Effects of historical periods on the structure of formal and informal care to noninstitutionalized elderly in an urban area.

摘要

This study examined the changes in the structure of formal and informal care of noninstitutionalized urban elderly over a twelve year period. Using the age stratification approach, it argued that caregiving to the elderly was subject to the influence of age, period and cohort effects. The antecedents of the use of care such as functional ability, social network and demographic characteristics were examined as well as the existing models on the use of care. It was noted that extant research did not address the issue of whether the pattern of the use of care is stable across different periods of time.; Several factors that might lead to changes in the structure of care were discussed: increased participation of females in the labor force, implementation of the DRG's, the growth of formal care agencies, the increasing level of education and income among successive cohorts of elderly and the reported lower fertility rate of the cohort born between 1905 and 1910 that had its main childbearing years during the Depression.; The difficulty in the simultaneous assessment of age, period and cohort effects was explained. The study focused on period effects on the use of formal and informal care due to the factors discussed earlier. Procedures for ruling out rival explanations due to cohort effects were outlined.; The findings showed significant interaction effects between functional status and period, and living arrangements and period on the use of care. Thus, the impact of functional status and living arrangements on the use of care were subject to change over time. There was a small but significant decline in the use of informal care over time. Contrary to the hypothesis, there was no increase in the use of formal care. The implications of this finding, given the low income range of the sample was discussed. There appear to be two divergent groups of elderly: those who need short term acute post-hospital care, and those who need chronic long term care. Future policy research needs to address both long term and short term care needs of the elderly.