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According to need?: Predicting use of formal and informal care in a Swedish urban elderly population
Stockholm University, Faculty of Social Sciences, Department of Social Work.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This dissertation studies factors that predict use of public eldercare, informal care, and purchase of private services in relation to an individual’s needs, social network characteristics, and sociodemographic factors. A further purpose is to examine whether use of public eldercare is correlated to receipt of informal care and purchase of private services in the Swedish welfare state.

The dissertation is based on the Kungsholmen Study, a population-based longitudinal study. Studies I–III used cross-sectional data from community-dwelling people aged 81-100 and examined (I) gender, (II) marital and parental status, and (III) dementia and depressive symptoms as predictors of use of home help. Study IV analyzed factors related to moving into institutional care and receipt of home help from 1994/96 to 2000.

The majority of support provided to elders living in the community comes from informal sources, even among people living alone. There was considerable overlap between home help and informal care. When all sources of care were considered, childless individuals had comparatively lower odds of receiving care. Factors predicting use of public eldercare and informal care differed depending on whether or not elders coresided. No gender differences in use of formal and informal care were found when controlling for household composition. Living alone, dementia, need of help with household chores, and walking limitations increased the likelihood of using public eldercare. Coresidence, informal care from outside the household, and use of private services decreased the likelihood. Depressive symptoms increased the likelihood of receiving home help and institutionalization when using longitudinal data, but not in the cross-sectional studies. Educational level was of importance and interacted with several factors; persons with higher levels of education were advantaged. Very few people moved into institutional care without previously having received home help services. Essentially the same factors that predicted receipt of home help services also predicted institutionalization.

Place, publisher, year, edition, pages
Stockholm: Institutionen för socialt arbete - Socialhögskolan , 2004. , 88 p.
Series
Stockholm studies in social work, ISSN 0281-2851 ; 20
Keyword [en]
home-based care, community-based services, predicting use of eldercare, home-help services, informal care, institutionalization, dementia, depression
National Category
Social Work
Identifiers
URN: urn:nbn:se:su:diva-109ISBN: 91-7265-862-2 (print)OAI: oai:DiVA.org:su-109DiVA: diva2:189396
Public defence
2004-05-14, Aula Svea, Socialhögskolan, Sveaplan, Stockholm, 13:00 (English)
Opponent
Supervisors
Available from: 2004-04-22 Created: 2004-04-22 Last updated: 2010-03-03Bibliographically approved
List of papers
1. Does gender matter?: Differences in patterns of informal support and formal services in a Swedish urban elderly population
Open this publication in new window or tab >>Does gender matter?: Differences in patterns of informal support and formal services in a Swedish urban elderly population
2002 (English)In: Research on Aging, ISSN 0164-0275, E-ISSN 1552-7573, Vol. 24, no 3, 308-336 p.Article in journal (Refereed) Published
Abstract [en]

When facing dependency, the majority of elderly men receive care from spouses whereas elderly women more often rely on relatives or public elder care. This Swedish population-based study of persons between ages 81 and 100 concerns public elder care and informal support in relation to having a coresiding caregiver. Findings indicate that men had higher odds of receiving care when coresident and/or extraresident and/or public home help services were included, compared to women, after controlling for functional and cognitive impairment as well as self-reported need of assistance with instrumental activities of daily living. After controlling also for coresiding, the gender differences disappeared. The main distinction was found between persons living alone and persons coresiding, not between men and women. Thus, when studying use of public elder care and support from relatives or friends, it is vital to include household composition, and thereby the possibility of receiving care from a coresiding caregiver, in the analyses.

Identifiers
urn:nbn:se:su:diva-22759 (URN)10.1177/0164027502243002 (DOI)
Note
Part of urn:nbn:se:su:diva-109Available from: 2004-04-22 Created: 2004-04-22 Last updated: 2010-08-02Bibliographically approved
2. The effects of marital and parental status on informal support and service utilization: A study of older Swedes living alone
Open this publication in new window or tab >>The effects of marital and parental status on informal support and service utilization: A study of older Swedes living alone
2004 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 0890-4056, Vol. 18, no 2, 231-244 p.Article in journal (Refereed) Published
Abstract [en]

Never-married individuals and childless persons living alone are at greater risk of having insufficient support in old age. This study investigated whether community-dwelling older people, living alone in an urban area of Sweden, benefit from having been previously married and having had children in terms of informal care received, and whether those without such filial support were compensated by formal services. The study sample consisted of 390 persons, 81 years and older, who were interviewed about family support and the use of public eldercare and market-based services. The study showed that parents had considerably higher odds of receiving informal support, whereas previously married individuals without children were no more likely to receive support than their never-married counterparts. Public home-help services did not fully buffer the lack of care among childless individuals. This indicates that even in an advanced welfare state like Sweden, children are assets for receipt of care in old age.

Keyword
Marital and parental status, Informal support, Service utilization
Identifiers
urn:nbn:se:su:diva-22760 (URN)10.1016/j.jaging.2004.01.001 (DOI)
Note
Part of urn:nbn:se:su:diva-109Available from: 2004-04-22 Created: 2004-04-22 Last updated: 2010-08-02Bibliographically approved
3. Dementia and depressive symptoms as predictors of home help utilization among the oldest old: A population based study in an urban area of Sweden
Open this publication in new window or tab >>Dementia and depressive symptoms as predictors of home help utilization among the oldest old: A population based study in an urban area of Sweden
2004 (English)In: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 16, no 5, 641-668 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The objective of this article is to investigate predictors of public home help utilization, particularly mental health problems such as dementia and depressive symptoms. Methods: A population-based sample of community-dwelling people aged 81-100 was interviewed and assessed with medical examinations (N = 502). Results: Dementia increased the odds of receiving public home help among people residing alone. Among coresiding people, it increased the odds of receiving home help, but only among those who had extra residential care. Depressive symptoms decreased the odds of receiving home help among people with lower levels of education who lived alone. Depressive symptoms among highly educated people who lived alone and among coresiding people of any educational level were not related to receipt of home help. Discussion: Improvement of screening activities for public home help needs of community-dwelling elders might allow better targeting of limited social resources to the most needy.

Keyword
depression, dementia, elderly, home- and community-based services, mental health problems
Identifiers
urn:nbn:se:su:diva-22761 (URN)10.1177/0898264304268586 (DOI)
Note
Part of urn:nbn:se:su:diva-109Available from: 2004-04-22 Created: 2004-04-22 Last updated: 2010-08-02Bibliographically approved
4. Are public care and services for older people targeted according to need?: Applying the Behavioural Model on longitudinal data of a Swedish urban older population
Open this publication in new window or tab >>Are public care and services for older people targeted according to need?: Applying the Behavioural Model on longitudinal data of a Swedish urban older population
2006 (English)In: European Journal of Ageing, ISSN 1613-9372, Vol. 3, no 1, 22-33 p.Article in journal (Refereed) Published
Abstract [en]

The objectives were to identify factors that predict the use of home help services and transition into institutional care and to study to what extent care services were targeted according to the individuals’ needs. A further objective was to study whether people who had moved into institutional care facilities had received home help prior to institutionalisation. A community-dwelling sample (n=502) aged 81–100 was twice interviewed and assessed with medical examinations. Their use of public elderly care between 1994/1996 and 2000 was studied using survival analyses. Need factors, according to the Andersen Behavioural Model, were the most important predictors for the use of elderly care. Among people living alone, dementia, functional limitations, and depressive symptoms predicted the use of home help services and institutionalisation. Among non-demented cohabiting people, depressive symptoms and dependence in ADLs increased the likelihood of both home help and institutionalisation. Among cohabiting people with dementia, the effect of dementia was difficult to separate from the effects of ADL limitations and depression. Enabling factors were of importance among cohabiting people. A high level of education increased the likelihood of moving into institutional care, and informal extra-residential care increased the likelihood of both outcomes indicating that elderly care resources had not been targeted solely according to need. Predisposing factors such as age and gender were of importance only among people living alone. Basically the same factors predicted both the receipt of home help and institutionalisation. Only 4% of people living alone and 5% of those cohabiting moved to institutions without previously receiving home help.

Keyword
Home- and community-based services, Elderly care, Dementia, Depression, The Andersen Behavioural Model
Identifiers
urn:nbn:se:su:diva-22762 (URN)10.1007/s10433-006-0017-1 (DOI)
Note
Part of urn:nbn:se:su:diva-109Available from: 2004-04-22 Created: 2004-04-22 Last updated: 2010-08-02Bibliographically approved

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