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

Published online by Cambridge University Press:  03 July 2019

Agnete Aslaug Kjær Open the ORCID record for Agnete Aslaug Kjær [Opens in a new window]  and
Anu Siren
Agnete Aslaug Kjær*
Affiliation:
The Danish Center for Social Science Research (VIVE), Copenhagen, Denmark Department of Political Science, University of Copenhagen, Copenhagen, Denmark
Anu Siren
Affiliation:
The Danish Center for Social Science Research (VIVE), Copenhagen, Denmark
*
*Corresponding author. Email: [email protected] or [email protected]
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Abstract

To adjust future care policies for an ageing population, policy makers need to understand when and why older adults rely on different sources of care (e.g. informal support versus formal services). However, previous scholars have proposed competing conceptualisations of the link between formal and informal care, and empirical examinations have often lacked a dynamic approach. In this study, we applied an analytical method (sequence analysis), allowing for an exploratory and dynamic description of care utilisation. Based on 15 years of data from 473 community-dwelling older individuals in Denmark, we identified four distinct clusters of care trajectories. The probability of belonging to each cluster varied with predisposing factors (such as age and gender), needs factors (such as dependence in activities of daily living and medical conditions) and enabling factors (such as co-habitation and contact with adult children). A key finding was that trajectories characterised by sporadic use of informal care were associated with low needs and strong social relations, whereas trajectories characterised by reliance on formal care were associated with high needs and limited contact with children. Taken together, our findings provide new evidence on the associations between care use and multiple determining factors. The dynamic approach to studying care use reveals that sources of individual care utilisation change over time as the individual and societal determinants change.

Keywords

care utilisationtransitionssequence analysisclustering
Type
Article
Information
Ageing & Society , Volume 40 , Issue 11 , November 2020 , pp. 2495 - 2518
Copyright
Copyright © Cambridge University Press 2019

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References

Abbott, A and Tsay, A (2000) Sequence analysis and optimal matching methods in sociology review and prospect. Sociological Methods & Research 29, 3–33.CrossRefGoogle Scholar
Aisenbrey, S and Fasang, A (2007) Beyond Optimal Matching: The ‘Second Wave’ of Sequence Analysis. New Haven, CT: Center for Research on Inequalities and the Life Course, Yale University.Google Scholar
Aisenbrey, S and Fasang, AE (2010) New life for old ideas: the ‘second wave’ of sequence analysis bringing the ‘course’ back into the life course. Sociological Methods & Research 38, 420–462.CrossRefGoogle Scholar
Andersen, R and Newman, JF (2005) Societal and individual determinants of medical care utilization in the United States. The Milbank Quarterly 83, 1–28.Google Scholar
Banks, J, Muriel, A and Smith, JP (2011) Attrition and health in ageing studies: evidence from ELSA and HRS. Longitudinal and Life Course Studies 2, 101–126.Google ScholarPubMed
Barrett, P, Hale, B and Butler, M (2014) The dynamic experience of caring. In Barrett, P, Hale, B and Butler, M (eds), Family Care and Social Capital: Transitions in Informal Care. Dordrecht, The Netherlands: Springer, pp. 35–52.CrossRefGoogle Scholar
Bonsang, E (2009) Does informal care from children to their elderly parents substitute for formal care in Europe? Journal of Health Economics 28, 143–154.CrossRefGoogle ScholarPubMed
Brandt, M, Haberkern, K and Szydlik, M (2009) Intergenerational help and care in Europe. European Sociological Review 25, 585–601.CrossRefGoogle Scholar
Cantor, MH (1979) Neighbors and friends. An overlooked resource in the informal support system. Research on Aging 1, 434–463.CrossRefGoogle Scholar
Chappell, N and Blandford, A (1991) Informal and formal care: exploring the complementarity. Ageing & Society 11, 299–317.CrossRefGoogle Scholar
Chatfield, MD, Brayne, CE and Matthews, FE (2005) A systematic literature review of attrition between waves in longitudinal studies in the elderly shows a consistent pattern of dropout between differing studies. Journal of Clinical Epidemiology 58, 13–19.CrossRefGoogle Scholar
Elzinga, CH (2007) Sequence analysis: metric representations of categorical time series. Department of Social Science and Research Methods, Vrije Universiteit Amsterdam, The Netherlands.Google Scholar
Esping-Andersen, G and Korpi, W (1986) From poor relief to institutional welfare states: the development of Scandinavian social policy. International Journal of Sociology 16, 39–74.CrossRefGoogle Scholar
Eurobarometer (2007) Health and Long-term Care in the European Union (Special Eurobarometer Report 283). Brussels: European Commission.Google Scholar
Gabadinho, A, Ritschard, G, Mueller, NS and Studer, M (2011) Analyzing and visualising state sequences in R with TraMineR. Journal of Statistical Software 40, 1–37.CrossRefGoogle Scholar
Geerlings, SW, Pot, AM, Twisk, JW and Deeg, DJ (2005) Predicting transitions in the use of informal and professional care by older adults. Ageing & Society 25, 111–130.CrossRefGoogle Scholar
Geerts, J and Van den Bosch, K (2012) Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts. European Journal of Ageing 9, 27–37.CrossRefGoogle ScholarPubMed
Greene, VL (1983) Substitution between formally and informally provided care for the impaired elderly in the community. Medical Care 21, 609–619.CrossRefGoogle Scholar
Haberkern, K and Szydlik, M (2010) State care provision, societal opinion and children's care of older parents in 11 European countries. Ageing & Society 30, 299–323.CrossRefGoogle Scholar
Kadushin, G (2004) Home health care utilization: a review of the research for social work. Health & Social Work 29, 219–244.CrossRefGoogle ScholarPubMed
Kalwij, A, Pasini, G and Wu, M (2014) Home care for the elderly: the role of relatives, friends and neighbors. Review of Economics of the Household 12, 379–404.CrossRefGoogle Scholar
Kelfve, S, Fors, S and Lennartsson, C (2017) Getting better all the time? Selective attrition and compositional changes in longitudinal and life course studies. Longitudinal and Life Course Studies 8, 104–120.CrossRefGoogle Scholar
Kemp, CL, Ball, MM and Perkins, MM (2013) Convoys of care: theorizing intersections of formal and informal care. Journal of Aging Studies 27, 15–29.CrossRefGoogle ScholarPubMed
Kjær, AA, Poulsen, MH and Siren, A (2016) Respons og bortfald i Ældredatabasen [Response and Attrition in the Danish Longitudinal Study on Ageing]. Copenhagen: SFI – The Danish National Centre for Social Research.Google Scholar
Larsson, K and Silverstein, M (2004) The effects of marital and parental status on informal support and service utilization: a study of older Swedes living alone. Journal of Aging Studies 18, 231–244.CrossRefGoogle Scholar
Leitner, S (2003) Varieties of familialism: the caring function of the family in comparative perspective. European Societies 5, 353–375.CrossRefGoogle Scholar
Lesnard, L (2010) Setting cost in optimal matching to uncover contemporaneous socio-temporal patterns. Sociological Methods & Research 38, 389–419.CrossRefGoogle Scholar
Lipszyc, B, Sail, E and Xavier, A (2012) Long-term Care: Need, Use and Expenditure in the EU-27 (No. 469). Brussels: Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.Google Scholar
Litwak, E (1985) Helping the Elderly: The Complementary Roles of Informal Networks and Formal Systems. New York, NY: Guilford.Google Scholar
Lyons, KS and Zarit, SH (1999) Formal and informal support: the great divide. International Journal of Geriatric Psychiatry 14, 183–192.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Noelker, LS and Bass, DM (1989) Home care for elderly persons: linkages between formal and informal caregivers. Journal of Gerontology 44, S63–S70.CrossRefGoogle ScholarPubMed
Pot, AM, Portrait, F, Visser, G, Puts, M, van Groenou, MB and Deeg, DJ (2009) Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based study. BMC Health Services Research 9, 139.CrossRefGoogle ScholarPubMed
Rauch, D (2008) Central vs. local service regulation: accounting for diverging old-age care developments in Sweden and Denmark, 1980–2000. Social Policy & Administration 42, 267–287.CrossRefGoogle Scholar
Rodríguez, M (2013) Use of informal and formal care among community dwelling dependent elderly in Spain. European Journal of Public Health 24, 668–673.CrossRefGoogle ScholarPubMed
Rostgaard, T (2011) Care as you like it: the construction of a consumer approach in home care in Denmark. Nordic Journal of Social Research 2, 54–69.CrossRefGoogle Scholar
Rostgaard, T and Szebehely, M (2012) Changing policies, changing patterns of care: Danish and Swedish home care at the crossroads. European Journal of Ageing 9, 101–109.CrossRefGoogle ScholarPubMed
Schulz, E (2010) The Long Term Care System for the Elderly in Denmark (ENEPRI Research Report No. 73). Brussels: European Network of Economic Policy Research Institutes.CrossRefGoogle Scholar
Shanas, E (1968) Old People in Three Industrial Societies. New Brunswick, NJ: Transaction Publishers.Google Scholar
Studer, M (2013) Weighted cluster library manual: a practical guide to creating typologies of trajectories in the social sciences with R (LIVES Working Paper 2013:24). Lausanne: University of Lausanne.Google Scholar
Suanet, B, van Groenou, MB and Van Tilburg, T (2012) Informal and formal home-care use among older adults in Europe: can cross-national differences be explained by societal context and composition? Ageing & Society 32, 491–515.CrossRefGoogle Scholar
Thygesen, LC, Daasnes, C, Thaulow, I and Brønnum-Hansen, H (2011) Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scandinavian Journal of Public Health 39, 12–16.CrossRefGoogle ScholarPubMed
Tomassini, C, Kalogirou, S, Grundy, E, Fokkema, T, Martikainen, P, Van Groenou, MB and Karisto, A (2004) Contacts between elderly parents and their children in four European countries: current patterns and future prospects. European Journal of Ageing 1, 54–63.CrossRefGoogle ScholarPubMed
van Groenou, MB, Glaser, K, Tomassini, C and Jacobs, T (2006) Socio-economic status differences in older people's use of informal and formal help: a comparison of four European countries. Ageing & Society 26, 745–766.CrossRefGoogle Scholar
Van Houtven, CH and Norton, EC (2004) Informal care and health care use of older adults. Journal of Health Economics 23, 1159–1180.CrossRefGoogle ScholarPubMed