Impact of Family Structure and Household Composition on Receipt of Caregiving, Trajectories of Disability, Hospital Discharge Destination and Risk of Readmission among Community-Dwelling Older Adults with Disability
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Date
2016-01-01
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Department
Gerontology
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Gerontology
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Distribution Rights granted to UMBC by the author.
Distribution Rights granted to UMBC by the author.
Abstract
Motivation. Informal caregivers, especially family and household members, are the primary source of help for community-dwelling older adults who need assistance with their disability. However, the impact of family and household characteristics on receipt of caregiving, trajectories of disability and adverse outcomes after hospitalization has not been systematically examined in nationally representative samples of community-dwelling older adults living with disability. Hypotheses. Building on the intergenerational solidarity framework which conceptualized the linkage between structural dimensions of family and household and functional support to older members in times of need, this study hypothesized that family structure and household composition would affect the following outcomes: 1) the likelihood of receiving help and the percentage of care needs met; 2) trajectories of disability over time; and 3) hospital discharge destination and risk of re-admission. Study Design. The 2000-2012 Medicare Current Beneficiary Surveys (MCBS) were the data source for the study. In the analyses of the first and third outcomes, pooled cross-sectional samples were used. In the examination of trajectories of disability, a longitudinal sample was constructed to track changes in disability states over a four-year period. To generate nationally representative estimates, all analyses were weighted by cross-sectional or longitudinal weights based on the nature of the observations and were also adjusted for complex sampling schemes of the MCBS. Results. Among community-dwelling older adults living with disability, large gaps between care needs and actual care received were found. Inadequacies in receiving care were most strongly felt by older adults who were divorced, childless and living alone. Trajectories of disability indicative of both recovery and progression over four years confirmed the dynamic nature of disability and also its long-term impact on older adults' functioning. Strong evidence was found of the rehabilitative potential of living with family members. Nationally, more than one in five (22.8%) hospitalized older adults were discharged to another institution rather than their private community home. Nearly a fifth (18.6%) of the discharged patients were re-admitted within 30 days. Childlessness is a potent indicator of both elevated risks of multiple institutional transitions after discharge and 30-day re-admission. Implications for the findings were discussed in respective chapters.