Carers Research Articles

Integrating informal and formal care: An innovative, scalable program blueprint.

People have infinite needs, including illness prevention, wellness, self-care, practical support, and quality of life. This article describes community-based, informal care programs that help people identify their needs, set goals, and organize networks of care to address their needs holistically in a way that can also significantly reduce healthcare costs. Approaches can be customized for primary care, home and community, hospice, and other care sectors to facilitate low-cost, high impact adoption. We provide a blueprint for programs that integrate informal and formal care across social, physical, and mental health domains as a key part of healthcare system transformation.

Good Together Makes it Better?

Abstract: Introduction: Informal caregiving can lead to burnout. The relationship between burnout and negative states has been the subject of extensive research. This study analyzes the mediation role of a positive psychological variable – the quality of the carer-patient relationship – between psychological distress and informal carers’ burnout. Methods: We recruited Portuguese informal carers of adult cancer patients online ( N = 92) to answer the Quality of Carer-Patient Relationship Scale gauging relationship quality, the Depression, Anxiety, and Stress Scales assessing psychological distress, and the Maslach Burnout Interview-Human Services Survey evaluating the dimensions of burnout, depersonalization, emotional exhaustion, and reduced personal accomplishment. The cross-sectional data were analyzed through descriptive statistics, correlations, multiple regressions, and simple mediation analysis. Results: Our results show that psychological distress variables directly affect burnout dimensions, and that relationship quality has a significant indirect effect on each burnout dimension, suggesting that relationship quality partially mediates the association between each distress dimension – depression, anxiety, and stress – and each of the burnout components – depersonalization, emotional exhaustion, and personal accomplishment. Discussion/Conclusion: This study underscores the importance of intervening in informal caregiver mental health and patient-caregiver relationships and encourages further investigation into the dynamics of the studied variables.

Temporal dynamics of unmet long-term care needs in China: an age period cohort analysis

Abstract Rapid demographic changes and heavy reliance on informal care pose significant challenges to meeting long-term care (LTC) needs in China. Understanding changes in unmet LTC needs across different times and places can inform future LTC system planning and care resource allocation, identifying emerging care needs and services gaps in different regions. Drawing on data from 6,030 urban and 5,070 rural residents in the Chinese Longitudinal Health Longevity Survey 2005–2017/18, this study investigates variations in unmet LTC needs across different age groups, periods and birth cohorts among Chinese older adults and their place-based rural–urban differences. We applied the age-period-cohort interaction model to disentangle the three temporal processes, and found that, overall, rural older adults experienced higher risk of unmet LTC needs and had larger variation in age effects, yet the age, period and cohort effects on unmet needs among rural older people differed from their urban counterparts. Although ‘younger’ older adults (aged below 85) had fewer care needs than older adults, they had a higher risk of experiencing unmet needs. The risk of having unmet needs did not change significantly over the 12 years, though unmet LTC needs were more pronounced among more-recent cohorts than previous generations, especially in urban areas. The findings contribute to the social gerontology debate regarding changing patterns in unmet LTC needs, and provide crucial policy insights, underscoring the necessity of targeted interventions to address ‘younger’ older adults’ care needs and increased investmed in the formal LTC system to tackle the escalating care gap.

Multidimensional gender ideologies: How do they relate to work-family arrangements of mothers with dependent children in Poland and western Germany?

This study uses a multidimensional approach to identify gender ideologies and investigate their association with work-family arrangements among mothers of dependent children in Poland and western Germany. Based on data from the Generations and Gender Survey, we apply ordinal latent class analysis and identify five gender ideology classes: (1) traditional, (2) intensive parenting, (3) ambivalent, (4) moderately egalitarian, and (5) strongly egalitarian. In both countries, we find that the intensive parenting class resembles the traditional class in terms of lower maternal employment, a more gendered division of housework and childcare, and a smaller probability of using formal childcare, whereas the ambivalent respondents mostly practice work-care arrangements that are similar to the moderately egalitarian class. With respect to informal care, mothers who identify with strong egalitarianism significantly differ from the traditional class in western Germany, but they do not in Poland—thus highlighting the role of the cultural and institutional context in explaining the complex links between mothers’ gender ideologies and work-family arrangements.

Aging in place or aging out of place? Family caregivers' perspectives on care for older Pakistani migrants in Norway.

The aging population in Europe is increasing, with growing ethnic diversity among older individuals due to migration. Public policies emphasize 'aging in place' to address financial challenges and reduce the burden on the healthcare system. However, research often overlooks the heterogeneity among older people, especially non-European migrants. Also, research on family caregivers' role in enabling 'aging in place' for older relatives with migrant backgrounds is limited, despite many older non-European migrants' preference for family care in comparison to long-term institutional care. This study aims to explore the experiences and perspectives of family caregivers in the context of formal and informal care and their preferences regarding the place of care for older family members with migrant backgrounds, particularly the Pakistani Ahmadiyya community in Norway. Eighteen semi-structured individual interviews and two group interviews were conducted in Urdu and English with nineteen female family caregivers of older relatives, ages 25-62, residing in Norway. The analysis yielded three main themes: (1) "Nursing homes are not for the ones who love their parents", (2) Preferences for home with the possibility of sharing care, and (3) Mismatch between family care needs and formal care. Family caregivers' perception of health services has a decisive impact on their older relatives' demand and use of formal health services, emphasizing the need for trust. Even though home care services were seen as a viable option, they should be adapted so that the family caregivers can use them and feel supported in enabling 'aging in place' for older migrants.

A Qualitative Exploration of the Role of Culturally Relevant Social Prescribing in Supporting Pakistani Carers Living in the UK.

Approximately 5.7 million people in the UK are providing informal care. Carers across all ethnic groups can experience negative impacts on their physical and mental health but some minority ethnic groups face greater challenges. Higher levels of social isolation exist among Pakistani carers compared to White British carers, yet the needs of Pakistani carers and how well support services meet these needs is less well understood. Social prescribing can help people get more control over their health care in a nonmedical way. South Asian and other ethnically diverse populations are under-served in social prescribing and there is little evidence available on why this is the case. To explore the potential role of culturally relevant and adapted social prescribing in assisting Pakistani carers and identify the cultural and religious influences and barriers on carer health behaviours. Semi-structured one-to-one interviews with Pakistani family carers (n = 27) and social prescribing stakeholders (n = 10) living in London and Sheffield, UK. Participants were recruited through voluntary and community sector organisations (VCSOs), social media, religious organisations, and word of mouth. Interview data was analysed in NVivo using reflexive thematic analysis methods. Two themes were developed; (1) Individual and community level influences: Navigating and accessing carer support within Pakistani communities, including carer identity and cultural barriers to accessing support provision, and cultural adaptation to facilitate support for Pakistani carer health and well-being, (2) societal and structural level challenges: Accessing and providing social prescribing for Pakistani carers, including funding challenges for the provision of culturally relevant carer support, integration of primary care and social prescribing, and enhancing cultural awareness and competence in social prescribing for Pakistani carers. There are complexities surrounding carer identity, family dynamics, stigma, and a lack of knowledge of social prescribing within Pakistani communities. There is a need for more culturally competent support, culturally relevant education, awareness-raising, and collaboration among primary care and VCSO's to better support Pakistani carers through social prescribing, which acknowledges and addresses the complexities. The study included a patient advisory group comprised of two South Asian family carers who contributed towards all stages of the study. They provided feedback on study documents (topic guides and recruitment materials) and recruitment strategy, supported with translation of study documents and interpretation of the interview data, and helped with facilitation of our dissemination activities.

Relationship Between Primary Caregiving Type and a Peaceful End-Of-Life Experience Among Older Adults in China

ABSTRACT Few studies have compared pain management provided by informal and formal caregivers of older adults in China at the end of life. This study aims to address this gap by investigating the association between formal and informal care and painfulness at the end of life among older adults in China. Specifically, the study focuses on the influence of various types of informal care. Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted from 2002 to 2018, which is the largest nationally representative study of older adults in China, with a sample size of 21,849 deceased participants. Results from multiple logistic regressions suggest that informal care is associated with a more painful end-of-life experience compared to formal care, with care provided by adult children being a more favorable option within informal care. These findings underscore the urgent need to prioritize education on death and dying, improve the formal care system, and enhance professionalism within informal care.

Academic Performance, Health and Support Needs: Comparing Foster Care Alumni and Peers in Higher Education in Norway

The completion rates of higher education are low among young adults with a history of foster care. Understanding how students from foster care alumni fare is imperative for facilitating attainment and preventing drop-out. The aim of this study was to compare students from foster care alumni and the general student population by examining (1) sociodemographic characteristics, academic functioning and need for special assistance; (2) contextual factors important for student life; and (3) mental and somatic health, loneliness, life satisfaction and use of cannabis and alcohol. Data comprised self-reports from the Norwegian national survey Students’ Health and Well-being Study 2022. Reports from foster care alumni students (n = 508) were compared to those of the general student sample (n = 59,036). Compared to the general sample, twice as many foster care alumni students reported receiving or needing special assistance in their studies. Moreover, they reported substantially higher economic burden than their student peers, by higher frequency of work income, more financial worries, and less parental financial support. Foster care alumni students also reported a higher load of informal care responsibilities, poorer mental and somatic health, more loneliness and lower life satisfaction. Foster care alumni students fare comparably well in terms of grades and study progression despite the reported economic burden and impaired health and well-being. As these are factors shown to impact study completion, policies need to be put in place to ensure that care-experienced students receive adequate support through their young adulthood and specifically in higher education.

The role of objects in negotiations in convoys of care: Addressing fundamental concerns of informal caregivers

Due to an increased policy focus on informal care in many Western countries, professionals and informal caregivers increasingly grow more interdependent. Increased involvement of informal caregivers in professional care has consequences for the work of professionals, the care that is received by care recipients, and the role of informal caregivers. Care needs to be negotiated between them within the dynamic networks of care recipients and caregivers (i.e., “care convoys”). Scant attention has been given to objects as part of these convoys and negotiations. Therefore, in this paper, we answer the question: How do objects become part of and what is their role in the negotiations between healthcare professionals and informal caregivers? We use interview data from 48 participants (care recipients, professionals, informal caregivers, and persons in managerial positions). In the results, we discuss how objects, in terms of their affordances and the values they embody, become important in the relationship between professionals and informal caregivers and how they become part of negotiations on quality of care. We find that seemingly mundane objects become topics of conversation to address more fundamental concerns in how healthcare is organized for and provided to individual care recipients. Our study helps to open the care convoys model to objects as important actors and further understand the politics within care convoys.

Changes in care provision to older parents during COVID-19 and the well-being of adult children: The moderating roles of the child-parent relationship and pandemic-related measures

Objective: The study addresses the associations between changes in care provision to older parents since the pandemic and worsened depression and anxiety in adult children. It also explores whether pandemic-related control measures and child-parent relationships moderated these associations. Background: Changes in informal care during the pandemic, such as increased or decreased caregiving frequency, may have affected caregivers’ psychological well-being. Limited research exists on how stressors and resources shape the well-being of adult children caregivers. Method: Data from 740 respondents in the first SHARE Corona Survey (SCS) who provided care for their parents during the pandemic were analyzed. Changes in depression and anxiety were assessed using data from SCS and pre-pandemic Wave. Logistic regression analyses were conducted, with added interactions between the moderators - pandemic measures and child-parent relationship characteristics - and changes in care frequency. Results: Increased caregiving frequency during the pandemic was associated with worsened depression. Stricter pandemic measures intensified this effect but also reduced the likelihood of anxiety for those who provided care less often. A higher quality of relationship with the mother in childhood was marginally associated with lower depression among those increasing caregiving but worsened depression for those decreasing it. Conclusion: To address post-pandemic caregiving challenges, efforts should focus on reducing caregiver stress and considering the enduring influence of early child-parent relationships.

Demographic ageing: an opportunity to rethink economy, society and regions

Abstract Ageing is often depicted negatively, but we challenge passive views, suggesting that an “active ageing” agenda requires rethinking economy, urban form and societal responses. We present demographic trends in ageing, migration and urbanization across global regions. Building from psychological theories of ageing regarding disengagement and continuity, we argue for an adjustment response at the societal level to address needed structural changes in economy, social policy and regional planning. These adjustments should prioritize well-being and purpose over economic growth; social policy that links household, informal and formal care and new approaches to urban and regional planning that remake cities for all ages. Ageing requires new paradigms. These societal adjustments will permit new approaches that could build a more inclusive world.

A novel explainable machine learning-based healthy ageing scale

BackgroundAgeing is one of the most important challenges in our society. Evaluating how one is ageing is important in many aspects, from giving personalized recommendations to providing insight for long-term care eligibility. Machine learning can be utilized for that purpose, however, user reservations towards “black-box” predictions call for increased transparency and explainability of results. This study aimed to explore the potential of developing a machine learning-based healthy ageing scale that provides explainable results that could be trusted and understood by informal carers.MethodsIn this study, we used data from 696 older adults collected via personal field interviews as part of independent research. Explanatory factor analysis was used to find candidate healthy ageing aspects. For visualization of key aspects, a web annotation application was developed. Key aspects were selected by gerontologists who later used web annotation applications to evaluate healthy ageing for each older adult on a Likert scale. Logistic Regression, Decision Tree Classifier, Random Forest, KNN, SVM and XGBoost were used for multi-classification machine learning. AUC OvO, AUC OvR, F1, Precision and Recall were used for evaluation. Finally, SHAP was applied to best model predictions to make them explainable.ResultsThe experimental results show that human annotations of healthy ageing could be modelled using machine learning where among several algorithms XGBoost showed superior performance. The use of XGBoost resulted in 0.92 macro-averaged AuC OvO and 0.76 macro-averaged F1. SHAP was applied to generate local explanations for predictions and shows how each feature is influencing the prediction.ConclusionThe resulting explainable predictions make a step toward practical scale implementation into decision support systems. The development of such a decision support system that would incorporate an explainable model could reduce user reluctance towards the utilization of AI in healthcare and provide explainable and trusted insights to informal carers or healthcare providers as a basis to shape tangible actions for improving ageing. Furthermore, the cooperation with gerontology specialists throughout the process also indicates expert knowledge as integrated into the model.

BE-SAFE: Intervention to reduce benzodiazepine and sedative hypnotics in elderly with sleep problems

Abstract Introduction Benzodiazepine and sedative hypnotics (BSH) may have significant adverse effects and associated costs, especially in older adults: increased risk of falls, fractures, hospitalisations, impaired functioning, delirium, cognitive impairment and mortality. Addressing BSH overuse is therefore an urgent priority to improve patient safety in Europe. Objectives To present the 5-year research project BE-SAFE, funded by the European Commission (HORIZON Europe) and by the Swiss State Secretariat for Education, Research, and Innovation. BE-SAFE aims to improve patient safety by addressing knowledge and practice gaps related to the reduction of BSH used by older adults for sleep problems. Methods BE-SAFE involves seven inter-related work packages and six European countries (Belgium, Greece, Norway, Poland, Spain and Switzerland) as well as experts from Canada; it proposes an interdisciplinary and inter-sectorial approach with experts in guidelines, implementation, dissemination, case studies, geriatrics and sleep. BE-SAFE will develop an intervention comprising trustworthy clinical guidelines, implementation recommendations and patient-centred material. This intervention will be tested in a cluster randomized controlled trial; 470 patients (65 years old and above) and 62 prescribing physicians in hospital and outpatient settings. Results BE-SAFE is expected to result in reduction of BSH use. Its toolkit, encompassing setting-specific implementation recommendations, will enable healthcare professionals (HCPs) to identify, evaluate and prevent risks of BSH use. The BE-SAFE approach could also be expanded to cover reduction of use of other medications. Conclusions Through BE-SAFE, patient safety is expected to improve; BE-SAFE project will reach a wide-ranging audience, including general population, informal carers, older adults, HCPs, healthcare system leaders and decision makers. Authors acknowledge the significant input of J. Grimshaw and W. Levinson, Canada. Key messages • Deprescription of benzodiazepine and sedative hypnotics, especially in older adults, is a priority due to their side effects, particularly in this age group. • The European project BE-SAFE aspires to create easy-to-use guidelines to this aim, improving thus patient safety and healthcare.

What characterizes the eldercare debut? A registry-based study of pre-entry health care use

Abstract Introduction Timely identification of needs due to functional loss in old age is important. Policy guidelines requires local collaborative care action. Eldercare debut circumstances are poorly investigated from a collaborative perspective. This study explored the socio-demographic characteristics, functional status and patterns of health care use leading up to the first application for eldercare, and how older people’s intensity of primary care use was associated with their intensity of granted eldercare at debut. Methods Data on socio-demographics, functional status, and informal care in people ≥65 years (July ‘21 to June ‘22; n = 3,649) were combined with data on inpatient and outpatient care six months preceding debut in Stockholm, Sweden. Descriptive and regression statistics were used. Results Every second person debuted following a hospital stay and one in four had extensive functional limitations. The majority made one or two visits in primary care, but 13% had a high intensity of use and 20% made no visits at all. More than half received informal care weekly or daily. Non-use and high use of primary care were both significantly associated with increased probability of receiving high intensity of eldercare. Conclusions and implications The intensity of primary care use can provide an indication of people’s intensity of eldercare at debut, which is important for resource allocation. Deeper collaboration between eldercare and primary care actors can facilitate early identification of people in need of support, thereby alleviating individual suffering, enabling secondary and tertiary prevention, and optimizing the management of welfare resources. Key messages • The intensity of primary care use can provide an indication of people’s intensity of eldercare at debut. • Deeper collaboration between eldercare and primary care actors can facilitate early identification of older people with social support needs.

Family function, psychological distress and burden in informal caregivers of people with dementia

Abstract Background Dementia presents a public health priority due to its high global prevalence, mortality, economic cost, and caregiver burden (CB). Dementia care can be stressful and may negatively influence the health of informal caregivers. This cross-sectional study aimed to identify psychological and social factors associated with subjective CB in informal home care providers of people with dementia (PwD), controlling for sociodemographic, clinical, and care-related variables. Methods We included 115 informal caregivers of PwD from community settings (mean age: 54.0±12.4 years; 81.7% women). Participants fulfilled the Zarit Burden Interview (ZBI-12), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Family APGAR, and the short IQCODE used to assess dementia severity. Multiple linear analyses were used to analyse the data. Results The mean caregiving duration was 4.8±4.8 years, and 55.7% of informal caregivers extend care for >40 hours/week. We found that a total of 52.5 % of informal caregivers experienced a high CB (ZBI-12 cut-off score: 17). Univariate analyses showed an association between depression (β = 0.36; p < 0.001), anxiety (β = 0.52; p < 0.001), family dysfunction (β = 0.36; p < 0.001), and CB. Regression analyses showed that CB was the most strongly associated with anxiety (β = 0.51; p < 0.001). This association weakened (0.47; p < 0.01) when family function was added to the final model (β=-0.22; p < 0.05). The final model explained 23.5% of the variance in CB. No associations between the caregiver's age, sex, caregiving duration, the extent of care per day, use of community care, dementia severity, and depression were identified. Conclusions Long-term care for people living with dementia can be very demanding. Thus, the implementation of tailored interventions to enhance family function and diminish psychological distress can mitigate level of caregiver burden. [Grant support: APVV-22-0587]. Key messages • Dementia caregiving is a global public health priority. • The caregiver’s burden and distress can be alleviated by the interventions focusing on family dysfunction.

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

How to improve informal caregiver’s quality of life and health literacy? – a NGT approach

Abstract Background Previous studies revealed that informal caregivers have a large number of unmet needs, reinforcing the necessity of national policies that ensure an adequate sustainability of the provision of informal care and takes into account the needs of caregiving dyads in the planning process. This study aimed to identify and consensualize initiatives and action strategies to improve the Portuguese Informal Caregiver’s reality and health literacy levels. Methods A Nominal Group Technique (NGT) was conducted with 10 experts. The NGT panel was asked about feasible action strategies to improve informal caregiver’s reality, consensualized and voted them according to perceived relevance in a semantic differential (1 pts to nothing relevant and 6 pts to very relevant), allowing a score calculation. Results Thirty-two initiatives emerged from the NGT. The five most relevant initiatives were identified based on an average score namely: 1) Pressure political decision-makers on the need for an effective implementation of the Informal Caregiver status, which is not being done (score=56); 2) Creation of a specific emergency social line for informal caregivers, as a measure of greater equity (score=52); 3) Raise employers awareness about caregiving demands (score=52); 4) Creation of a proximity social manager, linked to primary care services, that facilitates caregiver connection to health and social care services (score=51); 5) Decentralization of respite care services support, with multidisciplinary teams (score=49). Conclusions The informal caregiver’s role needs to be recognised and understood by healthcare and social care providers. (Re)design political, economic and social policies that address both caregiver and care recipients’ needs is critical to enable the continuity of informal care provision. Key messages • Informal caregivers play a fundamental social role but still have many needs to be addressed, particularly at the level of the official definition of their role. • (Re)design political, economic and social policies targeted to informal carers is imperative to enable the continuity of informal care provision.

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.

The health of older caregivers in Spain: a matter of age or a matter of care?

Abstract Introduction Informal care is crucial in Spain’s care system, with a rising number of caregivers aged 75 or older, yet studies on its health effects are lacking. This study aims to determine the differential impact of age and care-related variables on the health of older caregivers. Materials and methods This is a cross-sectional, national study with a sample of 3,870 informal caregivers from the Spanish 2020 Disability, Personal Autonomy and Dependency Survey. We performed a logistic regression where self-reported deterioration in caregiver health due to caregiving was the dependent variable and age (<75 vs. ≥ 75) was the independent variable. Caregivers’ sex, educational level (primary and lower or secondary and higher), income (<1,150 euros per month vs. ≥ 1,150), severe functional limitation of caregivers and care-receptors (yes or no), duration of care (< 8 years vs. ≥ 8 years), and daily hours of care were used as covariates. Results One in 6 caregivers was 75 or older (16,1%). Caregivers’ mean age was 58.4, and care-receptors’ 66.6 years. Women represented 63.0% of caregivers, and 42.8% of care-receptors. Up to 4.6% of caregivers had a severe limitation, and 43.7% of caregivers reported deterioration of their health due to caregiving. A greater perception of deterioration in caregiver health due to caregiving was associated with being 75 years or older (β = 0.34, p = 0.009). Covariates associated with caregivers’ health deterioration were being a woman (β = 0.77, p < 0.001), presence of severe limitation of care receptors (β = 0.58, p < 0.001), and increased daily hours of care (β = 0.01, p = 0.013). Caregivers’ severe limitation, level of education, income and years of care did not show a significant association with perception of health deterioration. Discussion Caregivers older than 75 years in Spain experience a key deterioration in their health associated with caregiving. This vulnerable population must be prioritized in health and social policies. Key messages • One out of 6 caregivers in Spain is aged 75 years or older. Caregiving impacts greatly in their health status. • Older caregivers is a vulnerable population that must be a priority for health and social services.

Risk Profiles of Avoidable and Unavoidable Hospitalizations: a Swedish population-based study

Abstract Background Older adults frequently experience multiple hospitalizations, owing to their complex health and social needs. This study aims to comprehensively characterize the risk factors associated with avoidable and unavoidable hospitalization among older adults. Specific emphasis is placed on avoidable/unavoidable hospitalization originating from chronic or acute causes. Methods Data on 3,166 individuals aged ≥60 years were obtained from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), linked to the Swedish National Patient Register. Multistate models were used to investigate the risk profiles of participants experiencing their first and recurrent hospitalizations over 15 years. The Swedish National Board of Health and Welfare criteria were used to define avoidable/unavoidable hospitalizations. Results Women had a lower hazard of avoidable hospitalizations for chronic conditions as well as unavoidable hospitalizations (HR range 0.46-0.84). However, receiving informal care was associated with 88% increased hazard of avoidable hospitalizations due to chronic causes (95%CI 1.18-2.99), while receiving formal care was associated with 44% increasing hazard of avoidable hospitalization due to acute causes (95%CI1.04-1.98). Factors such as slow walking speed, multimorbidity, and polypharmacy were associated with a high risk of avoidable hospitalizations due to both acute (HR range1.27-3.03) and chronic (HR range1.63-2.54) causes. Conclusions Both clinical and functional factors have emerged as key predictors of avoidable hospitalization, underscoring the importance of comprehensive risk assessment and proactive healthcare management strategies to reduce the burden of hospital utilization in older adults. Key messages • Targeted interventions are essential to improve healthcare outcomes among older adults at risk of avoidable hospitalizations due to chronic and acute conditions. • The study identified predictors such as slow walking speed, multimorbidity, and polypharmacy, underscoring the need for comprehensive risk assessment to prevent avoidable hospitalization.