As a result of fertility decline and increasing life expectancy, the age structure of the Dutch population is changing, with a larger proportion and number of elderly persons and declining proportions and numbers of younger adults. Hence, the number of people in need of care is growing. While -at the same time- the number of people that can provide care declines and numerous independently living elderly are on waiting lists for professional care. Concerns about care for the elderly in the future prompted us to do research about the topic of care for independently living elderly. Given the rural orientation of Wageningen University the research was focused on rural elderly. The age groups included were persons aged 75 years and older. The following research questions were formulated:What is the picture of instrumental and social-emotional care for rural elderly, who still live independently and are aged 75 and older? Which characteristics of the elderly and which of the informal care givers influence the care that elderly receive? Which problems in the care of the elderly can arise in the future and how could these be solved?
Data collection for this research proceeded in two stages. First, qualitative research was done to gain insight into the care for the elderly. Eleven elderly people and six informal carers ( mantelzorgsters ) were interviewed. In consequence of the qualitative research, the instrumental-care situation, the instrumental-care arrangement and the social-emotional-care arrangement were defined and hypotheses for the quantitative research were specified. For the quantitative research, the second stage of data collection, a survey was done among a random sample of people aged 75 years and over, stratified according to sex and marital status, living in seven rural municipalities in the Netherlands. We were able to analyse the cases of 465 elderly (response rate of 62,6%). Besides, interviews were conducted with 235 carers who give informal care to elderly persons from the sample. Below we will report about the main findings of the research.The instrumental-care situation
The instrumental-care situation pictures the degree to which the elderly receive instrumental care from people beyond the own household. Elderly people in self-caring households care for themselves and in households consisting of more than one person for each other. Elderly people in cared-for households receive much care of people who are no household members. They themselves cannot do much. In between are elderly persons in households that just can manage ( redzaam ). These elderly care largely for themselves, but in addition receive substantial care from people beyond their own household. They receive more instrumental care than self-caring elderly and less than cared-for elderly. In the quantitative sample 27,5% of the people aged 75 years and over can be called self-caring, 50,1% managing and 22,4% cared-for.
The quantitative research shows that the instrumental-care situation is significantly related to the variables of household composition, age and health indicators of the elderly. Elderly who live alone and older elderly receive more instrumental care from people who are no household member than elderly who share their household with someone else and younger elderly. At first sight the instrumental-care situation is not influenced by the sex of the elderly person. However, the female elderly in the sample are less healthy than the male elderly. Thus, for a comparison we have to control for health status. When women and men with a comparable health situation are compared, we can see that women receive less instrumental care than men. Besides, elderly who are less mobile receive more care than elderly who are more mobile.
These results enable us to put the instrumental-care situation in a live course perspective. When people become older their health tends to decline. Thus, the three types of the instrumental-care situation can be seen as phases in the life course.
Characteristics of informal carers are no predicting factors for the instrumental-care situation of elderly. When people give informal care it does not seem to matter whether they are woman or man and whether they are family or not. Furthermore, the quality of the relationship does not influence the amount of instrumental care elderly receive. The qualitative research has shown that children give informal care even when they experience the relationship with their parents not very positively. The obligations attached to kinship relations seem to be more important than the quality of the relationship.The instrumental-care arrangement
The instrumental-care arrangement pictures the proportion of informal carers and professional carers in the care elderly receive. We defined the instrumental-care arrangement only for the elderly that just can manage. In comparison with the sample, the degree to which these elderly receive instrumental care varies less. The qualitative research shows that elderly who receive predominantly informal care refer to this care in terms of self-care. This way they emphasise that the care they receive from their daughter or son is closely to them. Elderly who receive predominantly formal care emphasis their feeling of independence in the care relationship. From a professional care giver they receive care, pay for it and do not further have a relationship with her. Because of this elderly experience this care, in comparison with informal care, less as a threat to their independence.
Managing elderly with an informal safety net receive only or predominantly instrumental care of informal carers. Managing elderly with a formal safety net receive only or predominantly formal (professional) care. In the quantitative sample 36,0% of the managing elderly can be called managing with a informal safety net (18,0% of the sample) and 64,0% managing with a formal safety net (32,1% of the sample). The care they receive is diverse. Managing elderly with a formal safety net almost all are supported with the heavy tasks in the household such as vacuum cleaning and cleaning the windows. In comparison with the care managing elderly with an informal safety net, they receive fixed care. The care for elderly people with an informal safety net is more diverse and seems to be more adjusted to their individual needs and wishes.
The quantitative research shows that the instrumental-care arrangement is significantly related to the normative values and characteristics of the social network of the elderly. Elderly who believe that children (in-law) ought to give informal care and elderly who think traditionally about sex roles have more often an informal safety net than elderly who have other normative values about these topics. Furthermore, elderly who have a social network that consist for more than half of children, elderly who have more children and elderly who have more children without paid employment receive more often predominantly informal care than elderly for whom this is not true.
Characteristics that can not be influenced by the elderly such as their sex, their age and their health do not influence significantly the instrumental-care arrangement. This enables us to conclude that elderly choose for either informal or formal care.
Like the instrumental-care situation, the instrumental-care arrangement is not predicted by characteristics of informal carers. These results also show that when people give informal care it does not matter whether they are woman or man and whether they are family or not. Furthermore, the instrumental-care arrangement is not significantly related to reciprocity. The qualitative research has shown that material reciprocity is important to informal carers because they experience it as an expression of appreciation. Especially the meaning and intention of material reciprocity seems to be important.The social-emotional-care arrangement
The social-emotional-care arrangement pictures the degree to which the elderly receive social-emotional care and the proportion of kin and non-kin in this care process. Self-oriented elderly receive hardly any social-emotional care from people beyond the own household. Family-oriented elderly receive this type of care predominantly from family members who do not live in their household. They share the joyful and the more serious parts of social-emotional care with their children and other family members. Community-oriented elderly receive social-emotional care predominantly from non-kin. In comparison with the care for family-oriented elderly, the care for community-oriented elderly is more focused on the joyful parts. In the quantitative sample 19,6% of the elderly people can be called self-oriented, 36,3% family-oriented and 44,1% community-oriented.
The quantitative research shows that the social-emotional-care arrangement is significantly related to several variables. Elderly women are more often family-oriented and elderly men are more often community-oriented. Also elderly whose social network consists for more than half of family members and elderly who have more children are more often family-oriented than elderly for whom this is not the case. Furthermore, health indicators are related to the social-emotional-care arrangement. Elderly who use more technical aids and elderly who cannot drive a car are more often family-oriented than elderly who use less technical aids and elderly who can drive a car.
In contrast with instrumental care, characteristics of informal carers predict the social-emotional care elderly receive from people beyond the own household. Informal carers who say that the elderly appreciate the given care and informal carers who talk about their own problems with the elderly have more often a relationship with a community-oriented elderly than informal carers who do not experience immaterial reciprocity. Furthermore, informal carers who experience the care giving as a burden have more often a relationship with a family-oriented elderly than informal carers who do not experience it as a burden.
Looking at the predicting factors for social-emotional care, we see that this care diverts from instrumental care. Social-emotional care is significantly related to the sex, the number of children and the health situation of the elderly, but also to characteristics of informal carers, such as immaterial reciprocity and the experienced burden. Furthermore, the results show that the relationships with family-oriented elderly are more experienced as relationships containing obligations than the relationships with community-oriented elderly. In comparison to community-oriented elderly, family-oriented elderly seem to have less to offer to their informal carers. They are in poorer health and give less social-emotional care to their informal carers. Because of their better health, community-oriented elderly are much more able to visit other people and seem to give more social-emotional care to others.Conclusion
Our research shows that family members are an important source of care for the elderly. When they provide instrumental care, this care is more adjusted to the individual needs and wishes of the elderly people than the care provided by formal (professional) carers. When they provide social-emotional care, this care also includes the more serious aspects of this care. Furthermore, our data show that the quality of the relationship is not significantly related to the care that informal carers provide. The qualitative research has shown that children care for their parents even when they experience the relationship with them as not very positively.
|Qualification||Doctor of Philosophy|
|Award date||5 Jun 2001|
|Place of Publication||S.l.|
|Publication status||Published - 2001|
- old age
- home care
- health care
- social welfare
- rural areas