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

Informal Care Receiving Among Older Adults: The Role of Multimorbidity and Intersectional Social Position

BACKGROUND AND OBJECTIVES

Older adults with distinct multimorbidity combinations may require varying intensities of informal care and these needs may vary in important ways by race/ethnicity and sex. This study aims to examine informal care-receiving characteristics among older adults with varying multimorbidity patterns and race/ethnicity-sex characteristics.

RESEARCH DESIGN AND METHODS

A total of 4,875 participants from the National Health and Aging Trends Study were included. Five clinically informed multimorbidity categories (no condition(s), somatic-only, depression without cognitive impairment, cognitive impairment without depression, both depression, and cognitive impairment) and 6 intersectional groups (non-Hispanic White female, non-Hispanic White male, non-Hispanic Black female, non-Hispanic Black male, Hispanic female, and Hispanic male) were assessed. Negative binomial regression was applied to explore the associations among multimorbidity groups, race/ethnicity and sex combinations, and informal care-receiving characteristics.

RESULTS

Compared with the somatic-only multimorbidity group, individuals with no condition(s) received assistance with fewer ADL/IADL activities, whereas the cognitive impairment multimorbidity group received assistance with more ADL/IADL activities. Across race/ethnicity-sex groups, non-Hispanic White and Black males received assistance with fewer ADL/IADL activities, and no statistical significance was found for non-Hispanic Black females or Hispanics compared with non-Hispanic White female counterparts. Sensitivity analysis examining assistance with only ADL activities revealed the same pattern.

DISCUSSION AND IMPLICATIONS

The study highlighted the complexities of informal care-receiving characteristics among older adults, particularly among those with cognitive difficulties, and the ways in which race/ethnicity and sex are associated with care-receiving patterns. The findings highlight a need for person- and family-centered interventions sensitive to the diverse needs of care-recipients and caregivers.

The Intersection of Gender, Culture and Society for Caregivers of Older Adults Ageing in Place in Ontario, Canada

BACKGROUND

It is reported that women are more likely to be caregivers than men, experience a higher burden of care and increased emotional health sequelae as a result. Social location (a person's gender, culture, ethnicity, etc.) is known to influence caregiving experiences. However, there is limited work that draws attention to how cultural and linguistic diversity shapes the experiences and expectations of informal caregivers.

OBJECTIVE

The authors aimed to study how to reallocate health and social service resources to better support older adults ageing in place. However, some participants felt strongly about the role of gender. This report addresses the gap for better understanding (1) how gender influences informal caregiving for older adults ageing at home in Ontario, Canada, and (2) how culture may influence gendered caregiving expectations for this population.

DESIGN

A critical social justice paradigm and balance of care framework guided the research. Focus groups (15) and one-one-one interviews (7) were carried out. A collaborative approach to codebook thematic analysis was conducted.

SETTING AND PARTICIPANTS

This study was carried out in Peel, a diverse region in Ontario, Canada. 42 individuals participated in the study (14 older adults, 10 caregivers and 18 healthcare providers).

FINDINGS

Four themes were found regarding the role of gender in caregiving: (1) women caregivers as catalysts for ageing in place, (2) gender norms, generational standards and the societal expectation for women to be caregivers, (3) the intersection of culture and gender on caregiving for older adults and (4) health service workforce as women-dominant and linguistically diverse.

DISCUSSION AND CONCLUSION

Service needs not currently met by Canada's healthcare system often become absorbed by women caregivers who facilitate ageing in place. Further research is required to better understand: (1) how a larger breadth of communities experience the intersection of gender and culture in the care of older adults in Ontario, Canada, and (2) how to better harness the diversity within Canada's homecare workforce to allow for cultural, linguistic and/or gender alignment with older adult clients.

PATIENT OR PUBLIC CONTRIBUTION

Patients and caregivers were research participants; however, the focus groups were co-design sessions, in which participants built and shaped personas and care packages.

Does Social Health Insurance Influence Cognitive Impairments Among Older People? Evidence from Longitudinal Surveys in South Korea and China

Significant differences exist in the coverage and target population of social health insurance between South Korea and China. This study investigated the effects of different types of social health insurance on cognition trajectories and survival of older people with cognitive impairments. Data were drawn from the Korean Longitudinal Study of Aging (N = 1812) and the Chinese Longitudinal Healthy Longevity Survey (N = 1168) from 2008 to 2018. Growth mixture models were built to identify cognition trajectories. Logistic regression and Cox proportional hazards models were performed to identify risk factors. Results indicate that although social health insurance improved overall health outcomes among older people with cognitive impairments, there were significant socioeconomic inequalities in its protective influence. Results suggest that South Korea's Medical Aid and China's Basic Medical Health Scheme showed positive influences on cognition trajectories among illiterate older people. In contrast, results indicate that, in China, older adults with cognitive impairments from higher socioeconomic backgrounds benefited more from social health insurance in terms of cognition trajectories and survival. This study urges governments to consider expanding healthcare provision to protect the most vulnerable older people with cognitive impairments in general and those from low socioeconomic backgrounds in particular.

Who came to the rescue? Sources of informal support to older Europeans before, during and after the COVID-19 pandemic

BACKGROUND/OBJECTIVE

The COVID-19 pandemic disrupted the provision of informal care in major ways. This study documents the prevalences of informal support with (instrumental) activities of daily living (IADL and ADL) before, during and after the pandemic, distinguishing between children, other relatives and friends/neighbours and focusing on individuals 50 years and older across 27 European countries.

METHODS

This longitudinal analysis relies on the Survey of Health, Ageing and Retirement in Europe (SHARE)'s Wave 8 (2019), two Corona surveys (2020 and 2021) and Wave 9 (2022). Linear probability models adjusted for individual fixed effects and time-varying confounders were used to estimate prevalences of informal support over time.

RESULTS

During the pandemic, the prevalences of informal support with both IADL and ADL from all three groups of caregivers increased significantly (P < 0.01), to return to their pre-pandemic levels by 2022. For example, the adjusted likelihood of IADL help from children increased from 18.5% (2019) to 36.6% (2020) and 42.5% (2021), then dropped back to 19.7% in 2022. Friends and neighbours played a critical role, with the adjusted likelihood of IADL help going from 8.8% (2019) to 29.7% (2020), then down to 18% (2021) and 8.9% (2022).

CONCLUSIONS

Future emergency and disaster preparedness plans should contemplate the various sources of informal care, including support measures to non-relative caregivers, as those helpers may be able to rapidly respond to unexpected crisis.

Utilization of Long-Term Care Services and the Role of Institutional Trust in South Korea

With population aging, governments have become increasingly involved in the administration, funding, and regulation of formal long-term care (LTC) systems. We examine the association between institutional trust and formal LTC service utilization among older adults aged ≥60 years with care needs in South Korea's public LTC scheme. Using data from the Korean Longitudinal Study of Aging and hierarchical logistic regressions, we evaluate the respective roles of trust in government and trust in the LTC program on service utilization. Results show that trust in the LTC scheme is significantly associated with service utilization: a unit increase in the level of trust is associated with a 29% increase in the odds of service use on average, controlling for need-related factors (e.g., chronic conditions) and other covariates. Furthermore, the positive relationship between trust and LTC utilization increases in magnitude with age. Older adults who are aged 80 and above, unmarried, with more ADL limitations, with psychiatric disease, or with arthritis are more likely to utilize formal LTC services. Our findings are robust to variations in sample inclusion criteria. Policymakers and health administrators should pay attention to building and maintaining institutional trust in public LTC schemes through good governance and other relevant strategies.

Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP/START Version 2 Criteria

Background/Objectives: Numerous European countries, including Romania, are facing the concern of rapid ageing of their populations. Moreover, Romania's life expectancy ranks among the lowest in the European Union. In light of this, it is imperative that the assessment of medication-related harm be given national priority in order to secure and enhance pharmacotherapy and the medical act. In this study, we sought to describe and evaluate the under-prescribing practices among the Romanian elderly population. Methods: We conducted a cross-sectional study in urban areas of two counties in Western Romania (Timis and Arad) from November 2017 to February 2019. We collected chronic electronic prescriptions issued for elderly patients (>65 years old) with chronic conditions. The medication was prescribed by generalist or specialist physicians for periods ranging between 30 and 90 days. To assess inappropriate prescribing behaviours, a multidisciplinary team of specialists applied the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) v.2 criteria to the collected prescriptions. Results: Within the 1498 prescriptions included in the study, 57% were issued to females, the mean age was 74.1 ± 6.95, and the average number of medicines per prescription was 4.7 ± 1.51. The STOPP criteria most commonly identified were the (1) long treatment duration (23.6%) and (2) prescription of neuroleptics (14.6%) or zopiclone (14.0%) as medications that increase the risk of falls. According to START criteria, the following medicines were under-prescribed: (1) statins (47.4%), (2) beta-blockers (24.5%), (3) antiresorptive therapy (10.0%), and (4) β2-agonists and muscarinic antagonists for chronic obstructive pulmonary disease (COPD) (4.5%). Within our study group, the prevalence of potentially inappropriate medications was 18.58%, whereas the prevalence of potential prescribing omissions was 49.2%. Conclusions: To decrease medication-related harm and morbid-mortality, and to increase the quality of life for elderly people in Romania, immediate actions are needed from national authorities. These actions include reinforcing primary care services, providing periodic training for physicians, implementing medication review services by pharmacists, and utilising electronic health records at their full capacity.

Changes in Family Structure and Increasing Care Gaps in the United States, 2015-2050

Research on caregiving in the United States has not clearly identified the scope of the gap between care needed and care received and the changes implied by ongoing and anticipated shifts in family structure. This article examines the magnitude of contemporary gaps in care among older adults in the United States and how they are likely to evolve through 2050. We use data from the Health and Retirement Study (1998-2014) to estimate care gaps, operationalized as having difficulties with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) but not receiving care. We also estimate variation in care gaps by family structure. Then, we use data from demographic microsimulation to explore the implications of demographic and family changes for the evolution of care gaps. We establish that care gaps are common, with 13% and 5% of adults aged 50 or older reporting a care gap for ADLs and IADLs, respectively. Next, we find that adults with neither partners nor children have the highest care gap rates. Last, we project that the number of older adults with care gaps will increase by more than 30% between 2015 and 2050-twice the rate of population growth. These results provide a benchmark for understanding the scope of the potential problem and considering how care gaps can be filled.

The impact of social isolation on functional disability in older people: A multi-cohort study

OBJECTIVES

We assessed the relationship between social isolation and functional disability in older people.

DESIGN

Comparison of longitudinal cohort studies.

SETTING AND PARTICIPANTS

Harmonised longitudinal datasets from the United States, England, European countries, Japan, Korea, China and Hong Kong.

METHODS

Social isolation was operationalised as a composite score with five domains, such as marital status, living alone, and social contact with others. Functional disability was defined as whether the cohort participant had any difficulty in activities of daily living (ADL). In each dataset, we used robust Poisson regression models to obtain the relative risks (RRs) and the corresponding 95 % confidence intervals (CI). We combined the RRs to synthesize a pooled estimate using meta-analysis with random-effects models.

RESULTS

Overall, the social isolation composite score was not associated with ADL disability (pooled RR = 1.05, 95 % CI [0.97-1.14], n = 40,119). Subgroup analysis suggested social isolation composite score was associated with ADL disability in Asian regions (pooled RR = 1.09, 95 % CI [1.02, 1.16], but not in Western regions (pooled RR = 1.01, 95 % CI [0.96, 1.07]). The relationships between different domains of social isolation and ADL disability were heterogeneous, except that no participation in any social clubs or religious groups was consistently associated with ADL disability (pooled RR = 1.12, 95 % CI [1.04, 1.21]).

CONCLUSION

Targeting social isolation may prevent decline in functional abilities in older adults, providing an avenue to active and healthy ageing. Nonetheless, interventions tackling social isolation should tailor to the unique cultural and social underpinnings. A limitation of the study is that reverse causality could not be ruled out definitively.

Activity Limitations and Depression Among Middle-Aged and Older Adults in China: The Moderating Impact of Assistance Adequacy

This study aimed to examine the risk and protective factors associated with depression in middle-aged and older Chinese adults with activity limitations. Data were obtained from the 2018 Wave 4 Survey of the China Health and Retirement Longitudinal Study. In the logistic regression analysis, health and functioning, losing a child, and a perceived lack of future assistance with daily activities increased the odds of depression. Conversely, receiving adequate assistance with daily activities lessened the depressive impacts of activity limitations, as indicated by a significant interaction effect. Enhanced long-term support for individuals with disabilities is necessary to improve mental health.

What determines informal care need among community-dwelling older adults in China? Results from a longitudinal study

BACKGROUND

With an intensified aging population and an associated upsurge of informal care need in China, there is an ongoing discussion around what factors influence this need among older adults. Most existing studies are cross-sectional and do not focus on older people living in the community. Conversely, this study empirically explores the factors that affect informal care need of Chinese community-dwelling older individuals based on longitudinal data.

METHODS

This study constructed panel data using the China Health and Retirement Longitudinal Research Study (CHARLS) from 2011 to 2018 for analysis. Generalized linear mixed models were used to analyze the factors affecting reception of informal care, and linear mixed models were used to analyze the factors affecting informal care sources and intensity.

RESULTS

During the follow-up period, 7542, 6386, 5087, and 4052 older adults were included in 2011-2018, respectively. The proportion receiving informal care increased from 19.92 to 30.78%, and the proportion receiving high-intensity care increased from 6.42 to 8.42% during this period. Disability (estimate = 4.27, P < 0.001) and living arrangement (estimate = 0.42, P < 0.001) were the critical determinants of informal care need. The rural older adults reported a greater tendency to receive informal care (estimate = 0.14, P < 0.001). However, financial support from children did not affect informal care need (P > 0.05).

CONCLUSIONS

At present, there is a great demand for the manpower and intensity of informal care, and the cost of informal care is on the rise. There are differences in informal care needs of special older groups, such as the oldest-old, living alone and severely disabled. In the future, the region should promote the balance of urban and rural care service resources, rationally tilt economic support resources to rural areas, reduce the inequality of long-term care resources, improve the informal care support system, and provide a strong community guarantee for the local aging of the older adults.

Activities of daily living limitations and the use of physical examination among older adults with informal care in China: do gender and residence make differences?

BACKGROUND

This study investigated the relationship between activities of daily living (ADL) limitations and the use of physical examination among older adults receiving informal care, and to further examine whether this relationship varies by gender and urban-rural areas.

METHODS

The data in this study were obtained from the sixth Health Service of Shandong province, China. In total, 8,358 older adults aged 60 years or older who received informal care were included in the analysis. Binary logistic regression models were conducted to explore the association between ADL limitations and the use of physical examination and examine the differences between gender and urban-rural areas.

RESULTS

The prevalence of limitations in ADL and physical examination utilization rate among older adults receiving informal care in Shandong Province were 14.12% and 72.31%, respectively. After adjusting for confounders, ADL limitations were negatively correlated with the utilization of physical examination services among older adults receiving informal care (OR = 0.74, 95% CI: 0.64, 0.87, P < 0.001), and there were gender and rural-urban differences. The association between ADL limitations and the use of physical examination was statistically significant in older women receiving informal care (OR = 0.65, 95% CI: 0.53, 0.80, P < 0.001). And only among urban older adults receiving informal care, those with ADL limitations had lower utilization of physical examination services than participants without ADL limitations (OR = 0.59, 95% CI: 0.47, 0.74, P < 0.001).

CONCLUSIONS

Our study suggested that the relationship between ADL limitations and the use of physical examination among older adults receiving informal care differed by gender and urban-rural areas in Shandong, China. These findings implied that the government should provide more health resources and personalized physical examination service programs, especially to meet the differential needs of women and urban old adults receiving informal care, to contribute to the implementation of healthy aging strategies.

Living Alone During Old Age and the Risk of Dementia: Assessing the Cumulative Risk of Living Alone

OBJECTIVES

This study examines the association between living alone during old age and dementia. Whereas most previous studies on this topic utilize measures of living alone status that were obtained at a single point in time, we compare this typical approach to one that measures long-term exposure to living alone among older adults and assesses whether dementia is more likely to occur within individuals with more accumulated time living alone.

METHODS

Data come from the Health and Retirement Study, with a follow-up period of 2000-2018. A total of 18,171 older adults were followed during this period, resulting in 78,490 person-waves analyzed in a series of multi-level logistic models. Contemporaneous living alone was recorded when a respondent's household size was equal to 1 in a given wave. Cumulative living alone was calculated by adding the number of living alone statuses up to a given wave.

RESULTS

Contemporaneous living alone was either not associated (male-only subsample), or inversely associated (female-only subsample) with dementia. By contrast, a one-unit (i.e., one wave) increase in cumulative living alone was associated with about a 10% increase in the odds of dementia for both men (odds ratio [OR] = 1.111) and women (OR = 1.088), net of several covariates, including marital status, age, social activities, and social support.

DISCUSSION

Living alone during late life is an important risk factor for dementia, but the cognitive effects of solitary living probably do not take hold immediately for most older adults and potentially demonstrate a dose-response relationship.

Older Korean Americans' Perceived Burdensomeness to Their Healthcare Partners: An Egocentric Network Assessment

Objectives: The objective is to examine how older Korean Americans' perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants (egos) and their healthcare partners (alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of burdensomeness, the study suggests strategies to promote their health and healthcare use.

Living Arrangements and Intergenerational Support in Puerto Rico: Are Fathers Disadvantaged?

OBJECTIVES

To examine how intergenerational support varies by parents' living arrangements and whether there are gender differences in received support in Puerto Rico.

METHODS

Data come from the 2006-2007 Puerto Rican Elderly and Health Conditions Project, a representative longitudinal study of adults aged 60 and older in Puerto Rico (n = 2,288). We examined the association between parents' living arrangements (alone, with spouse/partner only, with children) and their receipt of functional (help with errands/housework/transport) and health (help when sick) support from children, and whether parents' gender moderates the association.

RESULTS

Intergenerational coresidence was associated with higher odds of receiving functional and health support than living alone. Women were more likely than men to receive both forms of support. Parents' gender significantly moderated the association between living arrangements and receiving health support-men living with their partners were less likely to receive health support from children than women in similar living arrangements. These associations persisted when analyses were restricted to those with disability.

DISCUSSION

Our findings suggest that parents' receipt of support from children is conditioned upon their living arrangement and gender, even when their functional health is jeopardized. We discuss these results in relation to the heterogeneous influence of living arrangements for older adults' support needs and provide suggestions for policy and directions for future research in rapidly aging Puerto Rico.

Analyzing Community Care Research Trends Using Text Mining

Purpose

This study utilized text mining to analyze research trends around community care, which focuses on improving patients' quality of life by lessening the financial burden on caregivers and relieving patient discomfort.

Methods

To examine research trends by community care stage, Section 1 is set from 2017 to 2019, when the community care was implemented, and Section 2 from 2020 to 2021, after the end of the community care. Papers used for the analysis were extracted using the Korea Citation Index (KCI); a total of 132 articles were selected and subjected to text mining analysis.

Results

First, the main community care research areas included work, housing, economy, disability, and mind. Second, from 2017 to 2019, there was considerable interest in community care centered on households, and main keywords, such as nursing, family, and experience, appeared. Third, from 2020 to the present, there was high interest in community care centered on disabilities, and keywords, such as space, business, and Seoul City, appeared.

Conclusion

The results reveal the changing issues, with the implementation of community care. Overall, research has tended to focus on social and welfare systems, rather than health and medical systems. In the future, local, community-integrated health and medical care systems should be restructured and regional delivery systems established to make them more accessible.