Distribution of informal caregiving for older adults living with or at risk of cognitive decline within and beyond family in rural South Africa.

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Aging populations will increasingly need care, much of this provided informally particularly in rural areas and in low and middle-income countries. In rural South Africa, formal support is severely limited, and adult children are frequently unavailable due to morbidity, early mortality, employment and migration. We describe how care is shared within and between households. We conducted quantitative interviews with 1,012 household members and non-household caregivers of 106 older adults (age ≥54) living with or at risk of cognitive decline in rural Mpumalanga, South Africa. Using descriptive statistics and regression analysis, we described how care is shared, with particular attention to generational patterns of care. Spouses, the majority women, commonly considered themselves primary caregivers. informal care was spread among family, friends, and neighbors, most commonly by unemployed female relatives one or two generations younger than the recipient. A small number of paid caregivers, also mostly female, provided the most intensive care. Informal care for older adults was spread widely, predominantly from co-resident family but with important contributions from others. Family commitment to care reflected shared history, reciprocal relationships, and easy access to care tasks within the household. A deeper understanding of how informal care for older adults is shared is essential for developing targeted interventions.