Family, households, and care arrangements of frail older women: a structural analysis

Transitions between care networks: a prospective study among older adults in the Netherlands

As health impairment increases, older adults utilize care from different types of caregivers, but little is known about changes in the composition of care networks. We mapped the transitions between different care networks to gain insight into which people develop care networks that include informal, privately and publicly paid care. We used three waves (2012-2015-2018) of the Longitudinal Aging Study Amsterdam with 1413 Dutch community-dwelling adults, aged 64-100. Network types were identified using six types of caregivers: (1) co-resident, (2) non-co-resident children, (3) other kin, (4) neighbours/friends/acquaintances, (5) publicly paid, (6) privately paid, in a latent transition analysis with mortality and moving to a care facility as missing states. Five types of care networks were identified: (1) no care, (2) privately paid, (3) mixed informal, (4) mixed publicly paid, (5) co-resident. The co-resident network was the most unstable and had a high transition rate to nursing homes. Participants from the privately paid care network often transitioned to a mixed informal network and rarely transitioned to a mixed publicly paid network. Transitions out of the no-care network were mostly to the privately paid network. The two mixed care networks were the most stable. Transitions appeared to be most triggered by deteriorating health. Transitions to institutional care were most likely in the mixed informal, mixed publicly paid and the co-resident network. Thus, these networks appear to require additional support to facilitate ageing in place.

Material Hardship and the Living Arrangements of Older Americans

This study investigates the extent to which the household living arrangements of older adults influences their experiences of material hardship. Using data from the 2014 Panel of the Survey of Income and Program Participation, we run linear probability models with individual fixed effects to estimate the likelihood that a change in living arrangements predicts a change in food insecurity, housing hardship and utility hardship. Although household living arrangements are associated with reports of material hardship for older adults, individual fixed effect models point to a reduced role for the change in living arrangements on the change in the probability of experiencing material hardship. For older adults, we find that moving into a non-family household increases the risk of housing hardship. This study illustrates how the risk of material hardship related to family living arrangements changes over the life course. We call for increased attention to the risk of material hardship for older adults living alone, those in multigenerational living arrangements, and non-family households.

Adult children's gender, number and proximity and older parents’ moves to institutions: evidence from Sweden

Older people's ability to thrive independently of their adult children is an important feature of a universalistic welfare system. However, population ageing puts this notion under stress. In separate multinomial logistic regression models for older men and women, we examined whether adult children's gender, number and proximity were associated with older parents’ relocations into residential care facilities, and whether the effects of these children's characteristics on older parents’ institutionalisation vary by parents’ severe health problems, operationalised as closeness to death – specifically, dying within the two-year observation period. Analyses were based on the Swedish register data between 2014 and 2016 (N = 696,007 person-years). Older parents with at least one co-resident child were less likely to move or become institutionalised than those without a co-resident child. We did not find a relationship between older adults’ institutionalisation and the closest child's gender. The negative effect of having a non-resident child living nearby on the likelihood of becoming institutionalised was more pronounced for mothers than fathers. Having a child nearby decreased the likelihood of moving to an institution more for mothers who had severe health problems than for those in better health. We found no evidence of a relationship between number of children and likelihood of institutionalisation.

On the move in search of health and care: Circular migration and family conflict amongst older Turkish immigrants in Germany

This study focuses on circular migration amongst older Turkish immigrants to investigate two main questions: (1) How do perceived health and available healthcare systems in Turkey and Germany determine the structure of circular migration? (2) How is eldercare shaped by intergenerational conflict and exchange relations amongst older immigrants, their adult children in Germany, and their extended families in Turkey? Through the analysis of 40 in-depth interviews, this study finds that while Turkey offers healthier physical, psychological, and religious options, older circular migrants are more drawn to Germany because they perceive its healthcare system to be superior. Furthermore, contrary to conventional accounts, eldercare has mostly been navigated through intergenerational conflict and exchange relations, instead of family solidarity or traditional filial roles, and these conflicts and exchange principles around eldercare regulate family living arrangements across the two countries. In short, older Turkish immigrants encounter unique challenges in both their home and host countries, which promulgates their circular migration.

Living Arrangements of Mothers and Their Adult Children Over the Life Course

Early in the last century, it was commonplace for elderly women to live with their adult children. Over time, the prevalence of this type of living arrangement declined, as incomes increased. In more recent decades, coresidence between adult children and their retirement-age parents has become more common, as children rely on parental support later into adulthood. We use panel data from the Panel Study of Income Dynamics to examine the living arrangements of older mothers and their adult children over the life course. We pay particular attention to the relationship between coresidence and indicators of parental and child needs. Our results suggest that for much of the life course, coresidence serves to benefit primarily the adult children rather than their older mother. We also highlight a little known phenomenon, that of children who never leave the parental home and remain coresident well into their later adult years.

Demography of Living Arrangements Among Oldest-Old Mexican Americans: Evidence From the Hispanic Epidemiologic Study of the Elderly

OBJECTIVE

In this article, we examine the demographics of living arrangements and household headship status among Mexican-origin individuals aged 85+ years.

METHOD

Data come from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) caregiver and respondent surveys.

RESULTS

Finances of the elderly individual and their caregiver inform living arrangement decisions. Physical and cognitive disability differentiate among living arrangements: The most mentally and physically impaired are most likely to live with others and less likely to be the head of the household.

DISCUSSION

Motivations for living with others are clearly more complex than simple filial piety considerations might hold. Extended living arrangements provide concrete financial and instrumental benefits for both elderly parents and their adult child caregiver. Future research should address the question of the capacity of the Mexican American family to provide care for elderly parents in the face of major demographic and social changes.

Adult Children Helping Older Parents

Using the 1993 Panel Study of Income Dynamics, the authors examine help given to older parents in typical American families. Daughters and sons not in couples were more likely to help than those in couples, and gave substantially more hours. In couples, daughters were less likely to help than sons, but they helped for considerably more hours. Black daughters helped at least as commonly as White daughters, and did so for substantially more hours than either White daughters or sons of either race. Results suggest that Black sons may help less commonly than White sons. Black sons who help, however, do so for at least as many hours as White sons. Findings suggest that changes in the Black American family have not produced the notable intergenerational relations breakdown anticipated by some researchers. Results also illuminate the important role of sons in family help and suggest that changing marriage patterns may not reduce help to older parents.

Living Arrangements among Older Persons

This study examines the effects of housing market conditions on the living arrangements of non-Hispanic White and African American persons 60 years old and older. The multilevel models include indicators of local housing market affordability and availability, as well as individual-level resources, evaluated for unmarried women, unmarried men, and married couples. The results indicate that older persons' and couples' living arrangement decisions are responsive to housing affordability in that those who live in areas with high housing costs experience increased likelihoods of living with nonnuclear adults. For married couples, housing availability is also associated with living arrangement decisions, and for single men and women, the relative share of the housing market composed of small rental units is positively associated with residential independence. In addition, housing availability and affordability are positively associated with the likelihood of living alone as compared to living in group quarters or an institution.

The Life-Course Trajectory toward Living Alone

Objectives: Dramatic increases in living alone in late life have been associated with higher incomes and better health, obscuring the risk to subgroups living alone with diminished health and socioeconomic resources. This study describes race differences in the stability and life-course antecedents of living alone. Method: The prospective cohort study used data from the Established Populations for Epidemiologic Studies of the Elderly at Duke University ( n = 4,132) to estimate 10-yearprevalence, incidence, and predictors of living alone among Black and White elders. Results: New episodes of living alone were equally likely. Black elders’lower prevalence of living alone was a function of their 80 percent greater probability of a new coresident episode. Home ownership, residential tenure, and perceived good health were lower among Blacks living alone, compared to Whites, who had fewer living children. Stressful life events had similar effects on household size. Discussion: Race differences in late life household size were primarily dependent on decisions embedded in midlife.

The Impact of Gender on Configurations of Care among Married Elderly Couples

This article analyzes data from the Supplement on Aging of the National Health Interview Survey to examine gender differences in the configuration of care among married elderly couples living in two-person households. The rational choice model provides the conceptual framework for the analysis. Results support the hypothesis that husband caregivers are more likely to incorporate extra-household assistance than are wife caregivers. There were no gender differences, however, in the source of extra-household assistance.

The Effects of Earlier Intergenerational Affection, Normative Expectations, and Family Conflict on Contemporary Exchanges of Help and Support

This article extends previous research by examining the relationship between prospective accounts of intergenerational affection, normative expectations, and conflict on current patterns of supportive exchanges between parents and adult children. Research questions are addressed using data from 680 parent-child dyads participating in the 1988 and 1991 waves of the University of Southern California Longitudinal Study of Generations. Findings indicate that a history of affection in a parent-adult child relationship is associated with equitable and reciprocal exchanges of support and a greater likelihood of receiving and giving various forms of help and support. A strong sense of obligation to family at an earlier time period was related to exchange relationships with fathers but not with mothers: Duty-driven exchanges were less equitable, with adult children giving much more than they received. Earlier conflict in parent-adult child relationships did not interfere with contemporary exchanges of help and support.

Coresidence between Unmarried Aging Parents and their Adult Children

Data from the 1993 to 1995 waves of the Asset and Health Dynamics among the Oldest Old were used to analyze unmarried elderly parents' and children's characteristics associated with their respective self-reported reasons for coresidence: always lived together, to help the child, to help the parent, or to help both. As compared to the parents in the always-lived-together pairs, parents as the help receivers were older, had more health problems, and were more likely to have moved in with an older, married child. Children as the help recipients were more likely to be sons than daughters and less likely to work or make a financial contribution to the household. Parents in the mutual-help group were more likely to have higher education and to have been divorced, separated, or never married than to be widowed, and the children were more likely to be married. Parental gender and race/ethnicity were not significant factors.

Preferences for Care

This study investigates which care provider an elderly person living independently and aged 65 and older would prefer most should he or she be in need of such care. Four (hypothetical) care-need situations were distinguished, and respondents were requested to state their preference in each situation. In addition, the influence on these preferences of both individual and social characteristics of the elders and their previous experience with care was examined. A preference for informal care declines when the expected duration of care is extended and/or the person requires personal care. Previous experience with either formal or informal care increased the likelihood that that type of care would be preferred. Other predictive factors were age, gender, socioeconomic status, and the level of well-being. More research on the preferences of the older persons would enable health care professionals and government to adjust their policies to accommodate the wishes of the elders.

Systems of Parent Care within Sibling Networks

This article examines factors related to the participation of adult children in their elderly parents' helping networks. A three-stage decision model was tested which predicts the likelihood that: (a) an adult child is named as a helper by elder respondents who have at least one living child; (b) an adult child is chosen as the primary helper in networks including at least one adult child; and (c) among those networks containing at least one son and one daughter (one of whom was named as the primary helper), a son is selected rather than a daughter as the primary helper. The analysis revealed the importance of geographic proximity in predicting the involvement of adult children in parental helping networks. The integral role of daughters and other female family members was also highlighted. Other factors, such as parents' marital status, gender, level of functional impairment, and family structure, were also examined.

Ethnic Differences in Time Transfers from Adult Children to Elderly Parents

This article examines differences across racial-ethnic groups in patterns of time transfers from middle-aged adult children to their elderly parents and the degree to which heterogeneity in unobserved family-level factors may explain observed differences. Using data from the 1992 Health and Retirement Study (HRS) on respondents and their siblings, the analysis supports the hypothesis that the determinants of time assistance vary across racial-ethnic groups: Controlling for socioeconomic attributes of potential donors and the recipient, there is evidence of unobserved family-level heterogeneity for Whites and Blacks but not for Hispanics.

Health and Living Arrangements Among Older Americans

Objective: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons. Methods: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags. Results: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others. Discussion: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.

Pragmatic and Internal Validity Issues in Sampling in Caregiver Studies

Objectives: Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer’s disease registry, and ancillary studies to existing epidemiologic studies. Methods: Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. Results: All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. Discussion: Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.

Factors Influencing the Use of Mobility Technology in Community-Based Long-Term Care

Objectives: This article adapts a framework commonly used to model personal long-term care services to examine factors influencing the use of mobility-related assistive devices, both in isolation and in combination with personal care. Methods: The authors analyze data from Phase 2 of the 1994-1995 National Health Interview Survey Disability Supplements to compare predictors of equipment use with those for personal care and rank the probabilities of using particular combinations according to health needs, access, and personal and family characteristics. Results: The authors find that underlying health needs are the dominant factor related to the type of care arrangement used. The typical person with a mobility-related disability is most likely to use equipment alone; only at younger ages or at greater levels of severity are other arrangements expected to dominate. Discussion: Research on the dynamic acquisition process, with attention to age and trajectories of disability severity, is needed to fully understand the integration of technology and personal care.

Can the Family Still Cope?

Objectives: This article examines the impact of disability, cognitive status, and social support on nursing home use in a sample of older Mexican Americans. Method: We used four waves of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE), a longitudinal study of 3,050 older Mexican Americans living in the Southwest initially contacted in 1993 to 1994. Results: The findings reveal that advanced age, being a man, activities of daily living disability, and cognitive impairment are strong predictors of institutionalization and death. Living with family, arriving in the United States in late life, and access to social support independently decreased the probability of dying in a nursing home. Discussion: Although it is clear that adequate social support can make it possible for an impaired older person to remain in the community serious impairment can eventually overwhelm even a supportive network and result in the institutionalization of an impaired older person.

How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study

OBJECTIVES

This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups.

METHOD

We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952).

RESULTS

Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups.

DISCUSSION

Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

Elasticity of care networks and the gendered division of care

The gender gap in family care-giving is an established research finding: men dedicate less time to care-giving and provide specific gendered types of help. This article argues that in order to grasp men's contribution to care arrangements one should recognise the multifaceted nature of care and examine care networks beyond the ‘care receiver–primary care-giver’ dyad with a dynamic perspective. A qualitative analysis of the care networks of three large Dutch families with an older parent in need of care confirms the greater involvement of women in care-giving and men's tendency to provide specific types of care. However, men also contribute to the elasticity and stability of the care arrangement by filling temporary gaps and supporting the female care-givers. This article puts forward the idea that men's contribution is in turn a factor in the perpetuation of the gendered structure of care-giving.

Household and living arrangement projections at the subnational level: an extended cohort-component approach

This article presents the core methodological ideas and empirical assessments of an extended cohort-component approach (known as the "ProFamy model"), and applications to simultaneously project household composition, living arrangements, and population sizes-gender structures at the subnational level in the United States. Comparisons of projections from 1990 to 2000 using this approach with census counts in 2000 for each of the 50 states and Washington, DC show that 68.0 %, 17.0 %, 11.2 %, and 3.8 % of the absolute percentage errors are <3.0 %, 3.0 % to 4.99 %, 5.0 % to 9.99 %, and ≥10.0 %, respectively. Another analysis compares average forecast errors between the extended cohort-component approach and the still widely used classic headship-rate method, by projecting number-of-bedrooms-specific housing demands from 1990 to 2000 and then comparing those projections with census counts in 2000 for each of the 50 states and Washington, DC. The results demonstrate that, compared with the extended cohort-component approach, the headship-rate method produces substantially more serious forecast errors because it cannot project households by size while the extended cohort-component approach projects detailed household sizes. We also present illustrative household and living arrangement projections for the five decades from 2000 to 2050, with medium-, small-, and large-family scenarios for each of the 50 states; Washington, DC; six counties of southern California; and the Minneapolis-St. Paul metropolitan area. Among many interesting numerical outcomes of household and living arrangement projections with medium, low, and high bounds, the aging of American households over the next few decades across all states/areas is particularly striking. Finally, the limitations of the present study and potential future lines of research are discussed.

Moving Considerations

Residential proximity is an important indicator of family members’ availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000–2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents’ anticipated longevity does not influence children’s moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support.

The Linkages between Informal and Formal Care of the Elderly

Cet article résume les résultats d'une recherche sur la nature des relations entre les soins officiels et officieux accordés aux aînés. Le hen entre les deux types de soins s'explique de diverses façons: le modèle rélie à la tâche, le modèle compensatoire, le modèle de substitution, le modèle supplémentaire et le modèle complémentaire (regroupant à la fois le modeèle compensatoire et les fonctions supplémentaires des soins officiels). Les explications ont été évaluées en fonction de données de l'Enquête sociale générate de 1985 concernant les personnes de 65 ans et plus ayant une invalidité fonctionnelle. On a évalué les données par analyse de régression logistique. Les résultats accordent la faveur à la fonction complémentaire des soins officiels. Selon les données, les soins officiels compensent l'absence de conjoint ou d'enfant et, dans certains cas restreints, remplacent le conjoint ou l'enfant soignant en matière de soins personnels et, dans une moindre mesure, sur le plan des tâches domestiques. Entre les deux, l'effet compensatoire des soins officiels semble primer l'effet de supplément.

Formal Assistance Among Dutch Older Adults: An Examination of the Gendered Nature of Marital History

Drawing from life course theory, this article examines gender differences in formal assistance among functionally dependent Dutch older persons within five distinct marital history groups – first-married, never-married, divorced (not remarried), widowed (not remarried) and the remarried. Hierarchical logistic regression analyses are performed for each of the marital history groups to test hypotheses regarding the interrelationships among gender and three sets of variables: 1) measures of age and functional health; 2) measures of socio-economic status; and 3) measures of the social network. The results indicate gendered patterns of formal help use among the first-married, never-married and widowed. Consistent with other studies, older first-married women are approximately three times more likely to receive formal help than are men, a difference that remains robust after statistically controlling for other factors, including frailty of spouse. However, we also find that never-married women are about one-third as likely to use formal help than are never-married men, which may be reflective of different preferences regarding formal service use. Among the widowed, we find that men with poorer functional health are more likely to receive formal help than are their female counterparts, suggesting contrasting patterns of help-seeking behaviour and social vulnerability. Additional differences are observed among the marital history groups in terms of the other independent variables, which are also interpreted from a life course perspective.

Sibling Influence on Care Given by Children to Older Parents

This study examines the degree to which siblings’ behaviors and characteristics influence a child’s caregiving. A sample of 186 older parents in need of care with at least two adult children reported on characteristics and caregiving of all their children ( N = 703). Multilevel regression models show that there is evidence of children’s joint caregiving efforts: The more care siblings give, the more care the child gives. Results demonstrate that the more sisters a child has, the less care that child gives. Children also substitute and support each other: The greater the number of siblings with partners and the lower the frequency of sibling emotional support exchanges with a parent, the more care the child gives. The study reflects the various outcomes of sibling solidarity when older parents become dependent.

Cross-survey differences in national estimates of numbers of caregivers of disabled older adults

CONTEXT

Public policy regarding family caregiving for disabled older adults is affected by their estimated number, their attributes, and the services provided. The available national surveys, however, do not have a uniform approach to ascertaining the number of family caregivers, so their estimated number varies widely.

METHODS

This article looks at nationally representative, population-based surveys of family caregivers conducted between 1985 and 2010 to find methods pertinent to ascertaining the number of caregivers. The surveys' design, definition of disability, and approach to identifying and defining caregivers of disabled adults aged sixty-five and older were identified, and cross-survey estimates were compared.

FINDINGS

Published estimates of the numbers of caregivers of older disabled adults ranged from 2.7 million to 36.1 million in eight national surveys conducted between 1992 and 2009. The surveys were evenly divided between caregivers identified by disabled older adults (n= 4, "disability surveys") and self-identified (n= 4, "caregiver self-identification surveys"). The estimated number of family caregivers of disabled adults aged sixty-five and older was, on average, 4.8 million in disability surveys and 24.4 million in caregiver self-identification surveys.

CONCLUSIONS

The number of family caregivers of disabled older adults estimated by national surveys varied substantially. Greater consistency in defining caregivers could yield more informative estimates and also advance policy efforts to more effectively monitor and support family caregivers.

Elderly Asian and Hispanic Foreign- and Native-Born Living Arrangements: Accounting for Differences

This study examines the relative importance of demographic, resource, and assimilation statuses in explaining the living arrangements of foreign- and native-born Asian and Hispanic elders from 11 origins in 2000 and accounting for why these groups have higher levels of extended living than native-born Whites. Drawing on the 2000 Public Use Microdata 5% Sample (PUMS) files and using logistic regression, the findings show that demographic characteristics are the major determinants of elderly extended living, followed by resource availability, assimilation, and group origin. Assimilation, on the other hand, is the major determinant of group differences between native White and Asian and Hispanic elders. While findings provide support for assimilation theory, the persistence of differentials across Asian and Hispanic groups after controlling for model covariates, and modest increases in extended living for most native-born Asian and Hispanic groups as well as native Whites in the 1990s underscores the enduring nature of ethnic diversity in living arrangements.

Does Gender Moderate Factors Associated with Whether Spouses Are the Sole Providers of IADL Care to Their Partners?

We explored whether gender moderated the influence of other factors on solo spousal caregiving. The subsample (N = 452) from the AHEAD study included elderly care recipients (CRs) receiving IADL assistance and their spouses. Logistic regression modeled the likelihood of solo spousal IADL care. Gender moderation was tested by product terms between CRs' gender and measures of partners' health, potential helpers, and sociodemographic characteristics. As numbers of CRs' IADLs and couples' proximate daughters increased, wives less often received care solely from their husbands, but husbands' receipt of care from their wives was unaffected. Age differences between spouses and CRs affected solo spousal caregiving to wives and husbands in opposite ways. Regardless of gender, CRs' number of ADL limitations and spouses with IADL or ADL limitations reduced the likelihood of solo spouse care. Identifying circumstances influencing solo spouse caregiving differently among couples with frail wives and husbands facilitates gender sensitive services.

What Will the Family Composition of Older Persons Be Like Tomorrow? A Comparison of Canada and France

L’ensemble des sociétés occidentales connaissent actuellement une croissance considérable des personnes âgées de 75 ans et plus. De nombreux changements familiaux affectant ces sociétés, il est pertinent de se demander qui prendra en charge les aînés de demain en cas de besoin d’assistance. Cet article compare les projections démographiques du réseau familial des personnes âgées de 75 ans et plus jusqu’en 2030 au Canada et en France. Au cours des 25 années prochaines, le vivier des aidants familiaux potentiels, constitué des conjoint(e)s et des enfants, s’élargira en raison des effets du Baby Boom (dont l’ampleur a été particulièrement forte au Canada) et de la proportion croissante de femmes qui ont un conjoint. Les populations les plus tributaires de l’aide formelle – sans soutien potentiel provenant d’un enfant ou d’un conjoint – augmenteront à un rythme beaucoup plus soutenu au Canada (123 pour cent) qu’en France (34 pour cent), mais moins rapidement toutefois que l’ensemble des personnes âgées. Les politiques publiques de ces deux pays devront être adaptées afin de soutenir adéquatement des effectifs croissants de personnes âgées confrontés à la dépendance de leurs conjoints. Au Canada, ces politiques devront, de plus, faire face à une hausse, plus forte qu’en France, du nombre d’aînés qui dépendront des services d’aide formelles.

Couples' provision of informal care for parents and parents-in-law: far from sharing equally?

This study examines whether and how couples share the provision of informal care for their parents. Four waves of the British General Household Survey contain cross-sectional information about caring for parents and parents-in-law. Descriptive and multivariate analyses were conducted on 2214 couples that provided parent care. The findings emphasise married men's contribution to informal caring for the parental generation and at the same time demonstrate the limits of their involvement. Spouses share many parts of their care-giving but this arrangement is less common with respect to personal and physical care. The more care is required the more likely are people to participate in care for their parents-in-law. More sons-in-law than daughters-in-law provide care but, once involved, daughters-in-law provide on average more hours of care than sons-in-law. Own full-time employment reduces both men's and women's caring for their parents-in-law, and men's caring drops further if their wife is not in the labour market. The findings suggest that daughters-in-law often take direct responsibility whereas sons-in-laws' care-giving depends more on their wives' involvement. Children-in-laws' informal care-giving might decrease in the future because of women's increasing involvement in the labour market and rising levels of non-marital cohabitation in mid-life.

Transitions to Supported Environments in England and Wales Among Elderly Widowed and Divorced Women: The Changing Balance Between Co-Residence with Family and Institutional Care

In this article we examine changes in the proportion of older widowed and divorced women in England and Wales moving from 'independent' to two kinds of 'supported' household--supported private households and institutions--during the decades 1971-81 and 1981-91. Our main aim was to see whether observed increases in institutionalisation over this period were the result of a decreased propensity to move to the households of relatives. We used the ONS Longitudinal Study, a record linkage study including individual level data from the 1971, 1981 and 1991 censuses of England and Wales. A multinomial logit model was used to investigate the correlates of transitions from independent to supported private households versus institutions among elderly widowed and divorced women. While the overall rate of transitions to join either supported private households or institutions was largely the same in the two decades, the balance between the two shifted markedly in favour of transitions to institutions. In terms of the limited range of covariates it was possible to consider, owner-occupiers were significantly more likely than tenants to move to supported private households than to institutions.

Future trends in health and marital status: effects on the structure of living arrangements of older Europeans in 2030

This article presents the results of projections of older people's living arrangements in 2030 in nine European countries. It analyses expected changes due to future trends in health and marital status. Future changes in the marital status of the older people will result in a higher proportion living in their own homes: women in each age group will more often grow old living with their partner, and this will also apply, to a lesser extent, to men aged 85 and over. Both men and women will be less likely to live alone, with people other than a partner, or in institutions. But for men aged 74-84 the likelihood of choosing one or another type of living arrangement will remain remarkably stable in the future. Further, an improvement in health will lead to older people living alone slightly more often, and they will also more often do so in good health. A comparison of two health scenarios shows that changes in marital status have a major impact on overall trends in living arrangements whereas an improvement in health-which is not certain to occur-will affect them only marginally.

Living alone and depression in Chinese older adults

Western literature has repeatedly indicated a strong relationship between living alone and depression among the aged population, however, studies among the Chinese population are scarce. In this paper, we examine whether the association between living alone and depression is independent of health status, social support and financial strain among Chinese older adults, and subsequently assess whether such association persists after adjusting these variables. Cross-sectional data drawn from the Hong Kong Population Census consisting of 2,003 Chinese elderly people aged 60 or over were analyzed. Chi-square tests and logistic regression analyses revealed that living alone results in higher levels of depressive symptoms for older women but not for older men. This relationship remained significant even when socio-demographic variables, health indicators, social support, and financial strains were adjusted; yet, the impact of living alone with depression disappeared when all variables were controlled. In summary, this paper is the first to report that living alone is an independent risk factor contributing to depression among Chinese older women, as well as identifying certain significant factors including social support and health indicators that can affect and explain the link between living alone and depression. Preventive measures and related issues were discussed.

Preferences for Receipt of Care Among Community-Dwelling Adults

Preferences for long-term care alternatives include both place of care and persons to provide care. In this analysis, these elements are separated for mature adults (N-1503, ages 40-70) regarding future care needs. Most adults preferred care in home/community settings by kin or non-kin, with few deeming nursing homes acceptable. Demographics and personal knowledge, experience, and expectations were marginally likely to influence preferences; males were more likely to prefer care in paid/professional settings. Women, who more often expressed preference for kin/home care, face demographic trends reducing available female kin who might be caregivers.

Living arrangements of older adults in the Netherlands and Italy: coresidence values and behaviour and their consequences for loneliness

Value studies indicate that the process of individualization in Europe started in Sweden and Norway, and continued via France and the Netherlands; the southern European countries lag behind, and are still characterized by more traditional family orientations. Starting from this point of view, this paper investigates the effects of differences between the Netherlands and Italy in the field of living arrangements of older adults with and without partners. The consequences of living alone and of coresidence with adult children have been further investigated, using loneliness as the dependent variable. The size and support functions of the network of social relationships, socio-economic resources, health, sex and age are also taken into account. Data come from face-to-face surveys among a random sample of older adults (55- to 89-year-old women and men) in the Netherlands (n=4,494) and in Italy (n=1,570), using the same research design and questionnaire. The data show country-specific differences in household types of older adults: the proportion living alone is much higher among older people without partners in the Netherlands; the proportion coresiding with their adult children is higher in Italy than in the Netherlands. Controlled for age, health, sex, size and support of the network, and for differences in socio-economic resources, household composition is still the most important determinant of loneliness. Living without a partner in the same household as one's adult children yields country-specific correlations that correspond with differences in value orientations: less loneliness in Italy, more loneliness in the Netherlands.

Bringing managed care home to people with chronic, disabling conditions: prospects and challenges for policy, practice, and research

This article examines the challenges and opportunities inherent in the idea that home care organizations may be able to reinvent themselves into managed care systems for the frail elderly and chronically ill. Data come from three sources: (a) existing literature, (b) a survey with experts, and (c) insights from an organization with direct experience in designing and implementing first- and second-generation managed care programs. The authors conclude that although even the best-positioned home care organizations will face significant challenges in transitioning to managed care systems (e.g., establishing medical linkages, building managed care capacity, securing funding, dealing with regulatory hurdles), changes in the environment may enable these challenges to be overcome. Home care organizations are beginning to use innovative techniques to manage care, and those with a strong commitment to the chronically ill may be interested and capable of pursuing the option of becoming home-based managed chronic care programs.

Resource effects on access to long-term care for frail older people

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.

The living arrangements of elderly people

"In order to assess possible future trends in the living arrangements of elderly people and their implications, we need to understand the causes of...relatively recent changes. Analysts have variously stressed demographic trends, economic factors and behavioural or cultural shifts as major influences on changing household patterns. These arguments are reviewed [in this article]." Aspects considered include the availability of spouse and children, coresidence between elderly parents and children, cultural factors, income, and health and health care. The primary geographical focus is on the United Kingdom, with some additional information for the United States and selected other developed countries.

Living arrangements and health status in later life: a review of recent literature

The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well-being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late-life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late-life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.

Living arrangements among older immigrants in the United States

This analysis uses data from the 1990 5% Public Use Microdata Sample (PUMS) to identify the individual-level characteristics that influence residential dependence among immigrants age 60 and older in the United States. Particular attention is given to differences among 11 immigrant groups. Separate models are shown by gender and marital status. The results indicate that Hispanic and most Asian immigrants, particularly those from Mexico, Central or South America, India, and the Pacific Islands, are at a greater risk of living with family than non-Hispanic White immigrants. Although resource, need, and demographic characteristics influence the risk of living with Family, these individual-level characteristics do not explain the observed differences across the immigrant groups. These findings suggest that preferences that are shaped by the immigrant's experience as well as cultural background are an important determinant of immigrant living arrangements in later life.

Care arrangement decisions for frail older women: quantitative and qualitative perspectives

This study uses both quantitative and qualitative methods to investigate how a range of care arrangement decisions for frail older unmarried women are made. Quantitative data from the 1989 National Long-Term Care Survey provides information concerning factors that predict the probability of five categories of care arrangements, including self only care, nursing home care, informal only care, formal only care, and a mix of formal and informal care. Qualitative interview data provides information on what occurs during care arrangement decision-making processes. Results are combined to explain the choice of care arrangements for a small sample of chronically disabled older unmarried women. Results show that need factors, such as age and disability, are strong predictors of the need for assistance. Family members played a central role in determining care arrangements and often helped an older woman to avoid an unwanted care arrangement. The use of a broad measure of impairment resulted in high levels of disability for the sample participants. Both disability status and care arrangements were transitory in nature.

Aging children and their older parents: the coming generation of caregiving

This study uses a data set of older children and their older parents to examine caregiving relationships. Using the 1993 Panel Study of Income Dynamics and the 1993 Health Care Burden file, we examine help given by children to their parents. We distinguish between daughters who are household heads and daughters who are wives. We find parents receive substantially more care from daughters than from sons. The caregiving role of daughters who are household heads differs notably from that of wives. An analysis of caregiving, employment, and house-work shows that children who are caregivers devote more combined hours to these activities than children who do not provide care.

The family as provider of long-term care: efficiency, equity, and externalities

The passage of the baby-boom generation into old age raises the prospect of intense pressures on public programs benefiting the elderly, limiting any contemplated expansion of programs serving those needing sustained personal care. This necessitates consideration of comparative efficiency of alternative resources for elder care. I focus on two distinct aspects of such efficiency: productive--the relationship between inputs and outputs--and target--the coincidence of served and those viewed as needing services. I argue that for theoretical reasons family members, specifically children, may be more productive and efficient carers than paid helpers. Furthermore, even if no more efficient than formal providers, care provided by children reduces public expenditures on long-term care. In view of the value to society of children's caregiving activities, if a collective program of long-term care insurance were to be adopted, it should be configured to target its financing and benefits according to family composition.

Changes in household composition among the over sixties: a longitudinal analysis of the Health and Lifestyles Surveys

Analyses of longitudinal data from the Health and Lifestyles Surveys (HALS) were carried out in order to examine the household changes of older people. Respondents who were interviewed at both the first HALS survey in 1984/85 (HALS1) and the second survey 7 years later (HALS2) and were aged 60 or over in HALS1 were selected (1156). Changes in household composition between the two surveys were examined and the relationship of these changes to socio-demographic factors and to both cross-sectional and longitudinal health factors investigated. Results of the analysis showed there was great diversity of experience and a considerable amount of change in what is often considered a fairly stable and homogeneous section of the population. Almost one-third of respondents changed household type, the majority changing to live alone and only a small proportion changing to live in households with their child/children or with others. Household changes were associated with poor and declining health (both physical and mental) and the rate of change was found to increase with age. In the case of ill health the first source of practical support and care is generally from within the household. Where this is not available it is sought from the wider community or the state. An increase in the proportion of the population aged over 60 and in the numbers of the oldest people, coupled with a rate of household change that increases with age, means that demand on health and community services can only be expected to increase.