scholarly journals A NATIONAL PROFILE OF FRAIL OLDER ADULTS WITH INSUFFICIENT CARE AND MISMATCHED SUPPORT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S798-S798
Author(s):  
Jyoti Savla ◽  
Karen A Roberto ◽  
Laura Sands
Keyword(s):  
Older Adults ◽  
Informal Care ◽  
National Health ◽  
Unmet Needs ◽  
Self Care ◽  
Sociodemographic Factors ◽  
Community Living ◽  
Care Needs ◽  
Household Activities ◽  
National Profile

Abstract Older adults differ widely both in the care they require and who they rely upon for care. We use data from the National Health and Aging Trends Study (2011; N=3,265; MAge [SD] = 77 [7.74] years, 62% women) to classify community-living older adults based on their care needs and the various informal and formal providers of care. We also examine the type of care they receive, predictors of this care, and its implications on their health. Older adults with a co-residing caregiver were more likely to report that their needs were not being met (OR = 1.67; 95% CI=1.15–2.42), compared to those who received informal care and paid support. Moreover, older adults who needed help with self-care activities, but received help with household activities were more likely to report unmet needs (OR = 1.55; 95% CI=1.13–2.12). Results are discussed in light of sociodemographic factors differences and mismatched support.

scholarly journals Informal and paid care for Brazilian older adults (National Health Survey, 2013)

2017 ◽  
Vol 51 (suppl 1) ◽  
Author(s):  
Maria Fernanda Lima-Costa ◽  
Sérgio Viana Peixoto ◽  
Deborah Carvalho Malta ◽  
Célia Landmann Szwarcwald ◽  
Juliana Vaz de Melo Mambrini
Keyword(s):  
Older Adults ◽  
Informal Care ◽  
National Health ◽  
Health Survey ◽  
Population Aging ◽  
Functional Limitations ◽  
Sociodemographic Factors ◽  
National Health Survey ◽  
Community Dwelling ◽  
Term Care

ABSTRACT OBJECTIVE To describe the prevalence and sociodemographic factors associated with informal and paid care for Brazilian older adults with functional limitations. METHODS Of the 23,815 participants of the National Health Survey aged 60 or older, 5,978 reported needing help to perform activities of daily living and were included in this analysis. The dependent variable was the source of care, categorized as exclusively informal (unpaid), exclusively formal (paid), mixed or none. The socio-demographic variables were age (60-64, 65-74, ≥ 75 years old), gender and number of residents in the household (1, 2, ≥ 3). The multivariate analysis was based on binomial and multinomial logistic regressions. RESULTS Informal care predominated (81.8%), followed by paid (5.8%) or mixed (6.8%) and no care (5.7%). The receipt of care from any source increased gradually with the number of residents in a same household, regardless of age and gender (OR = 4.85 and 9.74 for 2 and ≥ 3, respectively). Age was positively associated with receiving any care while the male gender showed a negative association. The number of residents in the household showed the strongest association with informal care (OR = 10.94 for ≥ 3 residents), compared with paid (OR = 5.48) and mixed (OR = 4.16) care. CONCLUSIONS Informal care is the main source of help for community-dwelling older adults with functional limitations. In a context of rapid population aging and decline in family size, the results reinforce the need for policies to support long-term care for older Brazilians.

scholarly journals The Impact of Late-Life Disability Spectrum on Depressive Symptoms: A Fixed-Effects Analysis of Panel Data

2020 ◽  
Author(s):  
Xiaoling Xiang ◽  
Yong Yang ◽  
Jianjia Cheng ◽  
Ruopeng An
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Fixed Effects ◽  
Self Care ◽  
Secondary Data ◽  
Late Life ◽  
Compensatory Strategies ◽  
Household Activities ◽  
The Impact ◽  
Reduced Activity

Abstract Objectives This study examines the impact of a previously validated disability spectrum that accounts for compensatory strategies on depressive symptoms in older adults. Methods This study was a secondary data analysis of 2011 through 2018 surveys from the National Health and Aging Trends Study (N = 7,609). The disability spectrum was categorized using a 5-level hierarchical scheme: fully able, successful accommodation, reduced activity, difficulty, and assistance for 12 mobility, self-care, and household activities. The individual fixed-effects panel model was used to examine the impact of this disability spectrum on depressive symptoms. Results Depressive symptoms rose progressively with each successive category on the disability spectrum in descriptive analyses. In fixed-effects models, moving from “fully able” to “successful accommodation” was not associated with significant changes in depressive symptoms; this result held for all self-care and mobility activities. Moving from “fully able” to “reduced activity” was associated with a significant increase in depressive symptoms for 3 household activities (doing laundry, making hot meals, and shopping for groceries) but not for paying bills/banking or keeping track of medications. Going up 2 or more stages above “fully able” on the disability spectrum was associated with a significant increase in depressive symptoms across all 12 activities. Discussion While limitations in a range of daily activities have harmful effects on mental health, using compensatory strategies that do not erode one’s perception of autonomy can help older adults cope with the psychological detriments of late-life disability.

Intention to use respite services among informal care-givers of frail older adults in China: the role of care needs change

2020 ◽  
Vol 41 (1) ◽  
pp. 101-120 ◽  
Author(s):  
Qian Sun ◽  
Nan Lu ◽  
Nan Jiang ◽  
Vivian W. Q. Lou
Keyword(s):  
Older Adults ◽  
Elderly People ◽  
Informal Care ◽  
Respite Care ◽  
Intention To Use ◽  
Care Giver ◽  
Care Needs ◽  
Frail Older Adults ◽  
Care Givers ◽  
Time Invariant

AbstractPopulation ageing in China calls for evidence-based solutions, especially in terms of fulfilling long-term care needs among frail older adults. Respite services are identified as effective resources for alleviating care-giver burden and promoting the wellbeing of both older adults and their family care-givers. However, respite care is often under-used in China. This research aimed to examine factors associated with intention to use respite services among informal care-givers in Shanghai, mainland China. This study was part of the Longitudinal Study on Family Caregivers for Frail Older Adults in Shanghai. Pairs of older adults and their care-givers (N = 583) who successfully completed the 2013 and 2016 waves were included in the data analysis. Two logistic regression models were conducted, one with time-invariant and one with time-variant factors. The model with time-variant factors had greater explanatory power than the original Andersen model with time-invariant factors influencing intention to use respite services among care-givers. Care-givers had higher odds of intending to use respite services if they had higher care-giving burden, were caring elderly people who experienced care-giver transitions, or were caring for elderly people with increased function of ambulation or decreased function of feeding. The findings imply that change in functional health was a significant determinant of intention to use respite care. Relevant policy and service implications will be discussed.

scholarly journals RACE AND GENDER DIFFERENCES IN PHYSICAL FUNCTIONING AMONG COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S780-S780
Author(s):  
Chanee D Fabius ◽  
Lauren J Parker ◽  
Roland J Thorpe Jr.
Keyword(s):  
Older Adults ◽  
Black Women ◽  
Physical Functioning ◽  
Self Care ◽  
Community Dwelling ◽  
Race And Gender ◽  
Formal Caregivers ◽  
Representative Study ◽  
Household Activities ◽  
And Gender

Abstract Prior work has demonstrated that there are race and gender disparities in the prevalence of need for assistance with tasks such as self-care, mobility, and household activities. Research has historically shown that older black Americans and women experience greater prevalence of physical functioning declines. It is unclear whether these differences persist among those receiving assistance. Using data from the 2015 National Health and Aging Trends Study (NHATS), a nationally representative study of Medicare beneficiaries aged 65 and older, and after adjusting for covariates, black men received less assistance with self-care and mobility activities, and white and black women received more help with mobility and household activities, compared to white men. Findings are critical to advancing our understanding of the needs of vulnerable older adults receiving assistance. More research is needed to understand the implications of these differences on long-term services and supports provided by both informal and formal caregivers.

scholarly journals Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Minhui Liu ◽  
Tianxue Hou ◽  
Yuxiao Li ◽  
Xiaocao Sun ◽  
Sarah L. Szanton ◽  
...  
Keyword(s):  
Older Adults ◽  
Incidence Rate Ratio ◽  
Fear Of Falling ◽  
Self Care ◽  
Community Dwelling ◽  
Daily Activities ◽  
The Past ◽  
Generalized Estimation Equation ◽  
Household Activities ◽  
Hispanic White

Abstract Background Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other. Methods We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates. Results Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates. Conclusions Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities.

scholarly journals Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China Health and Retirement Longitudinal Survey

2019 ◽  
pp. 1-20 ◽  
Author(s):  
Wei Yang ◽  
Si Ying Tan
Keyword(s):  
Older People ◽  
Informal Care ◽  
Daily Living ◽  
Long Term Care ◽  
Unmet Needs ◽  
People With Disabilities ◽  
Care Provision ◽  
Care Needs ◽  
Term Care

Abstract Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China.

scholarly journals Unmet needs in community-living persons with dementia are common, often non-medical and related to patient and caregiver characteristics

2019 ◽  
Vol 31 (11) ◽  
pp. 1643-1654 ◽  
Author(s):  
Betty S. Black ◽  
Deirdre Johnston ◽  
Jeannie Leoutsakos ◽  
Melissa Reuland ◽  
Jill Kelly ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Unmet Needs ◽  
Neuropsychiatric Symptoms ◽  
Dementia Care ◽  
Community Living ◽  
Care Needs ◽  
Cross Sectional ◽  
Home Based ◽  
Lower Education

ABSTRACTObjective:Understanding which characteristics of persons with dementia (PWD) and their caregivers are associated with unmet needs can inform strategies to address those needs. Our purpose was to determine the percentage of PWD having unmet needs and significant correlates of unmet needs in PWD.Design:Cross-sectional data were analyzed using bivariate and hierarchical multiple linear regression analyses.Setting:Participants lived in the greater Baltimore, Maryland and Washington DC suburban area.Participants:A sample of 646 community-living PWD and their informal caregivers participated in an in-home assessment of dementia-related needs.Measurements:Unmet needs were identified using the Johns Hopkins Dementia Care Needs Assessment. Correlates of unmet needs were determined using demographic, socioeconomic, clinical, functional and quality of life characteristics of the PWD and their caregivers.Results:PWD had a mean of 10.6 (±4.8) unmet needs out of 43 items (24.8%). Unmet needs were most common in Home/Personal Safety (97.4%), General Health Care (83.1%), and Daily Activities (73.2%) domains. Higher unmet needs were significantly related to non-white race, lower education, higher cognitive function, more neuropsychiatric symptoms, lower quality of life in PWD, and having caregivers with lower education or who spent fewer hours/week with the PWD.Conclusions:Unmet needs are common in community-living PWD, and most are non-medical. Home-based dementia care can identify and address PWD’s unmet needs by focusing on care recipients and caregivers to enable PWD to remain safely at home.

scholarly journals Qualitative exploration of the experiences of informal care-givers for dependent older adults in Mexico City

2018 ◽  
Vol 39 (11) ◽  
pp. 2377-2396 ◽  
Author(s):  
Liliana Giraldo-Rodríguez ◽  
Nathalia Guevara-Jaramillo ◽  
Marcela Agudelo-Botero ◽  
Dolores Mino-León ◽  
Mariana López-Ortega
Keyword(s):  
Older Adults ◽  
Mexico City ◽  
Informal Care ◽  
Family Care ◽  
Structured Interviews ◽  
Care Needs ◽  
Cross Sectional ◽  
Term Care ◽  
Care Givers ◽  
Care Giving

AbstractPopulation ageing and increasing prevalence of chronic diseases and their consequences, changes in family structure and a decrease in the potential pool of family care, increase the need for formal long-term care for older adults in Mexico, and the need to understand the experiences of informal care-givers and how this impacts their social, family and personal conditions. This study investigates the experience of informal care-givers of dependent older adults using a cross-sectional qualitative study with an ethnographic focus. Thematic analysis was performed. The study comprised 48 semi-structured interviews with care-givers of dependent older adults who are beneficiaries of an in-home medical programme in Mexico City. The average age of care-givers was 54.7 years (standard deviation = 13.1, range = 24–86) and 75 per cent (36) were women. Results show care-giving experiences are diverse and complex, and profoundly affect the care-giver's life in terms of emotional burden, health deterioration and adverse life conditions due to economic deprivation. They also revealed key aspects such as the need to improve communication between care-givers and health-care personnel, the need for training about specific care needs and opportunity costs incurred. This information can serve as a basis for generating support strategies that may be integrated into the in-home programme. It is essential to promote actions that consider the ‘dependent older adult–informal care-giver’ dyad, and that aim to reduce the care-giving burden.

scholarly journals ASSOCIATION OF WELL-BEING WITH ANXIETY, DEPRESSION, AND FUNCTIONAL IMPAIRMENT FOLLOWING REHABILITATION SERVICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S272-S272
Author(s):  
Adam Simning ◽  
Christopher L Seplaki
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Functional Impairment ◽  
Self Care ◽  
Well Being ◽  
Rehabilitation Services ◽  
Health Events ◽  
Household Activities ◽  
Clinically Significant ◽  
Anxiety Depression

Abstract Millions of older adults receive rehabilitation services yearly that aim to restore, sustain, or limit decline in functioning. Older adults who receive rehabilitation comprise a vulnerable population that is unfortunately at elevated risk for anxiety, depression, and functional impairment. We hypothesize that lower levels of wellbeing prior to rehabilitation services are associated with a greater risk of having clinically significant anxiety or depressive symptoms, or worsening impairments in self-care or household activities, following rehabilitation. This study uses data from 2015 and 2016 waves of the National Health and Aging Trends Study, and includes 853 participants with information on rehabilitation services, wellbeing, anxiety and depression, and functional impairment, as well as demographic characteristics, socioeconomic status, and health variables. In a series of multivariable logistic analyses with wellbeing serving as our primary independent variable, older adults in the lowest quartile of wellbeing (compared to those in the highest quartile of wellbeing) had greater odds for having anxiety symptoms (OR=3.04; 95% CI: 1.24-7.46), depressive symptoms (OR=6.54; 95% CI: 2.80-15.25), and worsening impairment in self-care (OR=2.15; 95% CI: 1.09-4.23), but not in household activities (OR=1.49; 95% CI: 0.67-3.32). This study’s findings suggest that older adults with low levels of wellbeing at baseline may be more susceptible for having mental illness and functional impairment at follow-up. Conversely, the findings suggest that perhaps those with high levels of wellbeing may be able to experience significant health events with fewer residual consequences. The mechanism by which wellbeing may affect these outcomes is unclear and warrants further investigation.

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