The association between employment and family histories and caregiving in later life. European findings based on SHARE and ELSA

While many theoretical arguments have been proposed to explain the decision whether to purchase long-term care (LTC) insurance, little work has been done to study this phenomenon empirically. This article uses cross-sectional data from the newly developed SHARE (Survey of Health, Ageing, and Retirement in Europe) database to estimate the determinants of the probability of purchasing LTC insurance in France. We show that LTC insurance is purchased not only to preserve bequests and to financially protect families in the event of disability, but also to reduce the burden on potential informal care givers. Risk behaviours as well as experience of disability also play a significant role in explaining the demand for LTC insurance in France.

The rising number of older adults with limitations in their daily activities has major implications for the demands placed on long-term care (LTC) systems across Europe. Recognizing that demand can be both constrained and encouraged by individual and country-specific factors, this study explains the uptake of home-based long-term care in 18 European countries with LTC policies and pension generosity along with individual factors such as socioeconomic status. Using data from the Survey of Health, Ageing and Retirement in Europe conducted in 2019, we apply a two-part multilevel model to assess if disparities in use of LTC are driven by disparities in needs or disparities in use of care when in need. While individual characteristics largely affect the use of care through its association with disparities in need, country-level characteristics are important for the use of care when in need. In particular, the better health of wealthier and more educated individuals makes them less likely to use any type of home-based personal care. At the country level, results show that the absence of a means-tested benefit scheme and the availability of cash-for-care benefits (as opposed to in-kind) are strongly associated with the use of formal care, whether it is mixed (with informal care) or exclusive. LTC policies are, however, shown to be insufficient to significantly reduce unmet needs for personal care. Conversely, generous pensions are significantly associated with lower unmet needs, underscoring the importance of considering the likely adverse effects of future pension reforms.

Network for improving the dementia care system

This article uses cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) database to test the effect of both long-term care (LTC) public benefits and insurance on the receipt of informal care provided by family members living outside the household in Italy and Spain. The choice of Italy and Spain comes from the fact that informal care is rather similar in these two countries while their respective public LTC financing systems are different. Our results support the hypothesis of LTC public support decreasing the receipt of informal care for Spain while reject it for Italy. They tend to confirm that the effect of public benefits on informal care depends on the typology of public coverage for LTC whereby access to proportional benefits negatively influences informal care receipt while access to cash benefits exerts a positive effect. Our results also suggest that private LTC insurance complements the public LTC financing system in place.

Background and ObjectivesDespite a growing body of literature on physical functioning and informal caregiving in later life, few studies have explored how physical functioning changes over time in older caregivers versus noncaregivers and the role of different functioning types in understanding these changes. This study investigates the association between informal caregiving and changes in physical functioning over time among older adults in the Northern Netherlands.Research Design and MethodsWe analyzed data from 2 waves of the Lifelines Cohort Study, using a sample of 9,912 older caregivers and noncaregivers. We examined 11 outcome variables: overall physical functioning and 10 physical functioning types (e.g., vigorous and moderate activities; lifting/carrying groceries; walking various distances). We also controlled for health and demographic characteristics. Associations between changes in physical functioning and caregiving were modeled using generalized estimating equations.ResultsCaregiving affects the effect of aging on older adults’ physical functioning, with caregivers experiencing less decline in overall physical functioning, moderate activities, and lifting/carrying groceries compared with noncaregivers. Despite this, caregivers exhibited higher mental and physical impairments at baseline, contradicting aspects of the healthy caregiver hypothesis. Gender differences were significant, with women showing more limitations in physical functioning than men. Additionally, higher household income and educational attainment were associated with better physical functioning, potentially weakening the negative association between caregiving and aging.Discussion and ImplicationsThis research contributes valuable insights into healthy aging, informal care, and disability in later life, indicating the need for tailored interventions and policies for older caregivers.

The purpose of this report is to provide basic descriptive information on community-dwelling, disabled, private long-term care (LTC) insurance policyholders who have accessed policy benefits. We focus on how benefits are used, whether claimants feel they are getting appropriate value from their policies, and what the patterns are of formal and informal service use. Data were obtained from a nationally representative sample of 693 LTC insurance claimants who were receiving benefits while living in the community and 424 of their informal caregivers. Eight of the largest LTC insurance companies representing about 80% of the market participated in the study. LTC insurance benefits are well targeted; they serve those truly dependent on ongoing care. The vast majority of claimants are satisfied with their policies, understand their coverage, and find it easy to file claims. Because of their LTC benefits, substantial numbers of disabled elderly individuals report that they are able to remain at home instead of being forced to seek institutional care. The availability of LTC benefits reduces stress among informal caregivers. For most claimants, formal care did not replace informal caregiving. As the LTC insurance market continues to grow and mature, there will be changes in the profile of claimants, the service delivery system, and the design of policies. Expansions in the private market will be associated with a greater number of disabled elderly remaining in their homes with a maintenance of and enhanced resiliency of informal support networks.

The purpose of this study was to better understand the social value of family caregiving in later life by examining the effects of social networks and family caregiving on the health of older adults. The study employed the positive gerontological framework. It was a cross-sectional, explanatory survey study using a questionnaire developed specifically for this study. Multiple data collection and data analysis methods were used to enhance the validity of the results. The results highlighted that family caregivers in later life had significantly lower levels of physical function and mental health, but social networks positively affected their well-being. More specifically, high levels of functional social networks significantly predicted better self-rated health and higher physical function. The nature of the study limits generalizability of the results. However, several implications were identified regarding research, practice, and policy. This study added new knowledge to the family caregiving literature by presenting new empirical evidence in the social realities of family caregivers and their health outcomes.

Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.

This study seeks to assess whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. Building on the stress process model and stress-appraisal moderation, we examine how formal and informal support varies in associations with caregiver distress for men and women. This study utilizes data provided by the National Study of Caregiving, which is linked with care-recipient information from the National Health and Aging Trends Study. Using panel methods for the pooled waves, we estimated caregiver outcomes of emotional well-being on the intersection of experiences of work strain and (a) the number of additional caregivers and (b) utilization of 6 different types of formal support. Additional informal caregivers for each respective care recipient are associated with lower levels of distress, although utilization of formal services (paid help and Medicaid funding) is positively associated with caregiver distress. Informal support can offset the impact of work strain, but interactions are only evident for women caregivers. The findings suggest that informal support, exemplified by the number of additional caregivers, corresponds with reduced emotional distress among employed caregivers and can mitigate the negative impacts of work strain. However, positive associations between formal support and male and female caregiver distress suggest that the context of formal services may offer limited or untimely support. This study is expected to broaden our understanding of informal caregiving in later life and provide practical implications on how to sustain informal care.

Population ageing is a well-known (and some decades old) phenomenon of European societies: according to Eurostat data in 2017 older persons (i.e. 65 years or more) represented 19.4% of the EU-28 population, an increase of 0.2 percentage points compared with 2016 and of 2.4 percentage points compared with 1997. Even more relevant is the expected doubling of the share of population aged 80 years or more: from 5.5% in 2017 to 12.7% in 2080 (Eurostat 2018).1 Although population ageing has not always and everywhere translated into an increasing number of individuals who need long-term care support, at the same time a number of studies have suggested that there is not a clear trend towards a compression of morbidity, or that trend can fully compensate for the progressive increase of elderly individuals. As a consequence, it is expected that the need for care services will significantly increase in the next future, especially when the baby-boomer generation will hit age 70–75. In most European countries, the growing need for long-term care services has not been matched by an equal increase in policies addressing these needs. This suggests that the possibility (or not) of receiving informal care in later life will be an increasingly relevant dimensions along which inequalities in well-being later life are structured. Inequalities in care support – given and received – are clearly the result not only of individuals and household’s situation at the moment in which care needs arises, but most importantly of their life course. Family histories – i.e. marital and parenthood careers of family members – and the characteristics and history of intergenerational family solidarity play a huge role in determining the availability of care. Next, the institutional context – broadly defined in terms of the characteristics of both the welfare and family systems in the country of residence – also dramatically influences the equal/unequal distribution of formal and informal care. Using data from the Survey of Health, Ageing and Retirement in Europe, and adopting the instruments and analytical approach typically utilized in the studies of income inequalities, the present contribution aims at: first, shedding light on the level of inequality of the distribution care support (given and received) characterizing different European societies; second, exploring the possible relations between different levels of inequality in care support and the characteristics of the national family and welfare system; third, analysing the typical life course patterns of households and individuals who are categorized as care-poor, thus identifying the factors that are associated with the lack of informal care in later life; finally, investigating how these factors vary across different European societies.

Disclosing socioeconomic differences in informal care provision is increasingly important in aging societies as it helps to identify the segments of the population that may need targeted support and the types of national investments to support family caregivers. This study examines the association between individual-level socioeconomic status and informal care provision within the household. We also examine the role of contextual factors, income inequality, and the generosity of social spending, to identify how macro-level socioeconomic resource structures shape individuals’ provision of care to household members. We use pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4, 5, 6) and the English Longitudinal Study of Ageing (ELSA, waves 2, 3, 4, 6, 7). Poisson regression multilevel models estimate the associations between household socioeconomic status (education, income, and wealth), and country socioeconomic resources (income inequality and social spending as a percentage of GDP), and the likelihood of older adults’ informal care provision within the household. Results indicate that lower individual socioeconomic resources—education, income, and wealth—were associated with a higher incidence of older adults’ informal care provision within the household. At the macro-level, income inequality was positively associated while social spending was negatively associated with older adults’ care provision within the household. Our findings suggest that socioeconomically disadvantaged groups are more likely to provide informal care, which may reinforce socioeconomic inequalities. At the national level, more equitable resource distribution and social spending may reduce intensive family caregiving.

Most care provided to the elderly living at home comes from informal caregivers: family members, friends and neighbours. With the development of community services such as community healthcare, personal lifeline systems for the elderly or the panic button, home care and similar, informal care is enhanced by formal community forms of care. The data from the SHARE (Survey of Health, Ageing and Retirement in Europe) survey was used to estimate the number of people (over 65 years old) who receive an individual type of care (no care, only informal care, only formal care, a combination of the two), as well as the number of people who need care, but fail to receive it. The multinomial logistic regression method was also used to evaluate the factors that influence the type of care. Similar to other European countries, the need and the availability of informal caregivers have the strongest influence on the type of care, whereas the distribution of types of care mostly resembles Mediterranean countries.

Models and Interventions for Informal Caregiving in Later Life

The role of migration status in the link between ADL/IADL and informal as well as formal care in Germany: Findings of the Survey of Health, Aging and Retirement in Europe

Objective: In Europes' ageing societies, informal care is increasingly critical for fulfilling the care needs of older people. Social inequalities in informal care are, however, still poorly understood, and the (differential) wellbeing consequences of caregiving remain unclear. Background: To this end, we provide an overview of empirical results, methodological challenges, and open questions originating from our research project IN-CARE (2019-22) that set out to assess inequalities in care and wellbeing in different care regimes. In this article, we focus on social gradients in informal care and its impact on wellbeing across European care contexts from the perspective of caregivers. Method: Based on the data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study (ELSA) we applied different regression techniques and estimated fixed-effects models. Results: We find a socio-economic gradient in informal care and wellbeing. Yet, we do not find socio-economic differences in the effects of caregiving on caregivers’ wellbeing across European countries with different LTC policies. Also, we observe strong gender differences in the association of caregiving with caregivers’ wellbeing within the population of 50+, which depend on different care arrangements and care regimes. Conclusion: We conclude that gender is still the central inequality dimension in informal caregiving, linked to many other inequality dimensions, and strongly dependent on different care contexts. Thus, when designing social policies, multiple cross-level interactions and path dependencies should be considered.