University, Victoria, Australia.
| | | | | |
Collapse
|
27
|
Skarupski KA, McCann JJ, Bienias JL, Wolinsky FD, Aggarwal NT, Evans DA. Use of home-based formal services by adult day care clients with Alzheimer's disease. Home Health Care Serv Q 2009; 27:217-39. [PMID: 19042238 DOI: 10.1080/01621420802320009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore the association between adult day care (ADC) attendance and utilization of home-based formal services among people with Alzheimer's Disease (AD). METHODS Data for this secondary analysis came from a longitudinal parent study of 457 subjects from 16 ADC programs and an Alzheimer's diagnostic center in metropolitan Chicago. We used the method of Generalized Estimating Equations to model the use of home-based formal services over time. RESULTS Adjusting for relevant covariates, more days of ADC use at each follow-up was associated with decreased use of home-based formal services (coefficient = .25, p< .0001). Older, unmarried caregivers who are children of the care recipients had lower use of home-based services. DISCUSSION Results suggest that ADC services may substitute for specific types of home-based formal services. The projected increase in AD prevalence over the next several decades warrants a clearer understanding of how people with AD use formal services.
Collapse
|
28
|
The inter-relationship between formal and informal care: a study in France and Israel. AGEING & SOCIETY 2009; 29:71-91. [PMID: 23316096 DOI: 10.1017/s0144686x08007666] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
Collapse
|
29
|
Abstract
Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help, with a special emphasis on the frequency of help from spouse, from children and other relatives and friends. We used nationally representative cross-sectional data from 1,166 community-dwelling Finnish persons aged 70-99. Determinants of formal help were assessed with logistic regression models. Receiving formal help was most strongly related to need factors such as age and functional capacity. Adjusted for need factors, receiving help from spouse or living with someone else than the spouse decreased the odds of receiving formal help. In contrast, the more frequently the children helped, the larger were the odds of receiving formal home-based help. Help from other informal sources did not affect receipt of formal help. Our results thus suggest that intra-household help from spouse or from other co-residents may partly offset expected cost increases in the formal care sector brought about by an aging population. The results further suggest that help from children and help from formal sources is likely to be concomitant and that children may act as agents seeking formal help also in a welfare state based on the universal and equal care services.
Collapse
|
30
|
Savla J, Davey A, Sundström G, Zarit SH, Malmberg B. Home help services in Sweden: responsiveness to changing demographics and needs. Eur J Ageing 2008; 5:47-55. [PMID: 28798561 DOI: 10.1007/s10433-008-0071-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Decreases in Swedish home help services have not resulted in increased rates of unmet need. To understand these changes, we identified predictors of home help services and rates of institutional care and how these effects changed over time using longitudinal data (1994-2000) from 286 Swedish municipalities. Outcomes were home help coverage rates, intensity of home help per recipient, and rates of institutional living. Predictors reflected availability and need for services. Services decreased over time, but not uniformly. Coverage rates were higher in municipalities with a greater proportion of population 65 and older and greater proportion of unmarried elders. Decreases in coverage rates were greater in municipalities with a higher proportion of unmarried elders, greater ratio of older women to men, with more home help staff workers, and more expensive services. Home help was provided more intensively in municipalities with higher median incomes, higher unemployment rates and municipalities spending more per inhabitant on child care. Decreases in intensity were greater in municipalities with lower proportions of unmarried elders and fewer home help staff workers. Rates of institutional living were higher in municipalities that spent more on old age services and with a greater proportion of unmarried elders. Decreases in institutionalization were greater in municipalities with a greater proportion of unmarried elders and lower ratio of older women to men. Variability in how municipalities responded to these changes may explain continued low rates of unmet need. Results are consistent with both increased efficiency and more effective targeting, but cannot capture service quality.
Collapse
Affiliation(s)
- Jyoti Savla
- Center for Gerontology, Virginia Polytechnic and State University, Blacksburg, VA USA
| | - Adam Davey
- College of Health Professions, Temple University, 1300 North Broad Street, Suite 313, Philadelphia, PA 19122 USA
| | - Gerdt Sundström
- Institute for Gerontology, Jönköping University, Jönköping, Sweden
| | - Steven H Zarit
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA USA
| | - Bo Malmberg
- Institute for Gerontology, Jönköping University, Jönköping, Sweden
| |
Collapse
|
31
|
Abstract
This study aimed to investigate whether contraction in services has led to inequitable service levels or simply large local variations. Previous attempts to explain service variations with aggregate, municipal level data have failed. We link representative Swedish data from 3,267 individuals aged 65 and older in 2002-2003 with coverage rates of public Home Help services in the 288 municipalities in which they reside. What past attempts have masked is that needs also vary substantially between municipalities; needs being defined as old people who live alone and need help with their activities of daily living (ADL). Once these local individual level variations are incorporated, municipal differences in public Home Help coverage largely vanish. Multivariate analyses confirm that advanced age, inability to perform ADL and solitary living are the major determinants of Home Help use. Variations in local supply have no association with individual use of public Home Help. These services are unequal but hence yet deemed to be reasonably equitable.
Collapse
|