Why do spouses provide personal care? A study among care-receiving Dutch community-dwelling older adults

The Impact of Stepfamily Structure on Older Parents' Frequency of Contact With and Care Receipt From Adult Biological and Stepchildren in the Netherlands

OBJECTIVES

Older people are increasingly entering their later years in stepfamilies. Because adult children play a central role in older parents' support networks, there is concern that the generally weaker intergenerational ties found in stepfamilies may imply an impending deficit in the care available to stepparents. It is currently unclear whether there are differences across stepfamily types including stepfamilies with only biological children. The aim of the study is to examine whether there are differences in contact frequency with and care receipt from adult biological and stepchildren in biological and different types of stepfamilies.

METHODS

Data are from the Longitudinal Aging Study Amsterdam (1992-2022; 10 observations); respondents' ages varied between 54 and 101. An average of 3.7 observations are available from 2,761 parents in biological families and 647 parents in stepfamilies.

RESULTS

Parents in biological families and in stepfamilies with joint children had more contact than in other stepfamily types. There was less contact in stepfamilies with biological and stepchildren formed in midlife and in families with only stepchildren. There were small differences in care receipt; the lowest likelihood was in composite families.

DISCUSSION

Our study challenges the idea that the relationships of the adult child to older parents in all stepfamilies are weaker than in biological families and points to the importance of considering that only some stepfamilies are vulnerable in terms of contact frequency. We query whether stepfamilies are resilient, for example, to greater pressures from a sharp increase in care needs for one or both parents.

The Translation of Intergenerational Care Potential Into Care Receipt of Older Parents: A Prospective Study

This study prospectively examined the extent to which intergenerational care potential translated into parent's care receipt. Data were from 510 parents (aged 70-97 years at baseline) who reported on their 1496 adult children in the Longitudinal Aging Study Amsterdam, with seven observations over ten years. Joint care potential considered the number of children and their care potential types. Children with high care potential lived nearby, had frequent contact, and had significant emotional and instrumental support exchanges with their parent. For unpartnered parents, each additional child increased the likelihood of receiving intergenerational care. Having children with high care potential further increased this likelihood. For partnered parents, receiving care was more likely if all children had medium or high care potential; an additional child only contributed under this condition. Policies and practice should not assume that older parents will receive care solely based on having multiple children or a child living nearby.

Self-care and health-related quality of life in Mexican older adults with type 2 diabetes

BACKGROUND

Type 2 diabetes (T2D) is one of the most prevalent chronic diseases in the world and represents one of the main risk factors for cardiovascular diseases. The evidence suggests that inadequate self-care behavior among patients with chronic diseases might negatively affect their health-related quality of life (HRQoL); however, the evidence in older adults with diabetes is inconclusive, and the information is scarce in the Mexican context. Therefore, this study aimed to determine self-care behavior and HRQoL in Mexican older adults with T2D and evaluate the association between both variables.

MATERIALS AND METHODS

An analytical cross-sectional design was used. Participants (n = 300) were recruited at six senior centers in Hidalgo, Mexico. The Self-Care Capacity and Perception Test for Older Adults and the brief version of the World Health Organization Quality of Life Scale (WHOQOL-BREF) were used to assess self-care behavior and HRQoL, respectively. The associations between the variables of interest were evaluated by logistic regression models adjusted for confounders.

RESULTS

Older adults with inadequate self-care behavior were more likely to have poor HRQoL in all domains of the WHOQOL-BREF: physical health [adjusted odds ratio (aOR) = 4.10; 95% CI = 1.59, 10.57], psychological health (aOR = 6.98; 95% CI = 2.41, 20.19), social relationships (aOR = 7.02; 95% CI = 2.64, 18.67), and environmental health (aOR = 4.25; 95%CI = 1.43, 11.50). Partially adequate self-care behavior also showed a significant association with poor HRQoL.

CONCLUSION

Self-care behavior was independently associated with HRQoL in Mexican older adults with T2D. Thus, it is important to plan awareness-raising interventions to improve self-care behaviors in older adults with chronic conditions.

Mechanism for meeting the care of older adults in rural China-relying on spouse, offspring or community?

BACKGROUND

Within the population aging and the trend of aging in place on the rise, it is crucial to explore how care needs are being met for this demographic within the community.

METHODS

This study utilizes data from the 2019-2021 survey on 1,126 rural older adults aged 60 years and above across 11 provinces and 31 villages in China. This study aims to examine the influence of spouse, offspring, and community status on the extent to which the care needs of rural older adults are met. Furthermore, it seeks to clarify the underlying mechanism of influence, as well as the change that occurs throughout the life cycle, using a multiple linear regression analysis.

RESULTS

This study demonstrates that the health status of spouses, the education level of offspring, the relationship with offspring, and the living with offspring significantly and positively influence the meeting of care needs among rural older adults. Notably, older adults with healthier spouses experience a 14.5% greater fulfillment of care needs compared to those without partners. Furthermore, those living with their offspring experience a 10.6% higher degree of care met. Additionally, the construction and operation of community senior care facilities, indicative of community quality, significantly enhance the meeting of care needs among rural older adults, with a 16.0% increase in met needs for those residing in communities equipped with such facilities compared to those without. From a life cycle perspective, the aforementioned significant effects are only observed among rural older adults aged 60-74 years or those in better health.

CONCLUSION

Our results indicate the meeting of the care needs among rural older adults is influenced by the quality of their spouse, offspring, and community, with these effects diminishing later in the life cycle.

Mental health impacts of spousal caregiving intensity in the US

In the US, spouses are a major source of informal care for older adults and, therefore, key to the US national strategy to provide long-term care to the growing population of older adults. Understanding the mental health impacts of spousal caregiving is therefore critically important. Existing studies on the topic have often been limited by methodological limitations, and most overlook the role of caregiving intensity. In this study, we assess the impact of providing different intensities of caregiving to a spouse on mental health outcomes using data from the Health and Retirement Study. We address the endogeneity of the decision to provide different caregiving intensities using an augmented inverse probability weighted (AIPW) estimator adapted to handle multivalued treatments. We check the robustness of our estimates to the AIPW's identifying assumptions by re-estimating the model using a dynamic fixed effects estimator. We find strong evidence that becoming a caregiver is associated with worsened mental health outcomes for women, while the evidence for men is weaker. When disaggregating by caregiving intensity, we find that transitions into high-intensity caregiving lead to large increases in depression symptoms and the probability of exhibiting major depression for both men and women. The overall mental health impact of transiting into caregiving is driven almost exclusively by the negative impact of high-intensity caregiving, as transitions into low- and moderate-intensity caregiving are not associated with worsening mental health in most specifications. This study provides timely insights that can inform the targeting of long-term care policies and programs aimed at supporting family caregivers of older adults.

Why is the composition of older adults' care network associated with psychological wellbeing: an application of the self-determination theory

OBJECTIVES

Older care recipients have different types of care networks, varying from spouse-only to large mixed care networks, that add to different levels of wellbeing. Applying Self-Determination Theory (SDT) to the care context, we argue that the care network composition may foster or hamper the three basic needs for wellbeing: relatedness, autonomy and competence.

METHOD

Data are from ten observations between 1992 and 2022 of the Longitudinal Aging Study Amsterdam (N = 18,434 observations from 4,837 older Dutch adults). Five care network types are used: no care, partner, informal, formal or privately paid care. Mixed-hybrid-multilevel regression analysis of depressive symptoms as measure of wellbeing is applied on care network type and loneliness, mastery and care sufficiency as indicators of the three basic needs for wellbeing.

RESULTS

Receiving care from a partner care network is, compared to the formal care network, the most negatively associated with depressive symptoms, followed by informal care and privately paid care. Differences in care network types existed in loneliness and care sufficiency, but not in mastery, and in part explained the association between care network types and depressive symptoms. Results of between and within effects are comparable.

CONCLUSION

Using a rich data set and advanced methodology support the hypotheses that formal care networks hamper wellbeing due to insufficient care and increased loneliness, in particular compared to partner and informal care. The role of mastery was less important, possibly because it does not measure care related level of control.

Depends on whom you ask: Discordance in reporting spousal care between older women and men across European welfare states

PURPOSE

We aim to investigate systematic differences in reporting spousal care between caregivers and cared-for persons and their possible effects for the analysis of care regimes and correlation of care with health.

MATERIALS AND METHODS

Using information on care provided/received from the Survey on Health, Ageing and Retirement in Europe (SHARE), we estimate the prevalence of spousal care and discordance between caregivers and cared-for persons in the reporting of care among caregiving dyads. Multinomial regressions are used to estimate systematic differences in reporting spousal care. We then use multivariable logistic regressions to assess the association between discordance in reporting informal care and carer's self-rated health (SRH) and depression using the EURO-D scale.

RESULTS

Only 53.9 % of dyads report care that is confirmed by both spouses. Multinomial regressions show that agreement on care being provided/received is more common when women are caregivers, while men are likely to underreport when providing or receiving personal care. Prevalence of spousal care across care regimes is sensitive to who reports care. There is no effect on the association of care with SRH regardless of who identifies the carer, while the magnitude and statistical significance of the association between depression symptoms and care varies according to the choice of respondent.

CONCLUSIONS

Informal care may be understated across Europe when relying solely on carer self-identification through description of tasks in surveys. From a policy standpoint, relying on self-identification of carers to access support or social benefits may potentially reduce the take-up of such benefits or support.

Affordance trajectories and the usefulness of online records access among older adults in Sweden

Objective

The current understanding of the breadth of individual differences in how eHealth technologies are perceived as useful for different purposes is incomprehensive. The aim/purpose of the study is to improve the understanding of diverse perceptions of the usefulness of technologies by exploring older adults' use of their patient-accessible electronic health records (PAEHRs).

Methods

The study applies and extends Affordance Theory based on an empirical analysis of data from the NORDeHEALTH 2022 Patient Survey on attitudes toward PAEHR in Norway, Sweden, Finland, and Estonia. Responses from 3964 participants in Sweden, aged 65 + years were analysed. Data included demographics and agreement ratings to reasons for using PAEHR. To analyse variation in the reasons for using PAEHR, group comparisons were conducted based on gender (male/female), age group (65-74, 75-84 and 85+) and earlier encouragement to use PAEHR.

Results

Overall, the findings suggest that PAEHRs have multiple parallel affordance trajectories and affordance potencies that actualise differently depending on needs. The top reasons, pointing to both orientational and goal-oriented affordances for using PAEHR, were improving understanding of health issues, getting an overview of medical history/treatment and ensuring understanding of what the doctor said. Men reported more often sharing information with relatives or friends as a reason to access PAEHR. Women were more inclined, albeit similarly to men less frequently, to read their PAEHR for detecting errors. Age had little influence on reasons for using PAEHR.

Conclusions

The study applies and extends Affordance Theory in the context of older adults' PAEHR use based on findings from the largest national investigation of reasons for older users to access PAEHR in Sweden demonstrating the applicability of the theory in improving the understanding of the diversity of individual perceptions on eHealth technologies.

The experiences of caring for disabled older adults in long-term: A qualitative study from the perspective of spousal caregivers

OBJECTIVE

To explore the care experiences of spouses as long-term and primary caregivers for disabled older adults in China.

METHODS

A descriptive phenomenological method was used in this study, as well as purposive and convenient sampling. Semi-structured interviews were conducted with 15 spousal caregivers in Guangdong, China, from March to December 2021. Interview audio-recordings were transcribed verbatim and data were analyzed using Colaizzi's phenomenological analysis method.

RESULTS

We identified four themes from the data: spousal care motivation; sacrifices in caregiving; obstacles in caregiving; spousal caregivers' positive experiences.

CONCLUSIONS

Spouses took responsibility for providing care for their disabled partners regardless of their willingness. They had positive experiences while providing care, but negative experiences were dominant, especially for spouses of severely disabled older adults. Spouses are always perfect in caregiving roles, although they may also need medical assistance. To prevent a decline in spousal caregivers' quality of life and relieve their care burdens, health care providers should support them as soon as possible or offer formal care for disabled older adults. It is necessary to intervene considering disabled older adults and their spousal caregivers as a unit to empower their confidence in coping with life together.

The Longitudinal Association between Co-Residential Care Provision and Healthcare Use among the Portuguese Population Aged 50 and Over: A SHARE Study

Co-residential care is associated with poor caregiver health and a high burden. Although Portugal relies heavily on co-residential care by individuals aged 50 and over, studies on the impact of co-residential care provision on Portuguese caregivers' healthcare use are lacking. This study aims to analyze the impact of co-residential care (spousal and non-spousal care) on healthcare use of the Portuguese population aged 50 plus. Data from waves 4 (n = 1697) and 6 (n = 1460) of the Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Negative Binomial Generalized Linear Mixed Models with random (individual level) and fixed (covariates) effects were performed. The results show that the number of visits to the doctor decrease significantly over time for the co-residential spousal caregivers as compared to the non-co-residential caregivers. This result highlights the fact that the Portuguese co-residential spousal caregiver group is at a higher risk of not using healthcare, thus jeopardizing their own health and continuity of care. Promoting more accessible healthcare services and implementing public policies adjusted to the needs of informal caregivers are important to improve the health and healthcare use of Portuguese spousal co-residential caregivers.

The care types choice in filial culture: A cross-sectional study of disabled elderly in China

For the past few decades, studies of care types choice have been restricted to the scope of individual characteristics and health status. Meanwhile, the historiography of the research largely ignores the role of filial culture within China. This study sets out to examine the influence of the factors in the cultural context of filial piety on the choice of care types for older people with disability in China. According to the characteristics of filial culture, the factors influencing the choice of care type for the older people in China are summarized as family endowment and support. The study concludes that gender, residence, living alone or not, family income, real estate, pension and community service have momentous effects on the choice of care type of older people with disability; informal care has a substitutive effect on formal care. The research was based on cross-sectional data of CLHLS 2018 and utilized binary logistic regression analysis to compare the factors influencing the choice of old disabled people between formal and informal care. The study implies that in the context of filial culture, the older people's choice of care types is affected by family endowment and community service supply for the older people in China. In the background of filial culture, the government should give informal care official support such as cash and services, so as to change its attribute of private domain of it and enhance the quality of long-term care.