Formal and informal care: trajectories of home care use among Danish older adults

Kjær, Agnete Aslaug; Siren, Anu Kristiina

doi:10.1017/s0144686x19000771

Cited by 17 publications

(10 citation statements)

References 40 publications

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“…Moreover, we found a similar relationship between being single and receiving LTC in both cases. Single people use more LTC services than their non-single peers [10,[44][45][46]. The composition of the variable InformalCare may determine the fact that single people receive informal care.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Inequality in the Use of Long-Term Care among European Older Adults: An Empirical Approach Using the SHARE Survey

Lera

Pascual-Sáez

Cantarero

2020

IJERPH

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The increase in the proportion of elderly people in developed societies has several consequences, such as the rise in demand for long-term care (LTC). Due to cost, inequalities may arise and punish low-income households. Our objective is to examine socioeconomic inequalities in LTC utilization in Europe. We use the last wave from the Survey of Health, Aging, and Retirement in Europe SHARE (Munich Center for the Economics of Ageing, Munich, Germany), dated 2017, to analyze the impact of socioeconomic status (SES) on LTC. For this purpose, we construct logistic models and control for socioeconomic/household characteristics, health status, and region. Then, concentration indices are calculated to assess the distribution of LTC. Moreover, we also analyze horizontal inequity by using the indirect need-standardization process. We use two measures of SES (household net total income and household net wealth) to obtain robust results. Our findings demonstrate that informal care is concentrated among low-SES households, whereas formal care is concentrated in high-SES households. The results for horizontal concentration indices show a pro-rich distribution in both formal and informal LTC. We add new empirical evidence by showing the dawning of deep social inequalities in LTC utilization. Policymakers should implement policies focused on people who need care to tackle socioeconomic inequalities in LTC.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic Inequality in the Use of Long-Term Care among European Older Adults: An Empirical Approach Using the SHARE Survey

Lera

Pascual-Sáez

Cantarero

2020

IJERPH

View full text Add to dashboard Cite

show abstract

“…These included marital status (with partner, widowed, divorced, separated, single) and living arrangement (number of generations in the household) as they are previously documented family-related predictors of receiving formal and informal care at home [ 19 ] and in the community [ 15 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

“…Enablers tend to be structural or contextual, and shape care access and use. They include income [ 10 , 15 , 16 ], availability of health insurance, local policies [ 17 , 18 ], and social support networks [ 18 , 19 ]. Enabling and predisposing factors sometimes overlap.…”

Section: Introductionmentioning

confidence: 99%

Inequities in home care use among older Canadian adults: Are they corrected by public funding?

et al. 2023

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Background Although care use should parallel needs, enabling and predisposing circumstances including the socio-demographic inequities of socioeconomic status (SES), gender, or isolation often intervene to diminish care. We examine whether availability of state-funded medical and support services at home can rebalance these individual and social inequities, and do this by identifying if and how intersecting social identities predict homecare use among older Canadian adults. Methods Using the Canadian Longitudinal Study on Aging (CLSA) of 30,097 community-dwelling adults aged 45 to 85, we performed recursive partitioning regression tree analysis using Chi-Squared automatic interaction detection (CHAID). Combinations of individual and social characteristics including sociodemographic, family-related, physical and psychological measures and contextual indicators of material and social deprivation were explored as possible predictors of formal and informal care use. Results Diminished function i.e. increased need, indicated by Activities of Daily Living, was most strongly aligned with formal care use while age, living arrangement, having no partner, depression, self-rated health and chronic medical conditions playing a lesser role in the pathway to use. Notably, sex/gender, were not determinants. Characteristics aligned with informal care were first—need, then country of birth and years since immigration. Both ‘trees’ showed high validity with low risk of misclassification (4.6% and 10.8% for formal and informal care, respectively). Conclusions Although often considered marginalised, women, immigrants, or those of lower SES utilised formal care equitably. Formal care was also differentially available to those without the financial or human resources to receive informal care. Need, primarily medical but also arising from living arrangement, rather than SES or gender predicted formal care, indicating that universal government-funded services may rebalance social and individual inequities in formal care use.

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“…Li ( 2005 ) found that older people received markedly less informal care in the 2 years after they had access to publicly funded home care. Drawing on data collected from 473 community-dwelling older individuals over 15 years in Denmark, Kjær and Siren ( 2020 ) identified four clusters of care trajectories and found that whether individuals used formal or informal care in the long term was associated with the levels of care needs and the availability of social support networks.…”

Section: Introductionmentioning

confidence: 99%

Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis

Farías

Brimblecombe

2022

Eur J Ageing

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This study investigates the developmental trajectories of long-term care needs and utilisation in older people aged 65 years and over in England. The data came from the English Longitudinal Survey of Ageing (ELSA, waves 6–9, 2012–2018, N = 13,425). We conducted dual trajectory analyses to cluster people’s trajectories of care needs (measured by functional disability) and utilisation into distinct groups. We conducted logistic regression analyses to identify the factors associated with trajectory memberships. We identified three trajectories of long-term needs (low, medium, and high) and three trajectories of care utilisation (low, medium, and high). Both care needs and care hours increased with age, but the speed of increase varied by trajectory. Females, minority ethnic groups, people with low wealth, and those experiencing housing problems were more likely to follow the joint trajectories characterised by higher care needs and higher care intensity. People with low or medium care needs stayed in the same trajectories of care utilisation. In contrast, people in the high-needs trajectory followed divergent trajectories of care utilisation: 63% of them followed the trajectory of high care intensity and the rest (37%) followed the trajectory of medium care intensity. Lack of spouse care was the leading predictor of trajectory divergence (OR = 3.57, p < 0.001). Trajectories of care needs and utilisation are highly heterogeneous in later life, which indicates persistent inequalities over time. Single people with multiple functional limitations face an acute and enduring risk of inadequate care and unmet needs. The amount of support is as important as the availability of support.

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Formal and informal care: trajectories of home care use among Danish older adults

Cited by 17 publications

References 40 publications

Socioeconomic Inequality in the Use of Long-Term Care among European Older Adults: An Empirical Approach Using the SHARE Survey

Socioeconomic Inequality in the Use of Long-Term Care among European Older Adults: An Empirical Approach Using the SHARE Survey

Inequities in home care use among older Canadian adults: Are they corrected by public funding?

Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis

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