Receipt Of Informal Care Research Articles

Evaluating the impacts of integrating health and social care systems on social care use among older adults with chronic diseases in China

Health and social care systems often operate in silos and cannot meet the complex needs of older adults with multiple chronic conditions. Since 2016, China has been implementing an integrated care initiative in some cities. This study aimed to evaluate the impacts of integrating health and social care in China on social care use among older adults with chronic conditions. Using panel data from the China Health and Retirement Longitudinal Study (N = 5,259), I employed a difference-in-differences analysis to evaluate the effects of the integrated care initiative. The initiative reduced social care use by 4.5 percentage points, primarily through a decreased receipt of informal care rather than formal care. The reduction in social care use was primarily due to a delayed increase in care levels, rather than a substitution with outpatient or inpatient services. The integration of health and social care was found to delay the progression of instrumental activities of daily living (IADL) by 8.8 percentage points but had no impact on activities of daily living (ADL). Heterogeneity analysis showed that the effects of the integrated care initiative on social care receipt and IADL limitation were weaker among those living in the Eastern region of China compared to other regions, indicating additional benefits of the initiative in mitigating geographical disparities. My findings suggest that integrating health and social care can effectively reduce the likelihood of older adults with chronic diseases receiving assistance for daily living tasks from family carers and delay the decline in their functional capabilities.

Care Need, Caregiver Availability, and Care Receipt: Variations Across Countries and Over Time in Three Middle-Income Countries.

Dementia is expected to increase more rapidly in low- and middle-income countries (LMIC) than in high-income countries (HIC) in the coming decades. Nevertheless, research on dementia care remains limited for LMIC. This study aims to fill this gap by investigating care needs and care receipt in three LMIC: China, Mexico, and India. Using harmonized data from the Gateway to Global Aging Data in China, Mexico, and India and focusing on individuals aged 65 and older with cognitive impairment (N = 15,118), we estimated the proportions of care needs related to difficulties with activities of daily living (ADL) and instrumental activities of daily living (IADL), and care receipt. We then used logistic regressions to examine the association between caregiver availability and informal care receipt. We observed relatively similar patterns in care need measures across countries and over time. In contrast, the association between caregiver availability and informal care receipt showed some cross-country variations. Generally, living with family members was associated with a higher probability of receiving informal care in China and India. However, for Mexico, this association was only evident for men. Additionally, we found that the magnitude of the association between caregiver availability and informal care receipt varied with the care recipient's gender. While living with family members was generally associated with a higher likelihood of receiving informal care in China, Mexico, and India, there are differences in the association between caregiver availability and informal care receipt across countries and over time.

Functional disability and receipt of informal care among Chinese adults living alone with cognitive impairment

BackgroundAdults with cognitive impairment are prone to living alone in large numbers but receive relatively little attention. This study aimed to evaluate whether living alone with cognitive impairment was associated with a higher burden of functional disability but lack of informal care. Methods982 observations of adults living alone with cognitive impairment and 50,695 observations of adults living with others and with normal cognition were identified from 4 waves (2011/2012, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). A matched comparator was selected using propensity score matching (1:2). Functional disability included disability in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility. The time of receiving informal care was measured in monthly hours. ResultsAdults living alone with cognitive impairment demonstrated significantly higher odds ratio of ADL disability (OR = 1.59, 95 % CI: 1.30, 1.95), IADL disability (OR = 1.19, 95 % CI: 1.00, 1.44), mobility disability (OR = 1.38, 95 % CI: 1.12, 1.70), but received fewer hours of informal care (β = −127.7 h per month, standard error = 25.83, P < 0.001), compared to the adults living with others and with normal cognition. ConclusionsThis study highlights the high burden of functional disability but low coverage of informal care among Chinese adults living alone with cognitive impairment and calls for more resources to be allocated to this vulnerable subpopulation to improve the functional health and to increase the provision of long-term care services.

The impact of formal care provision on informal care receipt for people over 75 in England.

In this study, we examine the relationship between formal care provision and informal care receipt from within the household for people over 75 years old using data from the British Household Panel Survey between 1991 and 2009. To address potential concerns about endogeneity of formal care we use a 'spatial lag' instrumental variable. We find a negative and statistically significant effect of formal care provision on informal care receipt from within the household, suggesting a substantial degree of substitutability between these two modes of care. These findings provide grounds for estimates of savings in the cost of informal care enabled by spending on formal care, which is important in light of the effects of the caregiving burden and associated responsibilities on carer's labour market participation.

Do Informal Care Recipients Internalise Carer Burden? Examining the Impact of Informal Care Receipt on Health Behaviours.

Providing informal care has a negative effect on the caregiver's health and well-being, but little is known about how individuals respond to receiving informal care. Care recipients may improve their health behaviours to minimise the onerousness of caregiving and the stress faced by their carer from seeing a loved one in ill-health. We aimed to examine whether informal care recipients internalise the potential for carer spillovers through changes in health behaviours. We used data from 3250 older adults with care needs who took part in the UK Household Longitudinal Study between 2017 and 2019. We examined the response to informal care receipt in terms of the probability of engaging in four health behaviours: healthy diet, physical activity, smoking and alcohol consumption. We estimated average treatment effects using regression adjustment with inverse probability treatment weights, comparing individuals that received informal care to those receiving either formal or no care. We found that informal care receipt increased the probability of refraining from negative health behaviours (smoking and alcohol consumption) but reduced the probability of engaging in positive health behaviours (eating fruits and/or vegetables and physical activity). The asymmetric effects detected suggest that the underlying mechanisms are different, and care recipients may be engaging in risk and effort compensation between negative and positive health behaviours. Failure to account for the behavioural responses from informal care recipients may lead to under-estimation or over-estimation of the extent of caregiving burden and the effectiveness of interventions impacting informal carers.

Impact of Long COVID on productivity and informal caregiving

BackgroundAround 2 million people in the UK suffer from Long COVID (LC). Of concern is the disease impact on productivity and informal care burden. This study aimed to quantify and value productivity losses and informal care receipt in a sample of LC patients in the UK.MethodsThe target population comprised LC patients referred to LC specialist clinics. The questionnaires included a health economics questionnaire (HEQ) measuring productivity impacts, informal care receipt and service utilisation, EQ-5D-5L, C19-YRS LC condition-specific measure, and sociodemographic and COVID-19 history variables. Outcomes were changes from the incident infection resulting in LC to the month preceding the survey in paid work status/h, work income, work performance and informal care receipt. The human capital approach valued productivity losses; the proxy goods method valued caregiving hours. The values were extrapolated nationally using published prevalence data. Multilevel regressions, nested by region, estimated associations between the outcomes and patient characteristics.Results366 patients responded to HEQ (mean LC duration 449.9 days). 51.7% reduced paid work hours relative to the pre-infection period. Mean monthly work income declined by 24.5%. The average aggregate value of productivity loss since incident infection was £10,929 (95% bootstrap confidence interval £8,844-£13,014) and £5.7 billion (£3.8-£7.6 billion) extrapolated nationally. The corresponding values for informal caregiving were £8,726 (£6,247-£11,204) and £4.8 billion (£2.6-£7.0 billion). Multivariate analyses found significant associations between each outcome and health utility and C19-YRS subscale scores.ConclusionLC significantly impacts productivity losses and provision of informal care, exacerbated by high national prevalence of LC.

The Potential of Informal Care for Self-Perceptions of Aging Among Older Community-Dwelling Adults: Longitudinal Findings From the Health and Retirement Study.

This is the first study to analyze, whether receipt of (informal) care with (instrumental) activities of daily living (IADL/ADL) is associated with (positive and negative) self-perceptions of aging among community-dwelling older adults; and whether chronological age moderates these associations, using a longitudinal design. Longitudinal data of the Health and Retirement Study in the United States was used. The sample was composed of up to 9,198 observations of community-dwelling adults aged ≥50 years pooled over 6 waves (2008-2018). Receiving care at all and the amount of care received with (I)ADL were analyzed in association with positive and negative attitudes towards own aging (ATOA; 8-item modified Philadelphia Geriatric Center Morale Scale, positive and negative subscore). Adjusted fixed effects regression analyses with robust standard errors were calculated. Transitioning into receipt of care with any (I)ADL was associated with lower positive ATOA but not with any change in negative ATOA. Chronological age moderated the association between receipt of informal care, primarily with IADL, and negative ATOA. More negative ATOA was found among care recipients between 50 and 64 years but less among care recipients aged ≥80 years. Receiving any form of informal care was associated with an increase in internalized ageism, in particular among adults aged 50 to 64 years, but a decrease among those aged ≥80 years. Psycho-educative measures are recommended for adults with care needs to prevent a loss of positive self-perceptions of aging, and reduce the danger to their healthy aging, with the receipt of care.

Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data

We assess whether informal care receipt affects the probability of transitioning to a nursing home. Available evidence derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data from the Netherlands, we use the gender mix of children to retrieve exogenous variation in informal care receipt. We find that informal care increases the chance of an admission within a three-year period for individuals with severe functional limitations, and increases the costs incurred on formal home care. For individuals with mild limitations, informal care substantially decreases total care costs, whereas its effect on nursing home admission is unclear. Further, informal care results in lower post-acute care use and hospital care costs, and does not increase mortality. Promoting informal care cannot be expected to systematically result in lower institutionalization rate and care costs, but it may nonetheless induce health benefits for its recipients.

The relationships between informal and formal social care for older people in England: A comparison before and after the Care Act 2014

ABSTRACT Social care is an integral part of the UK welfare system and plays an imperative role in promoting the well-being of older people. This study investigates the impacts of receiving informal social care on formal social care use among community-dwelling older people in England before and after the implementation of the Care Act 2014. Data came from the Health Survey for England for the years 2011 to 2018 (N = 17,292). Bivariate probit models were used to address the endogeneity issue. The analysis shows that receipt of informal care substitutes for formal care. Informal care had a strong substitution effect on formal personal care before 2015, which was significantly weakened after 2015. While the receipt of formal personal care has been increasingly “carer-blind,” that of formal domestic care depends on the availability of informal carers and personal affordability, which may result in unmet care needs.

Informal care at old age at home and in nursing homes: determinants and economic value

This paper provides a comprehensive analysis of informal care receipt by the French individuals aged 60 or older. The literature has focused on the community, leaving informal care in residential care settings in the shadow. We leverage data from a representative survey (CARE) conducted in 2015–2016 on both community-dwelling individuals and nursing home residents. Focusing on the 60+ with activity restrictions, we show that 76% of nursing home residents receive help with the activities of daily living from relatives, against 55% in the community. The number of hours conditional on receipt is yet 3.5 times higher in the community. Informal care represents 186 million hours per month and a value equivalent to 1.1% of GDP at least, care in the community representing 95% of the total. We investigate the determinants of informal care receipt. Using an Oaxaca-type approach, we disentangle between two mechanisms explaining that nursing home residents are more likely to receive informal care, namely the differences in population composition (endowments) and the differences in the association of individual characteristics with informal care (coefficients). Both are found to have a similar contribution. Our results imply that private costs make up for the majority (76%) of the costs associated with long-term care provision once informal care is taken into account. They also highlight that informal care is extremely common for nursing home residents. Existing evidence on the determinants of informal care receipt in the community has, however, limited relevance to understand informal care behaviors in nursing homes.

Exploring the Differences in Social Care Needs by the Degree of Obesity among Older Adults in England: A Cross-Sectional Study

Objectives. The study aims to determine the social care need among overweight and obese older adults by identifying the number of social care support receipts from different sources. Methods. A sample of 5640 participants (aged 50 years and over) taken from the English Longitudinal Study of Ageing Wave 8 dataset. Multivariate logistic regression analysis was performed to explore the relationship between the study variables. Results. The statistical analyses demonstrated that overweight and obese older adults are the recipients of increasing amounts of informal social care. Moderate and morbidly obese participants are the recipients of increasing amounts of formal care compared to their normal-weight counterparts, with morbid obesity being a strong predictor for receipt of formal care. Conclusions. The present study’s findings demonstrate that for older adults aged 50 years presence of morbid obesity is a strongest predictor for receipt of formal care, and their well-being is not associated with formal or informal care receipt. The findings on how wider lifestyle factors influence the number of social care receipts, from different sources, may help policymakers and healthcare providers to allocate limited resources for adult social care services and promote healthy ageing rather than just focusing on weight loss alone.

Factors associated with receipt of informal care among the Vietnamese older persons: Evidence from a national survey.

The rapidly growing older population in Vietnam poses an increasing need for care among the older persons, who have mainly relied on informal care at homes and communities. This study examined the Vietnamese older persons' individual and household factors determining their receipt of informal care. This study provided cross-tabulations and multivariable regression analyses to identify who provided assistance to the Vietnamese older people along with their individual and household characteristics. The nationally representative survey on older persons, namely Vietnam Aging Survey (VNAS) in 2011 was used in this study. We found that proportions of older persons having difficulty in activities of daily living (ADLs) were different in regard to their age, sex, marital status, health status, working status, and living arrangements. In care provision, gender differences were clear, in which females generally had significantly higher rates of providing care to older persons than their male counterparts. Care for older persons in Vietnam has been mainly provided by their families, and thus changes in socio-economic, demographic factors along with differences among generations in family values will be a key challenge to maintain such care arrangements.

Perceived autonomy of informal care recipients and the relevance of self-esteem.

This study aimed to analyze the longitudinal associations between receipt of (spousal and adult child) care and perceived autonomy, and their moderation by self-esteem. Data from the population-based longitudinal German Ageing Survey (2014, 2017) were used. Perceived autonomy was assessed using Schwarzer's perceived autonomy in old age scale and self-esteem was assessed using Rosenberg's global self-esteem scale. Adjusted fixed effects regression analyses indicated a significant association between both forms of care and reduced autonomy. A significant interaction effect between receipt of care from adult children and self-esteem was found. Recipients of care from adult children with lower levels of self-esteem perceived less autonomy once receiving care, while those with high self-esteem did not perceive a difference. The study's findings indicate that the receipt of informal care was perceived to reduce the care recipient's autonomy, when received from either a spouse or adult children. However, self-esteem was indicated to be either a risk (in the case of low self-esteem) or prevention factor (in the case of high self-esteem) among recipients of care from adult children. This was found irrespective of the care recipient's age. Thus, autonomy should be supported among all informal care recipients and additional actions are recommended to identify and foster self-esteem among recipients of care from adult children in particular. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Does Receiving Informal Care Lead to Better Health Outcomes? Evidence From China Longitudinal Healthy Longevity Survey.

Population aging has become a global challenge. Drawing data from Chinese Longitudinal Healthy Longevity Survey 2008, 2011, and 2014, this study examines the effect of informal care receipt on functional limitations and depressive symptoms among older people in China using lagged fixed effects model. Our findings suggest that receiving informal care is significantly associated with a slower functional decline. We also find that this effect varies across different income groups. The protective effect of informal care is more pronounced among older people with higher income compared to those with lower income. We do not observe any significant associations between receiving informal care and depressive symptoms of older people. This study highlights a pressing need for the Chinese government to establish a comprehensive long-term care system.

Do oldest old individuals perceive receipt of informal care as a restriction or support of their autonomy?

Objectives Autonomy (defined as self-governance; not equivalent to independence) is relevant to well-being and psychological functioning. However, there is a lack of research on individuals aged >85 years and their perception of autonomy when receiving informal care. This study aims to answer the question if and how the receipt of informal care is associated with perceived autonomy of individuals aged over 85 years. Method A cross-sectional study was conducted with data from follow-up 9 of the AgeQualiDe study (2015/2016), which is a multi-centric prospective cohort study in Germany. The analytical sample included 570 participants aged >85 years and with a score of ≥ 19 on the Mini-Mental-State-Examination. Perceived autonomy was assessed with the Perceived Autonomy in Old Age Scale. Receipt of care was assessed as performance of at least one care task (help with basic and instrumental activities of daily living, and supervision) by relatives or friends. Sociodemographic information, mental health, functional level and receipt of professional ambulatory care were controlled for. Results Unadjusted and adjusted linear regression analyses indicated a significant negative association between receipt of informal care and perceived autonomy. The results remained stable in sensitivity analyses; no significant interaction effect was found for gender or education. Conclusion Findings indicate that informal care recipients aged >85 years perceive lower autonomy compared to those not receiving care. Additional or other forms of support, and improving the care relationship and communication might be considered to support autonomy of care recipients aged >85 years.

Gateway to Global Aging Data: Resources for Cross-National Comparisons of Family, Social Environment, and Healthy Aging.

The Gateway to Global Aging Data (Gateway; g2aging.org) is a data and information platform developed to facilitate cross-country analyses on aging, especially those using the international family of Health and Retirement studies. We provide a brief introduction to the Gateway to Global Aging Data, discussing its potential for cross-national comparisons of family, social environment, and healthy aging. We summarize the survey metadata, study characteristics, and harmonized data available from the Gateway, describing the population represented in each study. We portray cohort characteristics and key measures of health and social environment from 37 countries in North America, Europe, and Asia using harmonized data. Significant cross-country heterogeneity was observed in many measures of family, social environment, and healthy aging indicators. For example, there was a threefold difference in coresidence with children, ranging from 14% in Sweden to over 46% in Spain and Korea in 2014. From 2002 to 2014, the difference between informal care receipt in individuals of low and high wealth decreased by 6% in the United States and remained unchanged in England. The percentage of individuals aged 50-59 living alone in 2012 varied 15-fold, from a low of 2% in China to a high of 30% in Mexico. By partnering with nationally representative studies around the globe, the Gateway to Global Aging Data facilitates comparative research on aging through the provision of easy-to-use harmonized data files and other valuable tools.

Gender Matters in the Receipt of Informal Care in Later Life: A Cross-National Comparison Across the USA, Korea, and China

This study compares patterns of gender difference in the receipt of informal care among community-dwelling older adults across the United States, Korea, and China. Data came from the 2014 HRS, the 2014 KLoSA, and the 2015 CHARLS. Logistic regression models were used to predict the receipt of informal care by gender. We also examined how the effects of health and living arrangement on the receipt of informal care differ depending on gender. In the United States and China, older women were more likely to receive informal care than men. However, older Korean women were less likely to receive informal care than men. The effects of health and living arrangement on the use of informal care were moderated by gender in different ways across countries. Discussions include implications for practice and policy to reduce the gender gap in the receipt of informal care.

Aging Experiences Around the World: Local Findings and Global Insights From Population Surveys of Aging

International comparisons of the aging experience offer a unique opportunity to understand how much the aging process varies according to differences in social environments. Despite the potential knowledge gained from global comparisons of health and aging, conducting cross-national comparisons can be challenging. The HRS-family of surveys, which have been harmonized within the Gateway to Global Aging, provides remarkable opportunities for cross-national comparative analysis. The papers in this session use harmonized data to compare the aging experience across different social dimensions in multiple countries from around the world, including examinations of: 1) the role of social engagement among married couples in cognitive function in Mexico and the United States; 2) the importance of work histories and macro-economic policies on later life health in England and Europe; 3) gender differences in the receipt of informal care in the U.S., Korea, and China; 4) the association between sensory impairment and disability-free life expectancy in England and the U.S.; and 5) end-of-life care arrangements and health care utilization in the context of different health systems across multiple countries.

The effect of long-term care public benefits and insurance on informal care from outside the household: empirical evidence from Italy and Spain

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.

Does Gender Matter in the Receipt of Informal Care Among Community-Dwelling Older Adults? Evidence from a Cross-National Comparative Study Across the United States, South Korea, and China.

This study compares patterns of gender difference in the receipt of informal care among community-dwelling older adults across the United States, Korea, and China where family-oriented systems for providing care to older adults are emphasized. Data came from the 2014 Health and Retirement Study, the 2014 Korea Longitudinal Study of Aging, and the 2015 China Health and Retirement Longitudinal Study. Logistic regression models were used to predict the receipt of informal care by gender. We also examined how the effects of health and living arrangement on the receipt of informal care differ depending on gender. In the United States and China, older women were more likely to receive informal care than men. However, older Korean women were less likely to receive informal care than men. The effects of health and living arrangement on the use of informal care were moderated by gender in different ways across countries. This study provides evidence that patterns of gender differences in the receipt of informal care vary across the three countries. More attention needs to be paid to the design and implementation of long-term supports and services to address the unique patterns of gender difference in care arrangement in each country.