Research Information System
20th Biennial Conference of the European Society for Health and Medical Sociology (ESHMS) , Brussels, Belgium, 2 - 05 July 2024, pp.125-126
European countries are undergoing population aging as a consequence of an extended life expectancy and continued declines in fertility rates. This aging population has specific and a variety of needs, particularly pertaining to their health and well-being. One of the health issues that become more prominent with age is about ADL/IADL limitations. In Europe, 10.4% of men and 12.8% of women aged 50 and older have at least one ADL limitation, while 13.4% of men and 21.2% of women have at least one IADL limitations. Alarmingly, more than half of this demographic group experiences unmet care needs. Existing literature also reveals a strong association between unmet I/ADL needs and long-term care systems (social care). However, there is limited understanding of how I/ADL care needs are addressed at the end of life and whether long-term care systems play a role in this outcome. Verbakel et al. 's typology (2023) categorizes various types of long-term care (LTC) policies in European countries based on macro-level indicators such as (1) supported familialism, measured by the availability of informal caregiver support and cash benefits to caregivers; (2) supported defamilialization through the market, involving cash benefits to care users; and (3) defamilialization through public provision, assessed by the relative number of LTC beds and the number of formal LTC workers. Based on this typology, this study investigates the prevalence of end-of-life I/ADL unmet care needs of older adults based on the indicators of long-term care policies of a country.
Methodology We utilize data from nationally representative surveys of older adults in Europe obtained through the Harmonized End of Life data provided by the Gateway to Global Aging Data. The Survey of Health, Ageing, and
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Retirement in Europe (SHARE) conducts surveys among adults aged 50 and older in 29 European countries. To gather information about respondents' experiences prior to death, SHARE conducts end-of-life interviews with a knowledgeable proxy, such as a spouse or child. The analytic sample for this study includes respondents from 17 European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Italy, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland) after excluding 12 countries for either not having deceased older adults with I/ADL care needs or for not being included in Verbakel’s typology. We use the corresponding Waves 6-8 (2015–2018) of the Harmonized HRS End of Life dataset (N = 3,729). In this study, descriptive analyzes are conducted and weighted hierarchical analysis will be conducted in line with the typology developed by Verbakel et al. (2023).
Results The preliminary results show that in the overall sample, on average, 7.29% of older adults had any unmet needs, 4,51% had unmet ADL needs, and 4,26% had unmet IADL needs. The availability of cash benefit to informal caregivers and more LTC beds, on average, across countries is associated with higher risk for unmet needs. 6.97% of older adults in countries without cash benefits to caregivers, and 8.28% of older adults in countries with cash benefits to caregivers have unmet needs. 8.45% of older adults in countries with more than average LTC beds for older adults, and 6.25% of older adults in countries with less than average LTC beds for older adults have unmet needs. However, caregiver support does not make a significant difference in the prevalence of unmet care needs. 7.31% of older adults in countries without informal caregiver support, and 7.28% of older adults in countries with informal caregiver support have unmet needs.
Conclusion This study investigates the prevalence of unmet I/ADL needs of older people approaching the end of their life in relation to a country’s long-term care policies. Preliminary results indicate that the provision of cash benefits to caregivers is associated with higher unmet needs even though informal caregiver support has no effect on unmet needs. Furthermore, the availability of more than average LTC beds is also associated with higher unmet needs. Further analyzes will enable us to draw conclusions about the prevalence of end-of-life I/ADL unmet needs based on a country’s long term care policies. This study aims to gain a better understanding of end-of-life care needs of older people and how certain indicators of long-term care policies either mitigate or increase the risks associated with these unmet needs. Considering that the end of life is a period in which health status and related needs of older people show the greatest variability, it is critical to examine needs associated both with different limitations and the availability of social care provisions. The inclusion of older people with a wide variety of care needs and health limitations would also allow for better social policymaking on long-term care arrangements.