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Time use and experienced wellbeing of older caregivers: a sequence analysis
- Authors:
- FREEDMAN Vicki A., et al
- Journal article citation:
- Gerontologist, 59(5), 2019, pp.e441-e450.
- Publisher:
- Oxford University Press
Background and Objectives: The diminished wellbeing of caregivers is well documented, but studies typically draw upon coarse measures of time use and thus provide limited understanding of the role of specific care activities in the daily lives of care providers. This study uses time diary data to explore whether there are signature care patterns throughout the day and whether these care patterns have implications for caregivers’ experienced wellbeing. Research Design and Methods: Using a national sample of 511 time diaries from older caregivers in the Disability and Use of Time supplement to the Panel Study of Income Dynamics, this study examined minutes of care provided on the prior day, overall and for four broad care categories (household, personal care, transportation, and visiting), and patterns of care over the day, the latter based on sequence and cluster analysis. Results: Older caregivers spend on average 2.3 hr providing care to another adult on care days. Caregiving follows a roller-coaster pattern over the day, peaking at mealtimes. Sequence analysis suggests five distinctive caregiving patterns, which vary by both demographic characteristics of the caregiver (gender, work status) and care arrangement type (relationship to recipient, whether sole caregiver to recipient). The 40% who provide only marginal assistance of about 1 hr report lower experienced wellbeing than the 28% who provide sporadic assistance with a mix of activities for about 2 hr. Discussion and Implications: A substantial share of older caregivers provides only 1 hr of assistance on a given day but appears to be at risk for reduced wellbeing. Better understanding of the reason for their marginal involvement and reduced wellbeing is warranted. (Edited publisher abstract)
Neighborhoods and disability in later life
- Authors:
- FREEDMAN Vicki A., et al
- Journal article citation:
- Social Science and Medicine, 66(11), June 2008, pp.2253-2267.
- Publisher:
- Elsevier
This paper uses the US Health and Retirement Study to explore linkages between neighbourhood conditions and stages of the disablement process among adults aged 55 years and older in the United States. The authors consider multiple dimensions of the neighbourhood including the built environment as well as social and economic conditions. Factor analysis was used to reduce indicators into eight neighbourhood scales, which were incorporated into two-level logistic regression models along with controls for individual-level factors. The authors find evidence that economic conditions and the built environment, but not social conditions, matter. Neighbourhood economic advantage is associated with a reduced risk of lower body limitations for both men and women. The authors also find for men that neighbourhood economic disadvantage is linked to increased chances of reporting personal care limitations, particularly for those aged 55–64 years, and that high connectivity of the built environment is associated with reduced risk of limitations in instrumental activities. These findings highlight the distinctive benefits of neighbourhood economic advantage early in the disablement process. In addition, findings underscore the need for attention in the design and evaluation of disability-prevention efforts to the benefits that accrue from more physically connected communities and to the potential harm that may arise in later life from living in economically disadvantaged areas.
Declines in late-life disability: the role of early- and mid-life factors
- Authors:
- FREEDMAN Vicki A., et al
- Journal article citation:
- Social Science and Medicine, 66(7), April 2008, pp.1588-1602.
- Publisher:
- Elsevier
Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.
Trends in the use of assistive technology and personal care for late-life disability, 1992–2001
- Authors:
- FREEDMAN Vicki A., et al
- Journal article citation:
- Gerontologist, 46(1), February 2006, pp.124-127,.
- Publisher:
- Oxford University Press
The authors describe national trends during the 1990s in late-life difficulty and assistance with self-care activities. Among older Americans living in the community and experiencing difficulty with self-care activities, assistive-technology use increased substantially whereas use of personal care declined. Using a decomposition technique, they demonstrate that these shifts in assistance toward technology account for half the decline in the number of people dependent on personal care.
A comparison of assistive technology and personal care in alleviating disability and unmet need
- Authors:
- AGREE Emily L., FREEDMAN Vicki A.
- Journal article citation:
- Gerontologist, 43(2), June 2003, pp.325-344.
- Publisher:
- Oxford University Press
The authors examine differences in reports of residual disability and unmet need by type of long-term care arrangement (assistive technology or personal care). This study compares three specific dimensions of residual difficulty (pain, fatigue, and time intensity) and reports of unmet need across care arrangements. Samples from the U. S. 1994-1995 National Health Interview Survey Phase 2 Disability Supplements include adults with limitations in bathing, transferring, walking, and getting outside.:Even when differences in underlying disability are accounted for, assistive technology (AT) confers no additional benefit in the three dimensions of residual difficulty analyzed here. AT users equally or more often report that tasks are tiring, time consuming, or painful, even when they use assistance. Though this would appear to indicate unmet needs for care, fewer AT users report a desire for hands-on personal care. Though disability alleviation by technology is no better on specific dimensions of difficulty, technology users report less unmet need for personal care. Designing appropriate and cost-effective home care for adults with disabilities requires a better understanding of the ways in which technology users may differ from others and the circumstances under which technology can be most effective.