Abstract
Objectives
In the course of demographic change, there is both a relative and an absolute increase in countries’ elderly population. Care and support needed by older dependent people are primarily provided by relatives or friends within the home environment. Family caregivers can be supported by specific services aiming to relieve their burden of care. The EUROFAMCARE project provides an overview of the situation of family caregivers of elderly dependents in Europe in terms of the existence, awareness, availability, use, and acceptance of support services. This article provides results of the German survey.
Methods
A total of 1,003 family caregivers were interviewed at home using a standardized questionnaire. Primary caregivers providing at least 4 h of personal care or support per week to a relative aged 65 years or older were included. Data analysis was based on a conditional inference-tree algorithm which embeds tree-structured regression models.
Results
The family caregivers were 54 years on average (standard deviation (SD) = 13.4); 76 % of them were female. The dependent elderly were 80 years on average (SD = 8.3); 69 % of them were women. The number of used service units increased with higher educational status of family caregivers and/or higher perceived burden of care. Less-educated family caregivers with a lower negative impact tend to utilize services less frequently. Regarding the number of different services used, we found interactions between higher dependency and higher education as predictors for service utilization, independently from the intensity of perceived burden by higher educated caregivers. Perceived burden only interacts with lower education.
Conclusions
Policymakers can particularly address predisposing factors to support informal care structures. Increased service utilization is likely when available information and support services are more easily accessible. The potential advantages and benefits of services must be emphasized to increase service utilization by caregivers.
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Notes
- 1.
The German Federal Statistical Office (Statistisches Bundesamt) defines “working age” as 20–64 years when calculating the old-age dependency ratio. Population calculations in other countries often use an age range of 15–64 years.
- 2.
The EUROFAMCARE project was funded by the European Union (EU) (contract no.: QLK6-CT-2002-02647) and coordinated by the Department of Medical Sociology at the University of Hamburg (www.uke.de/eurofamcare).
- 3.
For example: If a scale ranging from 0 to 10 points is split into a = 0–5 and b = 6–10, the subranges a and b may be split again, for example, into c (0–2) and d (3–5) as well as e (6–8) and f (9–10).
- 4.
Long-term care insurance is a type of social insurance which covers the risk of a future need for care. The majority of the German population has statutory long-term care insurance coverage. In the event that care is needed, covered individuals may obtain cash benefits for the “informal” caregivers and/or benefits-in-kind like professional care from the long-term care insurance funds. However, eligibility depends on the level of need for care. Following an assessment to determine an individual’s level of dependency, he or she is then classified under one of three care levels (CLs) needed.
- 5.
Including the listed variables in Table 10.1 as independent variables and intensity of service utilization as dependent variable.
- 6.
Including the same variables as in the first model as independent variables and number of different services utilized as a dependent variable.
- 7.
As a reminder: If there were an interaction between higher educational level, (higher or lower) subjectively perceived burden of care and service utilization, the covariate “negative impact” would have been significant and split the tree path from node 9 to 13 into two more subgroups. Thus, we can assume that services are utilized by higher educated caregivers, regardless of the negative impact of care.
References
Andersen RM, Davidson PL (2001) Improving access to care in America: individual and contextual indicators. In: Andersen RM, Rice TH, Kominski EF (eds) Changing the U.S. health care system: key issues in health services, policy, and management. Jossey-Bass, San Francisco, CA, pp 3–30.
Balducci C, Mnich E, McKee K, et al. (2008) Negative Impact and Positive Value in Caregiving: Validation of the COPE Index in a Six-Country Sample of Carers. The Gerontologist 48:276–286.
Barinaga M (1998) Caregivers need healing, too. Science 282:1031–1032.
Barusch AS (1988) Problems and coping strategies of elderly spouse caregivers. Gerontologist 28:677–685.
Bech P (2008) Measuring the dimensions of psychological general well-being by the WHO-5. Quality of Life Newsletter 32:15–16.
Bolin K, Lindgren B, Lundborg P (2008) Your next of kin or your own career? Caring and working among the 50+ of Europe. J Health Econ 27:718–738. doi: 10.1016/j.jhealeco.2007.10.004.
Brazier JE, Harper R, Jones NM, et al. (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305:160–164.
Brodaty H, Gresham M, Luscombe G (1997) The Prince Henry Hospital dementia caregivers’ training programme. Int J Geriatr Psychiatry 12:183–192.
Brodaty H, Green A, Koschera A (2003) Meta-Analysis of Psychosocial Interventions for Caregivers of People with Dementia. J Am Geriatr Soc 51:657–664.
Brodaty H, Thomson C, Thompson C, Fine M (2005) Why caregivers of people with dementia and memory loss don’t use services. Int J Geriatr Psychiatry 20:537–546. doi: 10.1002/gps.1322.
Carmichael F, Charles S (2003) The opportunity costs of informal care: does gender matter? J Health Econ 22:781–803. doi: 10.1016/S0167–6296(03)00044–4.
Chiu TML, Eysenbach G (2011) Theorizing the health service usage behavior of family caregivers: a qualitative study of an internet-based intervention. Int J Med Inform 80:754–764. doi: 10.1016/j.ijmedinf.2011.08.010.
DESTATIS (2008) Pressemitteilung Nr. 121.
Di Rosa M, Kofahl C, McKee K, et al. (2011) A typology of caregiving situations and service use in family carers of older people in six European countries: The EUROFAMCARE study. GeroPsych 24:5–18.
Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434.
Gräßel E (1996) Körperbeschwerden und Belastung pflegender Familienangehöriger bei häuslicher Pflege eines über längere Zeit hilfsbedürftigen Menschen. Psychother Psychosom med Psychol 46:189–193.
Gräßel E (1998) Häusliche Pflege dementiell und nicht dementiell Erkrankter. Teil II: Gesundheit und Belastung der Pflegenden. Z Gerontol Geriat 31:57–62.
Gräßel E (2000) Warum pflegen Angehörige? Ein Pflegemodell für die häusliche Pflege im höheren Lebensalter. Zeitschrift für Gerontopsychologie & -psychiatrie 13:85–94.
Hapfelmeier A, Hothorn T, Ulm K, Strobl C (2012) A new variable importance measure for random forests with missing data. Stat Comput. doi: 10.1007/s11222-012-9349-1.
Haug MR, Ford AB, Stange KC, et al. (1999) Effect of giving care on caregiver’s health. Research on Aging 21:515–538.
Heitmueller A, Inglis K (2007) The earnings of informal carers: wage differentials and opportunity costs. J Health Econ 26:821–841. doi: 10.1016/j.jhealeco.2006.12.009.
Hothorn T, Zeileis A (2009) partykit: A Toolkit for Recursive Party-tioning. http://R-forge.R-project.org/projects/partykit/.
Hothorn T, Hornik K, van de Wiel MA, Zeileis A (2006a) A Lego System for Conditional Inference. The American Statistician 60:257–263. doi: 10.1198/000313006X118430.
Hothorn T, Hornik K, Zeileis A (2006b) Unbiased Recursive Partitioning: A Conditional Inference Framework. Journal of Computational and Graphical Statistics 15:651–674. doi: 10.1198/106186006X133933.
Keady J, Nolan M (1996) Behavioural and instrumental stressors in Dementia (BISID): refocussing the assessment of caregiver need in dementia. J Psychiatr Ment Health Nurs 3:163–172.
Kofahl C, Arlt S, Mnich E (2007) “For Better or for Worse…” Differences and Similarities of Caring Spouses and Other Family Caregivers in the German Survey of the Project EUROFAMCARE. Zeitschrift für Gerontopsychologie & -psychiatrie 20:211–225.
Kofahl C, Lüdecke D, Döhner H (2009) Der Einfluss von Betreuungsbedarf und psychosozialen Determinanten auf Belastung und Wohlbefinden von pflegenden Angehörigen alter Menschen. Ergebnisse aus der deutschen Teilstichprobe des Projekts EUROFAMCARE. Pflege & Gesellschaft 3:236–253.
Kurz A (2011) Psychosoziale Interventionen bei demenziell Erkrankten und deren Angehörigen. Versorgungsforschung für demenziell erkrankte Menschen.
Lamura G, Döhner H, Kofahl C (2008) Family Carers of Older People in Europe. A Six-Country Comparative Study. LIT Verlag, Hamburg.
Lamura G, Mnich E, Wojszel B, et al. (2006) The experience of family carers of older people in the use of support services in Europe: selected findings from the EUROFAMCARE project. Z Gerontol Geriatr 39:429–442. doi: 10.1007/s00391-006-0416-0.
Lee R (2011) The outlook for population growth. Science 333:569–573. doi: 10.1126/science.1208859.
Lüdecke D, Mnich E, Kofahl C (2008) Characteristics of the sample. In: Döhner H, Kofahl C, Lüdecke D, Mnich E (eds) Family Care for Older People in Germany. Results from the European Project EUROFAMCARE. LIT Verlag, Hamburg, pp 107–124.
MacDonald A, Dening T (2002) Dementia is being avoided in NHS and social care. BMJ 324:548.
Mahoney FI, Barthel DW (1965) Functional Evaluation: The Barthel Index. Md State Med J 14:61–65.
McKee K, Philp I, Lamura G, et al. (2003) The COPE Index—a first stage assessment of negative impact, positive value and quality of support of caregiving in informal carers of older people. Aging & Mental Health 7:39–52.
McKee K, Balducci C, Krevers B, et al. (2008) The EUROFAMCARE Common Assessment Tool (CAT)—Item and scale development and description. In: Lamura G, Döhner H, Kofahl C (eds) Supporting Family Carers of Older People in Europe. Empirical Evidence, Policy Trends and Future Perspectives. LIT Verlag, Hamburg, pp 49–73.
Mestheneos E, Triantafillou J (2005) Supporting Family Carers of Older People in Europe—The Pan-European Background Report. LIT Verlag, Münster.
Mittelman MS, Ferris SH, Shulman E, et al. (1996) A family intervention to delay nursing home placement of patients with Alzheimer disease. A randomized controlled trial. JAMA 276:1725–1731.
Nagy K, Reiczigel J, Harnos A, et al. (2010) Tree-Based Methods as an Alternative to Logistic Regression in Revealing Risk Factors of Crib-Biting in Horses. Journal of Equine Veterinary Science 30:21–26. doi: 10.1016/j.jevs.2009.11.005.
Pfaff H (2011) Pflegestatistik 2009. Pflege im Rahmen der Pflegeversicherung—Deutschlandergebnisse. 31.
Pinquart M, Sorensen S (2003) Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta analysis. J Gerontol B Psychol Sci 58B:453–460.
R Development Core Team (2009) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.
Rauch U (2000) Unnahbare Helfer: Pflegende Angehörige. Pflegen ambulant 11:24–28.
Rothgang H, Borchert L, Müller R, Unger R (2008) GEK-Pflegereport 2008: Schwerpunktthema: Medizinische Versorgung in Pflegeheimen. Asgard, Sankt Augustin.
Schneekloth U, Wahl H-W (2005) Möglichkeiten und Grenzen selbständiger Lebensführung in privaten Haushalten (MuG III). Integrierter Abschlussbericht. Bundesministerium für Familien, Senioren, Frauen und Jugend, Berlin.
Schulz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. Journal of the American Medical Association 282:2215–2219.
Shahly V, Chatterji S, Gruber MJ, et al. (2012) Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys. Psychol Med 1–15. doi: 10.1017/S0033291712001468.
Statistisches Bundesamt (2009) Bevölkerung Deutschlands bis 2060: 12. koordinierte Bevölkerungsvorausberechnung. Wiesbaden.
Statistisches Bundesamt (2011) Pflegestatistik 2009. Statistisches Bundesamt, Wiesbaden.
Strasser H, Weber C (1999) On the Asymptotic Theory of Permutation Statistics. Mathematical Methods of Statistics 8:220–250.
Taggart L, Truesdale-Kennedy M, Ryan A, McConkey R (2012) Examining the support needs of ageing family carers in developing future plans for a relative with an intellectual disability. J Intellect Disabil 16:217–234. doi: 10.1177/1744629512456465.
World Health Organization (1998) WHO Info Package: Mastering depression in primary care (Version 2.2). WHO, Geneva.
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Lüdecke, D., Mnich, E., Kofahl, C. (2014). How Do Socioeconomic Factors Influence the Amount and Intensity of Service Utilization by Family Caregivers of Elderly Dependents?. In: Janssen, C., Swart, E., von Lengerke, T. (eds) Health Care Utilization in Germany. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9191-0_10
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