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Duran-Kiraç G, Uysal-Bozkir Ö, Uittenbroek R, van Hout H, Broese van Groenou MI. Informal caregiver and nurse perceptions of access to culturally appropriate health care for ethnic minority persons with dementia: A qualitative study. J Adv Nurs 2023. [PMID: 37113024 DOI: 10.1111/jan.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 03/16/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
AIMS This study explored what informal caregivers of ethnic minority (EM) persons with dementia in the Netherlands perceive as culturally accessible health care and nurses' perceptions of how cultural competence can be improved to facilitate access to health care for EM persons with dementia and their informal caregivers. DESIGN Qualitative description research with semi-structured individual interviews and focus group discussions (FGDs). METHODS Semi-structured interviews with 15 nurses and 6 informal caregivers provided input for two FGDs with nurses about the need to strengthen their cultural competence to improve access to health care for EM persons with dementia and their informal caregivers. Interview data were collected between September 2020 and April 2021 in the Netherlands. Focus group discussion data were collected between June and September 2021 in the Netherlands. RESULTS Nurses and informal caregivers experienced difficulty building and maintaining a relationship. Contrary to informal caregivers' experiences, nurses felt a shared cultural background with the persons with dementia and informal caregiver is necessary. Although nurses acknowledged the importance of cultural knowledge, cultural skills, in particular, were mentioned as needing improvement. Examples are mapping involved family members and their roles, asking the right questions and letting go of personal judgements. Nurses frequently mentioned stereotypical thinking and seeing 'the other' as different, and collaboration with(in) family proved difficult for informal caregivers and nurses. CONCLUSION Strengthening cultural skills will contribute to facilitating better access to cultural appropriate health care for EM persons with dementia and their informal caregivers. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT This study explores what is perceived as culturally accessible health care and what nurses need to improve their cultural competence. We show that strengthening nurses' cultural competence by addressing which skills should be improved can improve access to health care for EM persons with dementia and their informal caregivers.
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Affiliation(s)
- Gözde Duran-Kiraç
- Research Group Living Well with Dementia, Department of Health and Well-being, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Özgül Uysal-Bozkir
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Ronald Uittenbroek
- Department of Health and Well-being, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Hein van Hout
- Departments of General Practice and Medicine of Older People, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
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2
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Tange M, Broese van Groenou MI. [Did the COVID-19 pandemic change the care situation of older adults?]. Tijdschr Gerontol Geriatr 2022; 53. [PMID: 36408751 DOI: 10.36613/tgg.1875-6832/2022.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The study examined changes in giving and receiving care by community-dwelling older adults during the COVID-19 pandemic in 2020 compared to a period about two years before. Using data collected in two waves by the Longitudinal Aging Study Amsterdam (N = 1013), we study how many and which older adults report a change in care use and provision and how these changes impact on psychological well-being. The results show that only for a small part of the sample changes occurred. The large majority provides no care (73%) or uses no care (62%) in both waves. 7% stayed a care provider during the pandemic, where 15% quitted care provision and 5% started care provision. 17% remained a care user, where 15% did not receive care anymore and 6% started to use care. The informal carers mainly consisted of women and younger elderly in good health and the care recipients were mainly women and older elderly in poorer health. Using care had a negative impact on psychological well-being, but providing care was not related to wellbeing during the pandemic. The results imply that the pandemic and the measures taken affected the care situation of only a small part of the older adults.
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Affiliation(s)
- Marije Tange
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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3
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Bijnsdorp FM, van der Beek AJ, Broese van Groenou MI, Proper KI, van den Heuvel SG, Boot CRL. Associations of combining paid work and family care with gender-specific differences in depressive symptoms among older workers and the role of work characteristics. Scand J Work Environ Health 2022; 48:190-199. [PMID: 35128561 PMCID: PMC9523461 DOI: 10.5271/sjweh.4014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aims to provide insight into (i) how the combination of paid work and family care is longitudinally associated with gender-related differences in depressive symptoms and (ii) the role of work characteristics in this association. Methods Data were derived from STREAM, a Dutch prospective cohort study of older workers aged 45–64 years. Respondents were included if they were employed in at least one measurement between 2015 and 2017 (N=12 447). Mixed-models were applied to disentangle between-person (BP) and within-person (WP) effects of family caregiving on depressive symptoms. Analyses were stratified by gender. Work characteristics (social support, autonomy, emotional and mental workload) were separately added to the multivariable models. Results For older employees, family caregiving was positively associated with depressive symptoms between and within persons for both women [BP B=0.80, 95% confidence interval (CI) 0.52–1.08; WP B=0.32, 95% CI 0.08–0.56] and men (BP B=0.75, 95% CI 0.45–1.05; WP B=0.25, 95% CI 0.01–0.48). Social support at work reduced the adverse effect of family care on depressive symptoms for women (BP) and men (BP and WP). Emotional workload partly explained the effect of family care for both women and men (BP). Conclusions The longitudinal association between family care and mental health was similar for male and female employees. Resources at work (ie, social support) could protect caregiving employees against depressive symptoms. More research is needed regarding the relative impact of the care context compared to the work context of working family caregivers.
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Affiliation(s)
- Femmy M Bijnsdorp
- Department of Public and Occupational Health, Amsterdam UMC, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Klokgieters SS, Kok AAL, Visser M, van Groenou MIB, Huisman M. Changes in the role of explanatory factors for socioeconomic inequalities in physical performance: a comparative study of three birth cohorts. Int J Equity Health 2021; 20:252. [PMID: 34895239 PMCID: PMC8665629 DOI: 10.1186/s12939-021-01592-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to societal changes and changes in the availability of health promoting factors, explanatory factors of socioeconomic inequalities in health (SIH) may change with time. We investigate differences in the relative importance of behavioural, social and psychological factors for explaining inequalities in physical performance between three birth cohorts. METHODS Data came from N = 988, N = 1002, and N = 1023 adults aged 55-64 years, collected in 1992, 2002 and 2012 as part of the Longitudinal Aging Study Amsterdam. Physical performance was measured by three performance tests. We included lifestyle factors (physical activity, smoking, alcohol use and Body Mass Index (BMI)); social factors (network size, network complexity, divorce, social support); and psychological factors (mastery, self-efficacy and neuroticism). In multi-group mediation models, we tested whether the strength of indirect effects from socioeconomic position (SEP) via the explanatory factors to health differed between birth cohorts. Stronger indirect effects indicate an increase in the importance; weaker indirect effects indicate a decrease in importance. RESULTS Absolute SIH were present and similar across cohorts. The strength of indirect effects of SEP on physical performance through smoking, binge alcohol use, emotional support and mastery increased across cohorts. The indirect effects of BMI, network size, self-efficacy and neuroticism were similar across cohorts. CONCLUSIONS Inequalities in smoking, binge alcohol use, emotional support and mastery may have become more important for explaining SIH in recent cohorts of middle-aged adults. Policies that aim to reduce socioeconomic inequalities may need to adapt their targets of intervention to changing mechanisms in order to reduce SIH.
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Affiliation(s)
- Silvia S Klokgieters
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Uniersiteit Amsterdam, Amsterdam Public Health, de Boelelaan 1117, Amsterdam, Netherlands.
| | - Almar A L Kok
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Uniersiteit Amsterdam, Amsterdam Public Health, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Uniersiteit Amsterdam, Amsterdam Public Health, de Boelelaan 1117, Amsterdam, Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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5
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Duran-Kiraç G, Uysal-Bozkir Ö, Uittenbroek R, van Hout H, Broese van Groenou MI. Accessibility of health care experienced by persons with dementia from ethnic minority groups and formal and informal caregivers: A scoping review of European literature. Dementia (London) 2021; 21:677-700. [PMID: 34879748 PMCID: PMC8813582 DOI: 10.1177/14713012211055307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The number of persons with dementia from ethnic minority backgrounds is increasing.
However, ethnic minority groups use health care services less frequently compared to the
general population. We conducted a scoping review and used the theoretical framework
developed by Levesque to provide an overview of the literature concerning access to health
care for ethnic minority people with dementia and (in)formal caregivers. Studies mentioned
barriers in (1) the ability to perceive a need for care in terms of health literacy,
health beliefs and trust, and expectations; (2) the ability to seek care because of
personal and social values and the lack of knowledge regarding health care options; and
(3) lack of person-centered care as barrier to continue with professional health care.
Studies also mentioned barriers experienced by professionals in (1) communication with
ethnic minorities and knowledge about available resources for professionals; (2) cultural
and social factors influencing the professionals’ attitudes towards ethnic minorities; and
(3) the appropriateness of care and lacking competencies to work with people with dementia
from ethnic minority groups and informal caregivers. By addressing health literacy
including knowledge about the causes of dementia, people with dementia from ethnic
minorities and their informal caregivers may improve their abilities to access health
care. Health care professionals need to strengthen their competencies in order to
facilitate access to health care for this group.
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Affiliation(s)
- Gözde Duran-Kiraç
- Health and Social Care Department, 8771Windesheim University of Applied Sciences, Zwolle, Netherlands.,Vrije Universiteit, Amsterdam, Netherlands
| | - Özgül Uysal-Bozkir
- 6984Erasmus School of Social and Behavioural Sciences, Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Netherlands
| | - Ronald Uittenbroek
- Health and Social Care Department, 8771Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Hein van Hout
- Departments of General Practice & Medicine of Older People, 522567Amsterdam University Medical Centers, Amsterdam, Netherlands; Vrije Universiteit, Amsterdam, Netherlands
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Swinkels JC, Broese van Groenou MI, de Boer A, Tilburg TGV. Male and Female Partner-Caregivers' Burden: Does It Get Worse Over Time? Gerontologist 2020; 59:1103-1111. [PMID: 30321338 DOI: 10.1093/geront/gny132] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The general view is that partner-caregiver burden increases over time but findings are inconsistent. Moreover, the pathways underlying caregiver burden may differ between men and women. This study examines to what degree and why partner-caregiver burden changes over time. It adopts Pearlin's Caregiver Stress Process Model, as it is expected that higher primary and secondary stressors will increase burden and larger amounts of resources will lower burden. Yet, the impact of stressors and resources may change over time. The wear-and-tear model predicts an increase of burden due to a stronger impact of stressors and lower impact of resources over time. Alternatively, the adaptation model predicts a decrease of burden due to a lower impact of stressors and higher impact of resources over time. RESEARCH DESIGN AND METHODS We used 2 observations with a 1-year interval of 279 male and 443 female partner-caregivers, derived from the Netherlands Older Persons and Informal Caregivers Survey Minimum Data Set. We applied multilevel regression analysis, stratified by gender. RESULTS Adjusted for all predictors, caregiver burden increased over time for both men and women. For female caregivers, the impact of poor spousal health on burden increased and the impact of fulfillment decreased over time. Among male caregivers, the impact of predictors did not change over time. DISCUSSION AND IMPLICATIONS The increase of burden over time supports the wear-and-tear model, in particular for women. This study highlights the need for gender-specific interventions that are focused on enabling older partners to be better prepared for long-term partner-care.
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Affiliation(s)
- Joukje C Swinkels
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
| | | | - Alice de Boer
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam.,The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam
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7
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Timmermans EJ, Hoogendijk EO, Broese van Groenou MI, Comijs HC, van Schoor NM, Thomése FCF, Visser M, Deeg DJH, Huisman M. Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands. Eur J Public Health 2019; 29:1096-1102. [PMID: 31008512 PMCID: PMC6896978 DOI: 10.1093/eurpub/ckz065] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Monitoring of trends in functioning of older adults provides indispensable information for health care policy. This study examined trends in multiple indicators of functioning among Dutch older adults across a period of 20 years. METHODS Data from the Longitudinal Aging Study Amsterdam were used. We included 10 870 observations of 3803 respondents aged 64-84 years across seven waves (1992-12) and 931 observations of 603 respondents aged 85-94 years across four waves (2001-12). At each wave, 8 indicators of functioning were measured: multimorbidity, severe functional limitations, depression, anxiety, cognitive impairment, physical inactivity, loneliness and social isolation. In addition, a sum score (range: 0-8) of these indicators was calculated, with a score of ≥5 indicating 'multiple problems.' Trends in functioning over time were assessed using Generalized Estimating Equation analyses. RESULTS In the 64-84-years-olds, the prevalence of multimorbidity increased over time [OR(year) = 1.06, 95% CI = 1.05-1.06], whereas the prevalence of the other indicators decreased [i.e. cognitive impairment, physical inactivity (in women) and loneliness (in women)] or remained stable [i.e. severe functional limitations, depression, anxiety, physical inactivity (in men), loneliness (in men) and social isolation]. In the 85-94-year-olds, the prevalence of severe functional limitations increased over time [OR(year) = 1.08, 95% CI = 1.02-1.13], whereas the prevalence of the other indicators remained stable. In both age groups, the prevalence of 'multiple problems' remained stable. CONCLUSION Unfavorable trends were observed in multimorbidity among 64-84-years-olds and in severe functional limitations among 85-94-year-olds. Favorable trends were found in cognitive impairment, physical inactivity (in women) and loneliness (in women) among 64-84-years-olds.
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Affiliation(s)
- Erik J Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | | | - Hannie C Comijs
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Fleur C F Thomése
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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8
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Bijnsdorp FM, Pasman HRW, Francke AL, Evans N, Peeters CFW, Broese van Groenou MI. Who provides care in the last year of life? A description of care networks of community-dwelling older adults in the Netherlands. BMC Palliat Care 2019; 18:41. [PMID: 31092227 PMCID: PMC6521417 DOI: 10.1186/s12904-019-0425-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home-based care networks differ in size and composition, but little is known about the characteristics of care networks for those nearing the end of their lives. This study aimed to identify different types of home-based care networks of community-dwelling older adults in the Netherlands and to assess the association between care network type and the health status and socio-demographic characteristics of care recipients. METHODS/DESIGN We used data from participants of the Longitudinal Aging Study Amsterdam (2001-2013) with chronic diseases or functional limitations who died within 12 months of their last interview and received home based personal and/or household care (n = 146). Latent Class Analysis was used to model distinct end-of-life care networks among this pooled cross-section of older people whose characteristics imply care needs. The Akaike information criterion was used to determine the optimal model. Associations between network type and care recipient characteristics were explored using conditional inference trees. RESULTS We identified four types of care networks; a partner network (19%) in which care was mainly provided by partners, with little care from private caregivers or professionals, a mixed network (25%) in which care was provided by a combination of children, professionals and/or other family members, a private network (15%) in which only privately paid care was provided, and a professional network (40%) in which care was mainly provided by publicly paid professionals, sometimes with additional care from family or privately paid caregivers. Care networks near the end of life showed similar characteristics to those identified for older people more generally, but care seemed to be more intensive in the last year of life compared to the years preceding it. End-of-life care networks were mostly related to age, educational level and partner status. Formal care substitutes informal care whenever there is no partner or child present and able to provide care. CONCLUSION Our findings indicate that personal and household care can be quite intensive in the last year of life, especially for partner caregivers. To prevent caregiver burden, it is important that professionals make sure partner caregivers receive adequate and timely support to cope with the care situation.
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Affiliation(s)
- Femmy M. Bijnsdorp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - H. Roeline W. Pasman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
| | - Anneke L. Francke
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
- Nivel, Netherlands Institute for Health Services Research, Otterstraat, 118 Utrecht, The Netherlands
| | - Natalie Evans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Expertise Center for Palliative Care, De Boelelaan, 1117 Amsterdam, Netherlands
| | - Carel F. W. Peeters
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology & Biostatistics, Amsterdam Public Health research institute, De Boelelaan, 1117 Amsterdam, Netherlands
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9
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Boogaard JA, van der Steen JT, de Boer AH, van Groenou MIB. How Is End-of-Life Care With and Without Dementia Associated With Informal Caregivers' Outcomes? Am J Hosp Palliat Care 2019; 36:1008-1015. [PMID: 30983373 PMCID: PMC6719397 DOI: 10.1177/1049909119836932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Palliative care for older people with life-limiting diseases often involves informal caregivers, but the palliative care literature seldom focuses on the negative and positive aspects of informal caregiving. Objective: To assess the association of proximity to end of life (EOL) and dementia caregiving with informal caregivers’ burden of care and positive experiences and explain differences in outcomes. Design: Data on 1267 informal caregivers of community-dwelling older people were selected from a nationally representative cross-sectional survey and analyzed using analysis of variance and multivariable regression analyses. Measurements: The Self-Perceived Pressure from Informal Care Scale and the Positive Experiences Scale were administered to assess caregiver burden and positive experiences with providing care. Results: Dementia care, both at EOL and not at EOL, was associated with the most caregiver burden relative to regular care. Dementia care not at EOL was associated with the fewest positive experiences, and EOL care not in dementia with the most positive experiences. Only the differences in burden of care could be explained by variables related to stressors based on Pearlin stress-coping model. Conclusions: Informal caregivers of people with dementia are at risk not only of high caregiver burden but also of missing out on positive experiences associated with caregiving at EOL. Future research should examine how dementia-related factors reduce positive caregiving experiences, in order to make palliative care a positive reality for those providing informal care to community-dwelling persons with dementia.
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Affiliation(s)
- Jannie A Boogaard
- 1 Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,2 Department of General Practice & Nursing Home Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jenny T van der Steen
- 1 Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,3 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alice H de Boer
- 4 Netherlands Institute for Social Research, Hague, The Netherlands.,5 Department of Sociology, Vrije Universiteit, Amsterdam, The Netherlands
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10
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Jacobs MT, Broese van Groenou MI, Aartsen MJ, Deeg DJH. Diversity in Older Adults' Care Networks: The Added Value of Individual Beliefs and Social Network Proximity. J Gerontol B Psychol Sci Soc Sci 2019; 73:326-336. [PMID: 26912490 DOI: 10.1093/geronb/gbw012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 01/30/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives Policy reforms in long-term care require an increased share of informal caregivers in elderly care. This may be more feasible for older adults who (believe they) can organize the care themselves and have a local social network. This study describes care network types, how they vary in the share of informal caregivers, and examines associations with characteristics of community-dwelling older adults, including individual beliefs and network proximity. Method Latent class analyses were applied to a subsample of older care receivers (N = 491) from the Longitudinal Aging Study Amsterdam, in order to identify homogeneous subgroups of people with similar care networks. Multinomial regression analysis explored associations between network type and care receiver characteristics. Results Privately paid, coresidential, large informal, and publicly paid care network types were distinguished. Variation in informal care appeared mostly related to health, partner status, income, and proximity of children. Proximity of other potential informal caregivers did not affect the network type. Perceived control of care was highest in the privately paid network. Discussion The results suggest that local (non-)kin could be mobilized more often in coresidential networks. Increasing informal or alternative care in publicly paid networks is less likely, due to limited social and financial resources.
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Affiliation(s)
| | | | - Marja J Aartsen
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands
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11
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van Wieringen M, Groenewegen P, Broese van Groenou MI. ‘We’re all Florence Nightingales’: Managers and nurses colluding in decoupling through contingent roles. Journal of Professions and Organization 2017. [DOI: 10.1093/jpo/jox004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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van Wieringen M, Broese van Groenou MI, Groenewegen P. Impact of home care management on the involvement of informal caregivers by formal caregivers. Home Health Care Serv Q 2015; 34:67-84. [PMID: 25894592 DOI: 10.1080/01621424.2015.1029185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study explores the link between management characteristics of home care agencies and the involvement of informal caregivers in caregiving. Based on a study of policy documents of two agencies and semi-structured interviews with five team managers and 31 formal caregivers, we conclude that, although the importance of involving informal caregivers is emphasized in official documentation, actual contact with informal caregivers is often lacking. Comparison of the work processes of the two agencies shows that contact with informal caregivers and their potential involvement are enhanced by smaller teams, less task division, and clarity about the responsibilities of formal caregivers.
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Affiliation(s)
- Marieke van Wieringen
- a Department of Organization Sciences , VU University Amsterdam , Amsterdam , The Netherlands
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13
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Hoogendijk EO, van Hout HP, Heymans MW, van der Horst HE, Frijters DH, Broese van Groenou MI, Deeg DJ, Huisman M. Explaining the association between educational level and frailty in older adults: results from a 13-year longitudinal study in the Netherlands. Ann Epidemiol 2014; 24:538-44.e2. [DOI: 10.1016/j.annepidem.2014.05.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/17/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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14
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Jacobs MT, Broese van Groenou MI, de Boer AH, Deeg DJH. Individual determinants of task division in older adults' mixed care networks. Health Soc Care Community 2014; 22:57-66. [PMID: 23952585 DOI: 10.1111/hsc.12061] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 05/07/2023]
Abstract
Older adults in need of long-term care often receive help from both informal and formal caregivers. The division of tasks between these different types of caregivers may vary among such mixed care networks. Traditional models of task division suggest that formal and informal caregivers may either supplement each other or specialise in the care activities performed. Our study explores the determinants of various forms of task division in the Netherlands, using data collected in 2007 on 458 mixed care situations. Four types of task divisions of informal and formal care are distinguished: the complementation model [neither Activities of Daily Living (ADL) nor instrumental ADL (IADL) tasks shared, 14%], the supplementation model (both ADL and IADL tasks shared, 39%) and informal and formal specialisation (one type of task shared, one type of task not shared, 27% and 20% respectively). Marginal effects calculated with multinomial regression analyses show that the intensity of care provision, the informal caregivers' motives and the presence of privately paid help - more than care receiver's health - are related to type of task division with formal care. For example, when the informal caregiver provides more hours of help and out of a strong personal bond, the likelihood of informal specialisation increases, whereas the likelihood of formal specialisation decreases. When privately paid help is present, the complementation model is more likely, whereas the supplementation model is less likely to be found. Results are discussed regarding the differential consequences for co-ordination and co-operation in mixed care networks.
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Affiliation(s)
- Marianne T Jacobs
- Department of Sociology, VU University Amsterdam, Amsterdam, The Netherlands
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Broese van Groenou MI, de Boer A, Iedema J. Positive and negative evaluation of caregiving among three different types of informal care relationships. Eur J Ageing 2013; 10:301-311. [PMID: 28804305 PMCID: PMC5549208 DOI: 10.1007/s10433-013-0276-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Based on the caregiver stress model, we examined how care demands, caregiver motivation, coping style and external support are associated with positive evaluation and caregiver burden among spousal, adult child and other types of care relations. Data from a sample of Dutch informal caregivers of 1,685 older persons (55 and older) were analyzed employing multivariate linear regression analyses for each of the care relationship types. Spouses (N = 206) report high positive evaluation and high burden, adult children (N = 1,093) report low positive evaluation, and other caregivers (N = 386) report high positive evaluation and a low burden. Multivariate linear regression analyses showed that motives and external support were important for positive evaluation but the impact varied among types of caregivers, whereas care demands and not asking for help were associated with burden for all types. Only among 'other' caregiver relationships, positive evaluation was negatively associated with burden. It is concluded that results confirm the dual nature of caregiving among spouses and children. The care context and motivation of the different types of caregivers explain their differences in care evaluation. Various interventions for types of caregivers are discussed.
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Affiliation(s)
| | - Alice de Boer
- The Netherlands Institute of Social Research, the Hague, the Netherlands
| | - Jurjen Iedema
- The Netherlands Institute of Social Research, the Hague, the Netherlands
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Abstract
OBJECTIVE Older couples are likely to be confronted with health problems of both spouses and these health problems may negatively influence their marital satisfaction. The present study examined these possible negative effects using a dyadic perspective. METHOD Data from 78 independently living older couples were analyzed using the Actor-Partner Interdependence Model (APIM). Health problems were modeled as a latent factor of functional disability, the number of chronic diseases, and self-rated health. The couple's health context, that is, similarity or dissimilarity, was examined with an actor-partner interaction variable. RESULTS For wives, spousal health problems were negatively associated with their marital satisfaction, but only under the condition that their own health was relatively good. For husbands, neither own nor spousal health problems were associated with their marital satisfaction. DISCUSSION Future research focusing on older couples needs to consider the couple's health context next to health at the individual level.
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Pot AM, Portrait F, Visser G, Puts M, van Groenou MIB, Deeg DJH. Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study. BMC Health Serv Res 2009; 9:139. [PMID: 19656358 PMCID: PMC2739193 DOI: 10.1186/1472-6963-9-139] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 08/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well-known that the use of care services is most intensive in the last phase of life. However, so far only a few determinants of end-of-life care utilization are known. The aims of this study were to describe the utilization of acute and long-term care among older adults in their last year of life as compared to those not in their last year of life, and to examine which of a broad range of determinants can account for observed differences in care utilization. METHODS Data were used from the Longitudinal Aging Study Amsterdam (LASA). In a random, age and sex stratified population-based cohort of 3107 persons aged 55 - 85 years at baseline and representative of the Netherlands, follow-up cycles took place at 3, 6 and 9 years. Those who died within one year directly after a cycle were defined as the "end-of-life group" (n = 262), and those who survived at least three years after a cycle were defined as the "survivors". Utilization of acute and long-term care services, including professional and informal care, were recorded at each cycle, as well as a broad range of health-related and psychosocial variables. RESULTS The end-of-life group used more care than the survivors. In the younger-old this difference was most pronounced for acute care, and in the older-old, for long-term care. Use of both acute and long-term home care in the last year of life was fully accounted for by health problems. Use of institutional care at the end of life was partly accounted for by health problems, but was not fully explained by the determinants included. CONCLUSION This study shows that severity of health problems are decisive in the explanation of the increase in use of care services towards the end-of-life. This information is essential for an appropriate allocation of professional health care to the benefit of older persons themselves and their informal caregivers.
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Affiliation(s)
- Anne Margriet Pot
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
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Abstract
Objectives: This study examines the effects of own and spousal disability on social and emotional loneliness among married adults aged 65 and older. Method: Data from 710 men and 379 women of a Dutch community sample were analyzed with linear regression analyses. Results: For men, only their wives' disability was related to higher levels of social loneliness, whereas for women mainly their own disability was related to higher levels of social loneliness. Own disability and spousal disability were related to higher levels of emotional loneliness among both men and women. Effects of disability remained unaffected after controlling for characteristics of the social network and the marital relationship. Discussion: Findings underscore the importance of considering effects of both spouses' health on measures of individual well-being. Also, the traditional division of social roles makes older married men relatively vulnerable to social loneliness when their wives suffer from disability.
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Koster A, Bosma H, Broese van Groenou MI, Kempen GIJM, Penninx BWJH, van Eijk JT, Deeg DJH. Explanations of socioeconomic differences in changes in physical function in older adults: results from the Longitudinal Aging Study Amsterdam. BMC Public Health 2006; 6:244. [PMID: 17022819 PMCID: PMC1621070 DOI: 10.1186/1471-2458-6-244] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Accepted: 10/05/2006] [Indexed: 11/21/2022] Open
Abstract
Background This study examines the association between socioeconomic status and changes in physical function in younger- (aged 55–70 years) and older-old (aged 70–85 years) adults and seeks to determine the relative contribution of diseases, behavioral, and psychosocial factors in explaining this association. Methods Data were from 2,366 men and women, aged 55–85 years, participating in the Longitudinal Aging Study Amsterdam (LASA). Two indicators of socioeconomic status were used: education and income. Physical function was measured by self-reported physical ability over nine years of follow-up. Results In older adults, low socioeconomic status was related to a poorer level of physical function during nine years of follow-up. In subjects who were between 55 and 70 years old, there was an additional significant socioeconomic-differential decline in physical function, while socioeconomic differentials did not further widen in subjects 70 years and older. Behavioral factors, mainly BMI and physical activity, largely explained the socioeconomic differences in physical function in the youngest age group, while psychosocial factors reduced socioeconomic status differences most in the oldest age group. Conclusion The findings indicate age-specificity of both the pattern of socioeconomic status differences in function in older persons and the mechanisms underlying these associations.
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Affiliation(s)
- Annemarie Koster
- Department of Health Care Studies, Section Medical Sociology, Universiteit Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Hans Bosma
- Department of Health Care Studies, Section Medical Sociology, Universiteit Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Marjolein I Broese van Groenou
- Department of Social-Cultural Sciences, Faculty of Social Sciences, Vrije Universiteit, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands
| | - Gertrudis IJM Kempen
- Department of Health Care Studies, Section Medical Sociology, Universiteit Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Brenda WJH Penninx
- Department of Psychiatry, VU University Medical Center, Valeriusplein 91075 BG Amsterdam, The Netherlands
- Institute for Research in Extramural Medicine, LASA, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Jacques ThM van Eijk
- Department of Health Care Studies, Section Medical Sociology, Universiteit Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Dorly JH Deeg
- Institute for Research in Extramural Medicine, LASA, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Klinkenberg M, Visser G, van Groenou MIB, van der Wal G, Deeg DJH, Willems DL. The last 3 months of life: care, transitions and the place of death of older people. Health Soc Care Community 2005; 13:420-30. [PMID: 16048530 DOI: 10.1111/j.1365-2524.2005.00567.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Many older people die in hospitals, whereas research indicates that they would prefer to die at home. Little is known about the factors associated with place of death. The aim of the present study was to investigate the care received by older people in the last 3 months of their life, the transitions in care and the predictors of place of death. In this population-based study, interviews were held with 270 proxy respondents to obtain data on 342 deceased participants (79% response rate) in the Longitudinal Aging Study Amsterdam. In the last 3 months of life, the utilisation of formal care increased. Half of the community-dwelling older people and their families were confronted with transitions to institutional care, in most cases to hospitals. Women relied less often on informal care only, and were more dependent than men on institutional care. For people who only received informal care, the odds of dying in a hospital were 3.68 times the odds for those who received a combination of formal and informal home care. The chance of dying in a hospital was also related to the geographical region. The authors argue that future research is needed into the association that they found in the present study, i.e. that decedents who received both formal and informal care were more likely to die at home. In view of the differences found in geographical region in relation to place of death, further investigation of regional differences in the availability and accessibility of care is indicated.
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Affiliation(s)
- Marianne Klinkenberg
- Department of Palliative Care, Comprehensive Cancer Centre, Amsterdam, the Netherlands.
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Tomassini C, Glaser K, Wolf DA, Broese van Groenou MI, Grundy E. Living arrangements among older people: an overview of trends in Europe and the USA. Popul Trends 2004:24-34. [PMID: 15192891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This article compares the trends in living arrangements of older people in several European countries and in the United States. Trends and cross-country variability in several factors that could account for these cross-national differences, including marital status, fertility, labour force participation and attitudes, are also examined. In most countries the proportion of older people living alone increased substantially between 1970 and 1990. However the increase in living alone stabilised or even declined between 1990 and 2000 in most of the countries analysed indicating a possible reversal in the trend. Increases in proportions of older women who are married and reductions in the proportions childless may partially explain this. Considerable variability in both trends and levels of older people's living arrangements was seen especially between north-western and southern European countries. These variations mirrored contrasts in attitudes towards residential care and parent-child coresidence between the countries.
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Broese van Groenou MI. [Unequal chances for reaching 'a good old age'. Socio-economic health differences among older adults from a life course perspective]. Tijdschr Gerontol Geriatr 2003; 34:196-207. [PMID: 14694798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This article provides an overview of the socioeconomic inequality in physical and psychological health of older adults between 55 and 85 years of age, with a focus on the older adults whose socioeconomic status (SES) remains at a low level all their life. Data are derived from 1471 men and 1568 women, participating in the Longitudinal Aging Study Amsterdam (LASA) in 1992/1993. Based on the parental and own level of education, respondents are divided in four categories: those with a life time low level of SES, those with downward or upward mobility in SES, and those with a life time high level of SES. Logistic regression analyses showed that older adults with upward SES mobility and life time high SES, had a lower risk for functional limitations, chronic diseases (men only), 6-year mortality, depression and loneliness, compared with the older adults with life time low SES. The disadvantaged position of the low SES persons with regard to age, health and psychosocial conditions explained the SES differences in depression, but SES differences in mortality (for men) and in functional disability (for men and women) are not explained by the risk factors under study. SES differences in loneliness were attributed to differences in psychosocial conditions. Lifestyle did not add to the explanation of any of the SES differences. There were only small differences between those with a life time low SES and those with downward mobility in SES. It is concluded that a low level of education (regardless of the parental level) contributes to restricted psychosocial conditions, health problems and low well-being in old age, thereby decreasing the chances for a 'good old age' considerably.
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Affiliation(s)
- Marjolein I Broese van Groenou
- Afdeling Sociaal-Culturele Wetenschappen, Faculteit der Sociale Wetenschappen, Vrije Universiteit, De Boelelaan 1081c, 1081 HV Amsterdam.
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Broese van Groenou MI, Deeg DJH, Penninx BWJH. Income differentials in functional disability in old age: relative risks of onset, recovery, decline, attrition and mortality. Aging Clin Exp Res 2003; 15:174-83. [PMID: 12889850 DOI: 10.1007/bf03324497] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Socioeconomic status (SES) differences in health decline in late life may be underestimated, because the relatively higher risks of attrition of lower-SES persons are seldom taken into account. This longitudinal study aimed at comparing income differences in the course of disability, non-mortality attrition and mortality in older adults. METHODS A sample population of 3107 older adults who participated in the 1992/1993 baseline of the Longitudinal Aging Study Amsterdam was examined regarding changes in functional disability in 1998/1999. SES was indicated by household income. RESULTS Multinomial regression analyses revealed that, for men without disability at baseline, the relative rate for attrition was four times higher and the mortality rate was twice as high for low-income vs high-income persons. For non-disabled women, the relative risk for the onset of disability was nearly twice as high for low-income vs high-income persons. For both men and women, these risks decreased only slightly when behavioral and psychosocial risk factors were taken into account. Among persons with disability at baseline, the relative risks for attrition (for women) and mortality (for men) were twice as high for low-income persons, but no income differences were found with respect to recovery and decline. Adjustment for risk factors decreased the relative risks for attrition and mortality to a non-significant level. CONCLUSIONS Income inequality in health in late life is to a large degree explained by the higher incidence of disability among lower-status women and by the higher attrition and mortality risks among lower-status men.
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Affiliation(s)
- Marjolein I Broese van Groenou
- Department of Sociology and Social Gerontology, Faculty of Social Sciences, Vrije University, Amsterdam, The Netherlands.
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