What next for Shared Lives? Family-based support as a potential option for older people

Background: A rapidly ageing population presents major challenges to health and social care services. Cross-country comparative studies on survival among older adults are limited. In addition, Japan, the country with the longest life expectancy, is rarely included in these cross-country comparisons. Objective: We examined the relative contributions of social and behavioural factors on the differences in survival among older people in Japan and England. Methods: We used data from the Japan Gerontological Evaluation Study (JAGES; n = 13,176) and the English Longitudinal Study of Ageing (ELSA; n = 5,551) to analyse all-cause mortality up to 9.4 years from the baseline. Applying Laplace regression models, the 15th survival percentile difference was estimated. Results: During the follow-up, 31.3% of women and 38.6% of men in the ELSA died, whereas 19.3% of women and 31.3% of men in the JAGES died. After adjusting for age and baseline health status, JAGES participants had longer survival than ELSA participants by 318.8 days for women and by 131.6 days for men. Family-based social relationships contributed to 105.4 days longer survival in JAGES than ELSA men. Fewer friendship-based social relationships shortened the JAGES men’s survival by 45.4 days compared to ELSA men. Currently not being a smoker contributed to longer survival for JAGES women (197.7 days) and ELSA men (46.6 days), and having lower BMI reduced the survival of JAGES participants by 129.0 days for women and by 212.2 days for men. Conclusion: Compared to participants in England, Japanese older people lived longer mainly because of non-smoking for women and family-based social relationships for men. In contrast, a lower rate of underweight, men’s better friendship-based social relationships, and a lower smoking rate contributed to survival among participants in England.

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Balancing family and state care: neither, either or both? The case of Sweden

Ageing and Society ◽

10.1017/s0144686x06005101 ◽

2006 ◽

Vol 26 (5) ◽

pp. 767-782 ◽

Cited By ~ 36

Author(s):

GERDT SUNDSTRÖM ◽

BO MALMBERG ◽

LENNARTH JOHANSSON

Keyword(s):

Older People ◽

Public Services ◽

Family Care ◽

High Coverage ◽

Cross Sectional ◽

The Public ◽

Frail Elderly People ◽

Family Based ◽

Coverage Rates ◽

Family State

Old-age care has frequently been conceptualised as being either family-based or publicly-provided. This article analyses the overlap in provision from the two sources and their relationship in the Swedish welfare state. Many older people and their carers rely on both sources of help rather than on just one, and prefer to do so. The empirical evidence on patterns of care in Sweden supports a joint family-state conceptualisation of care. Its realisation may depend on general coverage rates of public services and the efficient targeting of frail elderly people who live alone. Most older people in need of care rely on help only from their family, but many are helped by both the family and the state, particularly those with the greatest needs. Dynamic concepts like ‘substitution’ and ‘complementarity’ are hard to apply in cross-sectional studies: there may be complementarity in individual cases but long-term substitution or its reversal in successive cohorts. Yet again, both sources of care may increase simultaneously in individual cases. The need for care varies considerably among Swedish municipalities, with implications for the levels of both public services and family support. High coverage rates of the public services may facilitate and support family care.

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“I live with other people and not alone”: a survey of the views and experiences of older people using Shared Lives (adult placement)

Working with Older People ◽

10.1108/wwop-03-2016-0005 ◽

2016 ◽

Vol 20 (3) ◽

pp. 179-186 ◽

Cited By ~ 3

Author(s):

Nadia Brookes ◽

Sinead Palmer ◽

Lisa Callaghan

Keyword(s):

Older People ◽

Well Being ◽

Community Based ◽

Negative Experiences ◽

Content Type ◽

Form Part ◽

Family Based ◽

And Control ◽

Practical Implications

Purpose The purpose of this paper is to report on the views and experiences of older people using Shared Lives (adult placement) in 2012/2013. Design/methodology/approach As part of a survey collecting information about outcomes for older users of Shared Lives issues of whether it had made a difference to quality of life, and positive and negative experiences of support were explored. Findings Questionnaires were returned by 150 older people using Shared Lives services. Findings suggest that this model of community-based support has a number of advantages for some older people, such as reducing social isolation and loneliness, promoting independence, choice and control, providing emotional support and increased well-being. Research limitations/implications The questionnaire was self-completed and so responses were not followed up to provide deeper insights. Practical implications Shared Lives is not appropriate for everyone but it is suggested that this option should form part of local commissioning strategies, be part of a range of options for social care practitioners to consider in their work with older people and helps to meet various current policy imperatives. Originality/value The potential of Shared Lives for older people is under-researched and this paper contributes to the literature in exploring the views of older people about family-based support in the community.

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Understanding the vulnerability of older adults: extent of and breaches in support systems in Uganda

Ageing and Society ◽

10.1017/s0144686x15001051 ◽

2015 ◽

Vol 37 (1) ◽

pp. 63-89 ◽

Cited By ~ 5

Author(s):

VALÉRIE GOLAZ ◽

STEPHEN OJIAMBO WANDERA ◽

GIDEON RUTAREMWA

Keyword(s):

Older Adults ◽

Older People ◽

Health Care Access ◽

Support Systems ◽

Safety Net ◽

Aids Epidemic ◽

Care Access ◽

The People ◽

Family Based ◽

Hiv Aids

ABSTRACTOlder adults’ vulnerability and resilience are a result of processes constructed throughout the lifecycle. In Uganda, older people almost always rely exclusively on their social networks for care and economic support when in need. These support systems are mainly family based, and play a role of safety net for their older members. However, localised in-depth studies have pointed out the limitations of family-based support systems, especially in the context of the HIV/AIDS epidemic. This paper uses 83 in-depth interviews conducted in various settings across Uganda with older people and their family members on the subject of their support systems. Over and above the lack of immediate/personal resources characterising most older people, our results highlight the importance of the extent of support systems and resource diversity. Most of the people in our case studies had lost descendants due to the civil war, the HIV/AIDS epidemic, or simply family break-ups, events which often create large breaches and gaps in support systems. Few older people can be resilient in this situation, primarily because there are often not enough resources available in their support networks to cover the needs of all, especially education for the young and health-care access for the old.

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Enhancing family-based long-term care with a model of community integrated intermediary care (CIIC) service for Thai older adults in Chiang Mai, Thailand: Protocol for a cluster randomized controlled trial (Preprint)

10.2196/preprints.20196 ◽

2020 ◽

Author(s):

Myo Nyein Aung ◽

Saiyud Moolphate ◽

Motoyuki Yuasa ◽

Thin Nyein Nyein Aung ◽

Yuka Koyanagi ◽

...

Keyword(s):

Older People ◽

Long Term Care ◽

Controlled Trial ◽

World Health ◽

Term Care ◽

Randomized Controlled ◽

Family Based ◽

Cluster Randomized ◽

Health Organization

BACKGROUND Thailand is one of the most rapidly aging countries in Asia. Traditional family-based care that has been the basis of most care for the older people is becoming unsustainable as families become smaller. In addition, women tend to be adversely affected as they still form the bulk of caregivers for older people, and many are likely to exit the labour market in order to provide care. Many family caregivers also have no or minimal training, and they may be called upon to provide quite complex care, raising the spectre of older people receiving sub-optimal care if they rely only on informal care that is provided by families and friends. Facing a rising burden of non-communicable diseases and age-related morbidity, Thai communities are increasingly in need of community integrated care model for older persons which can link existing health system and reduce the burden upon caring families. This need is common to many countries in the Association of Southeast Asian Nations (ASEAN). OBJECTIVE In this study, we aimed to assess the effectiveness of community-integrated intermediary care (CIIC) model to enhance family-based care for older people. METHODS This paper describes a cluster randomized controlled trial, comprising six intervention clusters and six control clusters that aim to recruit 2000 participants in each arm. This research protocol has been approved by the World Health Organization (WHO) Ethics Review Committee (ERC). The intervention clusters will receive an integrated model of care structured around 1) a community respite service, 2) the strengthening of family care capacity; and 3) an exercise program that aims to prevent entry into long-term care for older people. Control group clusters receive usual care i.e., the current system of long-term care common to all provinces in Thailand, consisting principally of a volunteer-assisted homecare service. The trial will be conducted in a period of two years. The primary outcome is the burden of family caregivers measured at a six month follow up, applying the caregiver burden inventory. Secondary outcomes consist of bio-psychosocial indicators including functional ability applying activity of daily living scale, depression applying geriatric depression scale and quality of life of older people applying the EuroQol 5-dimensions 5-levels scale. Intention-to-treat analysis will be followed. RESULTS n/A CONCLUSIONS Since ASEAN and many Asian countries share similar traditional family-based long-term care systems, the proposed CIIC model and the protocol for its implementation and evaluation may benefit other countries wishing to adopt similar community integrated care models for older people at risk of needing long-term care. CLINICALTRIAL World Health Organization Ethical Review Committee approval: WHO/ERC ID; ERC.0003064 Thailand Clinical Trial Registry, Trial registration number TCTR20190412004

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The Role of State and Family in the Living Conditions of Older People in Urban China: Changing Attitudes and Outcomes

Social Policy and Society ◽

10.1017/s1474746406003034 ◽

2006 ◽

Vol 5 (3) ◽

pp. 359-372 ◽

Cited By ~ 3

Author(s):

Peter Saunders

Keyword(s):

Older People ◽

Family Support ◽

Living Arrangements ◽

Urban Areas ◽

Living Conditions ◽

Urban China ◽

Living Standards ◽

Family Based ◽

Changing Attitudes

This paper uses a unique national dataset to examine the attitudes and living standards of older people (aged 60 and over) living in urban areas of China, including their living arrangements and income levels, and their attitudes to family-based and other forms of support. The results indicate that although there have been substantial improvements in the overall living conditions of the majority of older people in China, marked differences remain in the economic circumstances of sub-groups classified by age and, more particularly, gender. Many of today's older people are also wedded to traditional attitudes and patterns of behaviour, and informal family support remains important – for men and women, as well as for younger and older groups among those aged 60 and over.

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