A person’s health status is one of the strongest determinants of well-being. The negative impact of poor health on subjective well-being may be moderated by providing care to individuals in need. In this paper, we investigate the relationships between receiving informal care and the amount of care received and subjective well-being among people aged 65 or older in selected European countries. Our analysis of data from the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) showed that receiving regular informal care was associated with higher subjective well-being among older people in Northern European countries, and with lower subjective well-being among older males in Southern European countries. Moreover, we found that the perception of the amount of help received affected the subjective well-being of older people, as those who reported that the support they received was either insufficient or met their needs had lower subjective well-being than those who were not in need of care. Our results also showed that receiving formal care was negatively related with subjective well-being among older adults in Northern Europe and Central and Eastern Europe. In the context of population ageing and the growing need for care, social policies that support both sides of the caregiving relationship could enhance subjective quality of life.
Health is one of the most important predictors of well-being for all age groups, and it becomes increasingly important at older ages (Bergsma et al., 2008; Dear et al., 2002; Gerdtham & Johannesson, 2001; Heukamp & Ariño, 2011). Apart from its direct effect on how people feel, health has significant indirect effects on nearly all aspects of people’s lives, affecting their ability to participate in activities of daily living, and to engage socially. Health deterioration creates the need for support (Doblhammer & Ziegler, 2006; Vaupel & Kistowski, 2008), and an older person can be both a giver and a receiver of support. The body of research on the different types of support given and received by older people is large (Breeze & Stafford, 2008; Broese van Groenou & De Boer, 2016; Buchanan & Rotkirch, 2018; Haberkern & Szydlik, 2010; Haberkern et al., 2015; Hank & Buber, 2009; Solé-Auró & Crimmins, 2014).
The impact of providing care to dependent people on the health status, employment, and well-being of informal caregivers has received considerable attention in the scientific literature, with most studies showing that the effect is negative (Marks et al., 2002; Montgomery et al., 2007; Schulz & Sherwood, 2008; Wagner & Brandt, 2015). However, there are only a few existing analyses on the association between receiving informal care and the subjective quality of life of older care recipients (Djundeva et al., 2015; Hajek & König, 2016; Zwar et al., 2019). For instance, this issue has been analysed by looking at the unmet care needs of older people, and the impact of having unmet needs on their subjective quality of life. It may be assumed that receiving help reduces the negative impact of a person’s health status on his/her subjective well-being (SWB), as it has been shown that receiving social support is positively related to an individual’s quality of life (Sirgy, 2012). The existing literature has shown that having little or no social support is detrimental to a person’s health and well-being (Djundeva et al., 2015; Sirgy, 2012). While receiving social support generally contributes positively to an individual’s well-being (Landau & Litwin, 2001), the results from the literature on the relationship between receiving informal care and subjective well-being have been mixed (Carr et al., 2017; Djundeva et al., 2015; Hajek & König, 2016; Lee & Ellithorpe, 1982; Mitchell et al., 1982; Zwar et al., 2019). Thus, while the practical help and the emotional support an older person receives from informal caregivers may have a positive impact on his/her well-being, being dependent on care may elicit negative feelings. In addition, the amount of care an older person reports receiving may influence his/her subjective quality of life. The moderating effect of receiving help on an individual’s SWB may depend on many factors, such as the expectations of the care recipient, the quantum and the quality of the support received, the person’s relationship with his/her caregiver (close family member, friend, etc.), the individual characteristics of the person in need (gender, marital status, financial resources, etc.), and the person’s level of satisfaction with his/her relationships with other people (Carr et al., 2017; Maisel & Gable, 2009; Sirgy, 2012; Wolff & Agree, 2004). Moreover, an individual’s access to formal care and existing care arrangements may play a mediating role in the relationship between receiving informal care and subjective well-being. However, this relationship may vary across countries depending on the care arrangements for older people.
Thus, this paper aims to investigate the relationship between receiving care and the amount of care received and subjective well-being among people aged 65 or older in selected European countries. Moreover, we seek to analyse whether this association differs between selected groups of European countries with different types of care arrangements for older adults. For our analysis, we draw on data from the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). Subjective well-being is captured by a variable that describes quality of life (CASP-12). In the first section of the paper, we review the literature on the relationship between health, receiving informal care, and subjective well-being among older adults, and on the existing care arrangements for older people and the subjective quality of life of older people across European countries. In the second section, we outline the data and methods we used, and describe the variables we included in our models. In the next part, we describe our results. Finally, we present our conclusions.
Health, Informal Care, and Subjective Quality of Life among Older People
Health status is one of the pivotal factors of the subjective quality of life of older individuals. When a person’s physical health status deteriorates, and the individual experiences health problems, disability, and/or long-term disease, the person’s subjective quality of life is significantly reduced, and his/her depression levels tend to increase (Artés et al., 2014; Bergsma et al., 2008; Brugiavini et al., 2008; Freedman et al., 2012; Pinquart & Sörensen, 2000; Wurm et al., 2008). Moreover, mental health is crucial for an individual’s quality of life, as various mental disorders (sleep troubles, anxiety) are associated with lower subjective well-being (Dear et al., 2002; Michalos et al., 2003). It is worth emphasising that an individual’s subjective assessment of his/her health status is more predictive of his/her well-being than health status that is measured objectively (by a doctor) (Gwozdz & Sousa-Poza, 2010; Palmore & Luikart, 1972).
The effects of an individual’s health status on his/her well-being can also be indirect. Such effects can be transmitted via other life domains that influence the person’s life satisfaction, but that are also dependent on his/her health situation. On the one hand, being in better health has positive effects on an individual’s levels of physical activity (e.g., Lindwall et al., 2011), employment (Brugiavini et al., 2008), income (Pinquart & Sörensen, 2000), and leisure (Ferring et al., 2004; Mannell & Snelgrove, 2012; Nimrod & Shrira, 2016). On the other hand, various aspects of a person’s life may mitigate the negative impact of the deterioration of his/her health on his/her subjective well-being. For example, having a better financial situation, bigger social networks, frequent social contacts, and high-quality relationships, and participating in different activities, may be beneficial for a person’s quality of life, even if s/he is having health troubles (Freedman et al., 2012, 2019; Pinquart & Sörensen, 2000; Schüz et al., 2009; Sirgy, 2012; Tomini et al., 2016). All of these domains are associated with higher life satisfaction and/or lower levels of depression.
It has been argued that receiving support is beneficial for a person’s health status, mortality risk (Tay et al., 2013; Zhen et al., 2013), and subjective well-being, as, in general, having social support contributes to an individual’s quality of life (Bélanger et al., 2016; Landau & Litwin, 2001; Sirgy, 2012). However, the impact of this social support may depend on the individual characteristics of the caregivers and care recipients, the relationship between them, the expectations of the care recipients, the quantum and the quality of the support received, etc. (Carr et al., 2017; Maisel & Gable, 2009; Sirgy, 2012; Wolff & Agree, 2004). The help older adults receive may be perceived by them in two ways: on the one hand, it may provide them with a sense of relief in periods when their health is deteriorating and their care needs are growing; while on the other hand, it may lead them to worry about losing their independence. In addition, receiving social care may influence older people’s well-being via different channels: through the direct channel, social support can be a source of general positive affect, enhanced self-esteem, and feelings of belonging and security; while through the indirect channel, social support can play a positive role in buffering the adverse effects of stressful life events (Ashida & Heaney, 2008). When older people have social networks that are not supportive or that provide assistance and stress at the same time, older people may have negative feelings towards their caregivers. The quality of the relationship between a potential caregiver and a care recipient is an important determinant of the quality of the caregiving, and of the psychological well-being of both sides (Montgomery et al., 2007; Stuifbergen et al., 2008). This means that receiving care from a close family member and a loved one may lead to a better connection and reinforce the relationship between the older person and the family member, and may thus have a positive influence on the care recipient’s subjective well-being. In contrast, receiving support from a person whom the recipient dislikes, does not respect, or is in a conflict with may reduce the recipient’s psychological well-being.
In their study on disablement and the moderating effect of the quality of relationships on older adults’ emotional well-being, Carr et al. (2017) found that the severity of the impairment affected older adults’ well-being levels, with the effect being stronger on the emotional lives of women than of men. Their results also showed that support received from a spouse was positively associated with subjective well-being among older women with severe disabilities. Surprisingly, they found that receiving emotional support from a partner increased the negative effects of severe impairment among older men, and thus had no buffering effects. They also found that among men only, the negative impact of disablement on subjective well-being was amplified when the relationship quality was poor. Analogous results were obtained by Thomas (2010), who showed that receiving help from a spouse and siblings enhanced the subjective quality of life of older people. Moreover, there is evidence that the quality of relationships plays a significant role in predicting the quality of life of older people. For example, Warner and Adams (2016) found that a deterioration in marital quality contributed to a higher level of loneliness among older women and men without disabilities. The results obtained by Djundeva et al. (2015) showed that the relationship between the amount of support received from adult children not living in the same household and depression levels among their older parents was U-shaped. This means that for older adults with severe disabilities, receiving a little help was better than not being cared for at all, while receiving more frequent filial care was positively associated with depression symptoms. Moreover, this effect was found to be larger for women than for men. Similarly, Silverstein et al. (1996) demonstrated that for single older adults with low expectations of help, receiving more support from adult children increased positive feelings at first, and then reduced these feelings thereafter. Thomas (2010) also found that obtaining aid from adult children was associated with lower subjective well-being. In addition, the effect of receiving instrumental support from other kin (apart from a spouse) and friends has been shown to worsen the effects of health deterioration, and to increase levels of loneliness (Warner & Adams, 2016). Moreover, other analyses have found that the amount of help people receive from their informal networks has an indirect negative impact on their self-assessed health status through the effect on their psychological morale (Stoller, 1984). Similarly, Seeman et al. (1996) found that a greater frequency of instrumental support was associated with a significantly increased risk of ADL limitations among men and women (but the results were not significant for women). The authors explained their findings by citing the loss of confidence of the care recipient, who may have stopped believing in his/her ability to do things independently. This perception may have decreased the person’s fitness, or the individual’s fitness may have remained stable, but his/her answers to questions on daily limitations may have been adjusted to reflect a lower level of self-confidence. Likewise, Silverstein et al. (1996) showed that the support older parents receive variously improves or damages their psychological well-being depending on its volume, the marital status of the parent, and the strength of their expectations for support. The results of an analysis of the impact of intra- and intergenerational care on different measures of subjective well-being showed that intragenerational care was negatively related to cognitive well-being among older women, and positively related to mental health (mostly among older men) (Hajek & König, 2016). The findings of a longitudinal analysis showed that receiving informal care was negatively related to life satisfaction among older people in Germany (Zwar et al., 2019).
An important feature of social relations and support exchange is reciprocity, which is essential for the durability of a relationship over the life course (Evandrou et al., 2018), mortality (Brown et al., 2003), psychological well-being (Fyrand, 2010; Thomas, 2010; Wahrendorf et al., 2006), and depression levels (Wolff & Agree, 2004). The perception among older adults that a relationship was balanced or underbalanced was found to be associated with lower mental distress and depression levels, while the opposite relationship was observed for those who felt that the support they received was above expectations (Fyrand, 2010). Thus, the authors found when people were receiving help they were unable to reciprocate/return, their quality of life was lower than in the other two situations. They also found that reciprocity shaped the exchange relationship between older dependent parents and their adult children, with parents being more likely to financially support those children who were caring for them (Leopold & Raab, 2011).
Another essential issue is whether the support received meets the needs of the care recipient. Receiving help that adequately responds to a person’s desires was found to be more positively related to positive feelings than receiving support that does not satisfy these needs (Maisel & Gable, 2009). In addition, whether the care received is accompanied by emotional support appears to be important. It may be assumed that the provision of simple instrumental help with little or no social interaction and emotional support signifies the quality of the relationship between the caregiver and the care recipient is low, and may therefore be detrimental for the subjective well-being of both sides.
Furthermore, it has been shown that perceived support – i.e., the perceived readiness of members of a social network to provide emotional, financial, or instrumental support – is positively related to well-being (Ashida & Heaney, 2008; Auslander & Litwin, 1991; Berg et al., 2006, 2009; Bowling & Browne, 1991; Landau & Litwin, 2001; Tomini et al., 2016). For instance, Landau and Litwin (2001) found that the supportiveness of named social network members, as measured by the extent to which they were perceived as being available to provide assistance on a number of tasks (socialising, practical assistance, financial aid, advice, emotional support, being a confidant, and talking about the Holocaust) was positively associated with subjective well-being. Similar results were found for the link between network supportiveness and health (Ashida & Heaney, 2008; Bowling & Browne, 1991; Gallo, 1984).
Care Arrangements for Older People and Subjective Well-Being in European Countries
Care arrangements for older people are described by legal regulations related to the organisation of and the responsibility for providing care to older people, the institutions that provide care services, and the sets of norms that refer to care for older people in a given society (Pfau-Effinger, 2005). The prevalence of formal and informal care, as well as the direction and the intensity of intergenerational financial and non-financial transfers, have been used to classify countries and regions into different care regimes. The care arrangements for older adults differ significantly across European countries. Geographically, there is a clear north–south division between countries characterised by weak family ties and by strong family ties (Bolin et al., 2008; Reher, 1998). The strength of family ties is usually discussed using categories of familial loyalty, obedience, and authority; or based on demographic models of intergenerational co-residence (living arrangements) and models of support for older people (Bolin et al., 2008; Kohli et al., 2005). Co-residence with other people is an important source of informal care for older people (especially in Southern European countries), while institutional services are an important source of formal care (especially in Northern European countries). Europe has been divided into the Northern, Southern, and Continental regimes. Compared to Northern Europe, the Southern European countries are characterised by less frequent but more intense transfers from parents to children, more frequent co-residence of parents and children, and more informal care provided within families (Albertini & Kohli, 2013; Albertini et al., 2007; Attias-Donfut et al., 2005; Bolin et al., 2008; Brandt et al., 2009; Damiani et al., 2011; Haberkern & Szydlik, 2010). The Continental European countries are positioned somewhere in between these two regimes.
Thus, formal and informal care can be seen as interdependent, as the family members’ decisions about their level of engagement in care provision depends on the individual characteristics of the caretakers and caregivers, the family structure, the cultural norms, and the welfare state institutions (Haberkern & Szydlik, 2010; Haberkern et al., 2015). Bolin et al. (2008) argued that the regions with strong family ties (Southern Europe) are more likely to substitute formal care with informal care. The level of engagement of the family and the state (or the market) differs between countries depending on their care arrangements (Anttonen & Sipilä, 2005; Pfau-Effinger, 2005; Saraceno & Keck, 2010). Even though the welfare state has expanded in Europe, filial obligation norms are prevalent in Western European countries; however, the strength of support follows a North–South gradient (Daatland & Herlofson, 2003), and the differences between countries are greater for the profiles than for the levels of solidarity between the generations (Lowenstein & Daatland, 2006).
Public spending on long-term care may also condition the provision of and the access to formal care services, and may moderate the relationship between receiving care and subjective well-being among older adults. In recent decades, the European countries with the highest expenditures on long-term care have been in Northern (Norway, Sweden, Denmark) and Western Europe (Belgium, Netherlands, Germany, Switzerland), while the European countries with the lowest expenditures have been in Southern (Italy, Greece) and Central Europe (Poland, Bulgaria, and Slovakia) (European Commission, 2021). Thus, in general, it may be observed that in the more generous welfare states, the levels of informal care provided to older people are less demanding and less intensive than those provided in countries where public expenditures on formal/institutional care for older people are low, and where caregivers are forced to provide more specialised care because of the underdeveloped care services (Dykstra, 2018). Therefore, in countries where the provision of formal care services is insufficient, older people often have limited access to such services, which may lead them to rely on informal care. Older people might have ambiguous emotions about relying on informal care. In some cases, they may feel uncomfortable about being dependent on help provided by other people because they worry that they are burdening their caregivers. In other cases, older people may have to rely on the help of individuals they do not like, which could have an adverse effect on their subjective well-being. To sum up, these patterns may have varying effects on the subjective quality of life of both caregivers and care recipients in different countries depending on their welfare states and care regimes.
European countries differ with respect to the subjective well-being of their citizens, including their older subpopulations (Cordero et al., 2017; Ferring et al., 2004). In general, a clear-cut division between Northern and Western European countries and countries in Southern and Central Europe has been found (von dem Knesebeck et al., 2005). Similar results on late-life mental health were reported by Ploubidis and Grundy (2009), who showed that the countries with the lowest depression levels and the highest well-being levels were the Scandinavian countries, the Netherlands, and Austria, followed by Germany and France, and then by Spain, Italy, and Greece. Some interesting insights into the relationship between the welfare state typology, the support network, and subjective well-being among older people in Europe was provided by Requena (2010), who used the typology of welfare states proposed by Anttonen and Sipilä (1996) extended by the former socialist countries in Eastern Europe. They found that liberal welfare regimes contributed the most to the subjective well-being of older people, followed by conservatist regimes. The authors explained their findings by noting that in liberal systems, trust in people is more important for subjective well-being. They also explained the significant contribution of conservative systems to the SWB of retired people by citing the provision of compulsory social security and retirement schemes, and the marginal role of the market in these countries.
Bearing in mind the above considerations, we argue that little is known about the differences between European countries with respect to the relationship between receiving informal support and subjective well-being among older adults. In this paper, we aim to fill this gap by investigating whether the type of informal care and the amount of care received affect the subjective well-being of older people, and whether these effects amplify the differences in the quality of life of older adults across European countries. In this context, it is worth referring to the results of Djundeva et al. (2015) cited earlier in this paper, which showed that the U-shaped relationship between the amount of instrumental support received from non-co-resident children and the depression levels among older adults were similar in all of the analysed European countries, regardless of their care regimes for older people.
Thus, in this paper, we address the following research questions: (1) What is the relationship between receiving informal care and subjective well-being among older adults? (2) What is the association between the amount of support received and subjective well-being among older individuals? (3) Does the care arrangement type affect these relationships differently across Europe? (4) Do these relationships differ by sex?
Data and Analytical Strategy
We used the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) (Börsch-Supan, 2017; Börsch-Supan et al., 2013; Malter & Börsch-Supan, 2017). The original database contains information on more than 68,000 respondents aged 50 and older and their partners (and 36,600 respondents aged 65 +) who were interviewed in 2015. For the purposes of our analyses, the sample was limited to older individuals aged 65 and older living in private households, and to 17 European countries: Austria, Germany, Sweden, Spain, Italy, France, Denmark, Greece, Switzerland, Belgium, the Czech Republic, Poland, Luxembourg, Portugal, Slovenia, Estonia, and Croatia. We kept the observations with non-missing values for all variables in the models. The final sample included 30,179 respondents (13,942 males and 16,237 females).
We captured subjective well-being using the quality of life measure based on Maslow’s need pyramid, known as CASP-12, which stands for control, autonomy, self-realisation, and pleasure. SHARE implemented a 12-question version of the original CASP-19 questionnaire (von dem Knesebeck et al., 2005). The most important characteristic of the CASP measure is that it is based not on an individual’s subjective evaluation of his/her life satisfaction, but on his/her assessment of the main domains of life that are considered important for achieving positive emotional states: control, autonomy, self-realisation, and pleasure. The CASP index is based on responses to 12 questions about the person’s experiences over the past four weeks. Thus, it may be assumed that it captures a temporary or short-term assessment of the respondent’s quality of life. The answers are measured on the Likert scale: often, sometimes, rarely, or never. The obtained dependent variable ranges from 12 to 48, with higher values indicating higher well-being.
We controlled for the basic socio-demographic characteristics of the respondents (such as sex, age, marital status, education level) and the economic situation of the household (subjective financial situation). For the purposes of our analysis, we incorporated into the models different subjective and objective measures of health status, including the presence of chronic diseases, as well as the respondent’s subjective evaluation of his/her health, disability, number of limitations in activities of daily living (ADL) and in instrumental activities of daily living (IADL), hand grip strength, and depression levelFootnote 1 (denoting the respondent’s mental health status). We also included a binary variable describing the use of formal care services (no/yes). It should be noted here that this variable incorporates all of the information gathered about the type of formal care received, as positive answers to single questions were rare.
In order to capture how the informal care received and its quantity was associated with an individual’s subjective well-being, a set of variables that captured different types of support received were added to the models. Although this dataset was longitudinal, we could employ data from its 6th round only, as it was not possible to derive comparable information on the informal care received. In the previous waves, the information on care received from someone outside the household was collected for all members of the household, and not only for the respondent. In Model 1, we included a variable that captured the informal care that was regularly received (almost daily) using two categories: 1. no (reference category), 2. yes. This variable was based on information gathered on the regular personal support received within and outside the household (all cases of rare or occasional support were included in the first category). In Model 2, we introduced a variable that described the respondent’s perception of the amount of help received, which was based on two questions. The first question was: “Thinking about the ADL/IADL activities that you have problems with, does anyone ever help you with these activities?” (with the answers “yes” and “no”). The next question was posed to the respondents who gave a positive answer to the question of whether the care they were receiving was meeting their needs. The first question was posed to the individuals who reported that they had at least one limitation in ADL/IADLFootnote 2 or in mobility activities.Footnote 3 Thus, the final variable had the following categories: 1. no need of care (reference category), 2. all the time, 3. usually, or 4. sometimes or hardly ever. Moreover, the sometimes or hardly ever category included respondents who reported having at least one limitation in ADL/ IADL/ mobility activities, and who said that they did not receive help; while the no need of care category also included the respondents who had no ADL/ IADL/ mobility limitations, and did not answer the first question (missing values). It should be noted that the two variables we used to evaluate informal care in our models were based on different questions. In model 1, informal care was assessed on the basis of responses to questions on the source of the care received and its regularity, with informal care being defined as help that was received almost daily. In model 2, this variable denoted only whether a person was receiving help (without specifying the frequency). Thus, this variable also covered cases in which support was given only rarely. However, as this variable was related to another variable that captured the quantity of the care received (described above), we incorporated it into the models. Additionally, in some countries, this variable captured formal care.
Descriptive statistics for all of the dependent, control, and explanatory variables may be found in Table 4 in the annex.
As we assumed that the dependent variables could be treated as continuous, we estimated a set of OLS regression models 1 and 2 for the total sample, for groups of countries, and for both sexes separately (with robust standard errors).Footnote 4 In addition, to verify whether the relationship between informal care and SWB was moderated by formal care, we estimated the regression model (1a), which incorporated an interaction term between these two types of care. We divided the 17 analysed European countries into four groups according to their geographical positions, which, generally speaking, also reflected their care arrangements for older people described earlier: Nordic (Sweden, Denmark), Western (Austria, Belgium, Germany, France, Luxembourg, Switzerland), Central and Eastern (the Czech Republic, Poland, Slovenia, Estonia, Croatia), Southern (Spain, Italy, Greece, Portugal).
We start by presenting the descriptive results for dependent variables by the group of countries, and by the levels and the amounts of informal care received (Figs. 1 and 2). In general, there were substantial differences in the subjective well-being of older people across the analysed groups of countries. The level of well-being was found to be highest in the Nordic countries, followed by in the Western European countries, then by in the Central and Eastern European countries, and, finally, by in the Southern European countries, where the SWB of older people was the lowest. In addition, the informal care received differentiated the level of well-being, which was, in general, lower for the respondents who were receiving any type of informal support, which may be linked to their worse health status. The subjective well-being of the older people was associated with the perception of the quantity of informal care received. In general, we found that as expected, the lower the amount of support people received, the lower their subjective well-being levels. The biggest differences were observed in the Southern European countries.
The parameter estimates for most variables incorporated into the models were significant at the level of 0.01 (Tables 1, 2, and 3). As for the key explanatory variables, the estimates for model 1 for both sexes suggest that in all of the analysed countries, the SWB among older people did not differ depending on whether they were receiving regular informal care (Table 1). However, the estimates for groups of countries showed that receiving regular informal care was positively related to life satisfaction among older respondents in the Nordic countries, although this result did not hold in separate models for women and men. In addition, receiving informal help was found to be negatively associated with SWB among older men, especially those living in Southern European countries. The outcomes for women turned out to be insignificant. For formal care, our estimates showed that it was negatively related to subjective well-being only for older people in the Northern European (NE) and Central and Eastern European (CEE) countries, and was significant only for women in the NE countries.
The results for model 1a with interaction effects between formal and informal care showed that receiving regular informal care was negatively related to SWB only among older men, especially among those living in Southern European countries (Table 2). The results also showed that receiving formal care lowered CASP-12 levels only among older adults in Nordic countries, especially among older women. It is worth emphasising that in the model for females (all countries), the estimates suggested that there was a positive relationship, but it turned out to be insignificant for groups of countries (except for the NE countries). In addition, receiving both types of care (formal and informal) was found to be negatively associated with lower CASP-12 levels in CEE countries, especially among women. In contrast, a significant positive relationship was found for males living in the NE countries.
The results of model 2 demonstrated that the perception of the amount of help received affected subjective well-being (Table 3). In particular, receiving help that met their needs was negatively associated with SWB in all groups of countries and for both sexes, except in the Nordic countries. Similarly, older adults who considered the care they received as insufficient (i.e., meeting their needs usually/ sometimes or hardly ever) reported a lower subjective quality of life than individuals who did not require help in all groups of countries and for both sexes. It is worth mentioning that receiving formal care was positively related to SWB among older women in Southern European countries, and negatively related to SWB among women in Nordic countries.
Conclusion and Discussion
The aim of this paper was to investigate the relationship between receiving informal care and the perception of the amount of care received and subjective well-being among people aged 65 years and older in selected European countries, as this topic has rarely been covered in previous research (Hajek & König, 2016; Zwar et al., 2019). Moreover, we intended to analyse whether this relationship differed between selected groups of European countries that differ with respect to their care arrangements for older people. Our results showed that receiving formal and informal support was indeed related to the subjective well-being of older people. First, we found that receiving formal care was negatively related to the subjective well-being of older people in Northern European and Central and Eastern European countries. Second, we found that receiving regular informal care was associated with higher CASP-12 levels in Northern European countries (NE), which may have reflected other emotional advantages of having frequent contact with family members/ close friends, etc. Moreover, as we stated earlier, the informal care provided in those countries may be less demanding, and might therefore tend to provide different types of support (e.g., emotional). Thus, in these countries, having additional contacts with other people may enhance the subjective well-being of older people. In contrast, we observed that in the models for males only (for all the countries), receiving regular informal care was related to lower subjective well-being, and especially for males living in Southern European (SE) countries, which was in line with previous findings for Germany (Zwar et al., 2019). Our results may indicate that other characteristics of a caregiver and a care recipient, as well as the quality of their relationship, moderate the effect of receiving care on subjective well-being. It is possible that living with their adult children reduced positive feelings and increased stress levels among the older adults in our sample. Moreover, because formal care services are underdeveloped in some countries, caregiving may be detrimental for carers, which may, in turn, increase the risk of conflicts between family members. Thus, older people may be forced to accept support from family members other than their spouse, which tends to lower their subjective well-being (Allen & Wiles, 2014; Thomas, 2010; Warner & Adams, 2016).
In terms of the relationship between the perception of the amount of care received and subjective well-being, our results revealed that older people who reported that the support they received met their needs all the time had lower SWB levels than those who said they did not need help. Moreover, in almost all of the analysed regions, receiving insufficient support was negatively related to subjective well-being among older people (both men and women).
Thus, with regard to our first research question in this article, we can conclude that receiving informal care mattered for the SWB of older adults (research question 1). However, the relationship between receiving regular informal care and subjective well-being among older people differed between the analysed countries. This association depended on a number of factors, including the group of countries and the sex of the care recipient (research questions 3 and 4), with an especially negative relationship being found for men living in Southern European countries. In contrast, a positive relationship was observed for older people in Nordic countries. Moreover, with regard to the second research question, we found that compared to older people who did not need care, older people who were receiving care that both met their needs and met their needs only sometimes or rarely had a lower subjective quality of life. These findings probably reflect negative emotions related to a person’s health status, and to his/her dependency on the help of other people. We believe that the best explanation for the negative relationship between the informal care received and subjective well-being is the one that was provided by, for example, Seeman et al. (1996), Silverstein et al. (1996), Stoller (1984). These authors argued that receiving informal care has a negative effect on psychological morale, which may lower a person’s self-esteem and confidence in his/her abilities. As the person stops participating in activities, his/her health status and well-being deteriorate. However, this is a hypothesis that should be tested with further research.
Our analytical approach had numerous limitations. For instance, we did not specifically examine the relationship between an older person and his/her main informal caregiver, which would give a clearer picture of the issues we were analysing. As we stated in the literature review, the effects on well-being of receiving help from a spouse differed from those of receiving support from children, other kin, and friends (Allen & Wiles, 2014; Thomas, 2010; Warner & Adams, 2016). As Allen & Wiles put it: “In essence, being a support receiver was acceptable if support was given by the right people for the right reasons” (2014: 680). We estimated similar regression models with explanatory variables describing the source of informal care (within the household, outside the household, and both types), as well as the older person’s relationship with his/her informal caregivers. However, the obtained results were not conclusive due to a relatively small number of cases. Thus, this issue needs further investigation. Furthermore, taking into account other individual characteristics of the caregiver as well as the characteristics of the relationship between the caregiver and the care recipient (such as the quality of the relationship) would broaden our knowledge. In addition, little is known about the duration of the informal support received. The questions on the informal support received within and outside the household referred to a minimum duration of 12 months. However, this length of time seems insufficient, since in many cases the exchange of care may have lasted for many years, possibly with the caregiver changing. The duration of the support received would also have an impact on the subjective well-being of older people (Kroemeke & Gruszczynska, 2016). This gap could be filled by longitudinal survey data. However, given that in the previous waves of the SHARE survey, information on care obtained by individuals outside the household was collected for all members in the household, and not only for the respondent, longitudinal analyses using these data are not possible. We hope that subsequent editions of the survey will provide us with comparable data suitable for exploring this topic more broadly. In addition, controlling for the different types of formal care services received would be helpful in investigating the effects of receiving different types of support on the subjective well-being of older individuals in Europe. However, it is important to keep in mind that in some countries (Southern or Central and Eastern European countries), such support is rather rare, and may therefore be difficult to capture and to analyse in more depth. Furthermore, in this paper, we concentrated on older people living in private households, which means that especially in countries with high institutionalisation rates, a portion of the older people with the worst health status who were living in institutions were excluded from our analysis. Their absence may have influenced our results. Moreover, we approximated the quantity of care received by evaluating whether the help they received met the respondents’ needs. The use of this approach may be debated, since this assessment can be seen as a minimum requirement. Thus, this topic needs further investigation.
To conclude, the informal care received and the amount of care received seem to be important determinants of the subjective well-being of older adults. Thus, as the populations of Europe age, individuals and countries should prepare for increases in the number of older dependent individuals, and for the impact this growing need for care will have on the subjective well-being of both caregivers and care recipients, by supporting the individuals on both sides of this relationship. Additionally, the responsibility of each individual to plan for his/her old age should be underlined, especially in relation to those who would have to support the person if s/he became sick or disabled. In particular, an individual should focus on his/her relationships with his/her spouse and children who are likely to be the main sources of informal care. Research has shown that having high-quality family relationships increases the subjective well-being and life satisfaction of older people (Montgomery et al., 2007), as well as their chances of receiving support (Bromley & Blieszner, 1997; Stuifbergen et al., 2008).
Access to the SHARE data is provided free of charge for registered users through the website www.shareeric.eu/data/.
This variable is based on 12 questions that ask respondents about symptoms related to depression, pessimism, a desire to die, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment, and tearfulness. The possible answers are 0-no and 1-yes. The final variable of the EURO-D scale varies from zero to 12, with higher values signifying greater depression levels.
ADL activities included the following items: 1. Dressing, including putting on shoes and socks; 2. Walking across a room; 3. Bathing or showering; 4. Eating, such as cutting up your food; 5. Getting in or out of bed; 6. Using the toilet, including getting up or down. IADL activities included the following items: 1. Using a map to figure out how to get around in a strange place; 2. Preparing a hot meal; 3. Shopping for groceries; 4.Making telephone calls; 5. Taking medications; 6. Doing work around the house or garden; 7. Managing money, such as paying bills and keeping track of expenses; 8. Leaving the house independently and accessing transportation services; 9. Doing personal laundry.
Mobility activities included: 1. Walking 100 m; 2. Sitting for about two hours; 3. Getting up from a chair after sitting for long periods; 4. Climbing several flights of stairs without resting; 5. Climbing one flight of stairs without resting; 6. Stooping, kneeling, or crouching; 7. Reaching or extending your arms above shoulder level; 8. Pulling or pushing large objects like a living room chair; 9. Lifting or carrying weights over 10 pounds/5 kilos, like a heavy bag of groceries; 10. Picking up a small coin from a table.
Variance inflation factors (VIF) were used to check for multicollinearity. The check revealed small to moderate amounts of multicollinearity, which are usually not a problem.
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This paper uses data from SHARE Waves 1, 2, 3, 4, 5, 6 and 7 (DOIs: 10.6103/SHARE.w1.700, 10.6103/SHARE.w2.700, 10.6103/SHARE.w3.700, 10.6103/SHARE.w4.700, 10.6103/SHARE.w5.700, 10.6103/SHARE.w6.700, 10.6103/SHARE.w7.700), see Börsch-Supan et al. (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982) and Horizon 2020 (SHARE-DEV3: GA N°676536, SERISS: GA N°654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org).
This research was carried out within a project Quality of life of people aged 50 and more in Poland supported by the grant of the Polish National Science Centre [DEC-2012/07/D/HS4/01778].
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The authors declare no conflict of interest.
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Abramowska-Kmon, A., Łątkowski, W. & Rynko, M. Informal Care and Subjective Well-Being among Older Adults in Selected European Countries. Ageing Int (2023). https://doi.org/10.1007/s12126-023-09521-0
- Informal care
- Older adults
- Quality of life
- Subjective well-being
- Quality of care