Health Care Utilization in Germany pp 171-189 | Cite as
How Do Socioeconomic Factors Influence the Amount and Intensity of Service Utilization by Family Caregivers of Elderly Dependents?
Abstract
Objectives
In the course of demographic change, there is both a relative and an absolute increase in countries’ elderly population. Care and support needed by older dependent people are primarily provided by relatives or friends within the home environment. Family caregivers can be supported by specific services aiming to relieve their burden of care. The EUROFAMCARE project provides an overview of the situation of family caregivers of elderly dependents in Europe in terms of the existence, awareness, availability, use, and acceptance of support services. This article provides results of the German survey.
Methods
A total of 1,003 family caregivers were interviewed at home using a standardized questionnaire. Primary caregivers providing at least 4 h of personal care or support per week to a relative aged 65 years or older were included. Data analysis was based on a conditional inference-tree algorithm which embeds tree-structured regression models.
Results
The family caregivers were 54 years on average (standard deviation (SD) = 13.4); 76 % of them were female. The dependent elderly were 80 years on average (SD = 8.3); 69 % of them were women. The number of used service units increased with higher educational status of family caregivers and/or higher perceived burden of care. Less-educated family caregivers with a lower negative impact tend to utilize services less frequently. Regarding the number of different services used, we found interactions between higher dependency and higher education as predictors for service utilization, independently from the intensity of perceived burden by higher educated caregivers. Perceived burden only interacts with lower education.
Conclusions
Policymakers can particularly address predisposing factors to support informal care structures. Increased service utilization is likely when available information and support services are more easily accessible. The potential advantages and benefits of services must be emphasized to increase service utilization by caregivers.
Keywords
Service Utilization Family Caregiver Care Level Care Recipient Male CaregiverReferences
- Andersen RM, Davidson PL (2001) Improving access to care in America: individual and contextual indicators. In: Andersen RM, Rice TH, Kominski EF (eds) Changing the U.S. health care system: key issues in health services, policy, and management. Jossey-Bass, San Francisco, CA, pp 3–30.Google Scholar
- Balducci C, Mnich E, McKee K, et al. (2008) Negative Impact and Positive Value in Caregiving: Validation of the COPE Index in a Six-Country Sample of Carers. The Gerontologist 48:276–286.PubMedCrossRefGoogle Scholar
- Barinaga M (1998) Caregivers need healing, too. Science 282:1031–1032.CrossRefGoogle Scholar
- Barusch AS (1988) Problems and coping strategies of elderly spouse caregivers. Gerontologist 28:677–685.PubMedCrossRefGoogle Scholar
- Bech P (2008) Measuring the dimensions of psychological general well-being by the WHO-5. Quality of Life Newsletter 32:15–16.Google Scholar
- Bolin K, Lindgren B, Lundborg P (2008) Your next of kin or your own career? Caring and working among the 50+ of Europe. J Health Econ 27:718–738. doi: 10.1016/j.jhealeco.2007.10.004.PubMedCrossRefGoogle Scholar
- Brazier JE, Harper R, Jones NM, et al. (1992) Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305:160–164.PubMedCrossRefGoogle Scholar
- Brodaty H, Gresham M, Luscombe G (1997) The Prince Henry Hospital dementia caregivers’ training programme. Int J Geriatr Psychiatry 12:183–192.PubMedCrossRefGoogle Scholar
- Brodaty H, Green A, Koschera A (2003) Meta-Analysis of Psychosocial Interventions for Caregivers of People with Dementia. J Am Geriatr Soc 51:657–664.PubMedCrossRefGoogle Scholar
- Brodaty H, Thomson C, Thompson C, Fine M (2005) Why caregivers of people with dementia and memory loss don’t use services. Int J Geriatr Psychiatry 20:537–546. doi: 10.1002/gps.1322.PubMedCrossRefGoogle Scholar
- Carmichael F, Charles S (2003) The opportunity costs of informal care: does gender matter? J Health Econ 22:781–803. doi: 10.1016/S0167–6296(03)00044–4.PubMedCrossRefGoogle Scholar
- Chiu TML, Eysenbach G (2011) Theorizing the health service usage behavior of family caregivers: a qualitative study of an internet-based intervention. Int J Med Inform 80:754–764. doi: 10.1016/j.ijmedinf.2011.08.010.PubMedCrossRefGoogle Scholar
- DESTATIS (2008) Pressemitteilung Nr. 121.Google Scholar
- Di Rosa M, Kofahl C, McKee K, et al. (2011) A typology of caregiving situations and service use in family carers of older people in six European countries: The EUROFAMCARE study. GeroPsych 24:5–18.Google Scholar
- Fillenbaum GG, Smyer MA (1981) The development, validity, and reliability of the OARS multidimensional functional assessment questionnaire. J Gerontol 36:428–434.PubMedCrossRefGoogle Scholar
- Gräßel E (1996) Körperbeschwerden und Belastung pflegender Familienangehöriger bei häuslicher Pflege eines über längere Zeit hilfsbedürftigen Menschen. Psychother Psychosom med Psychol 46:189–193.PubMedGoogle Scholar
- Gräßel E (1998) Häusliche Pflege dementiell und nicht dementiell Erkrankter. Teil II: Gesundheit und Belastung der Pflegenden. Z Gerontol Geriat 31:57–62.CrossRefGoogle Scholar
- Gräßel E (2000) Warum pflegen Angehörige? Ein Pflegemodell für die häusliche Pflege im höheren Lebensalter. Zeitschrift für Gerontopsychologie & -psychiatrie 13:85–94.CrossRefGoogle Scholar
- Hapfelmeier A, Hothorn T, Ulm K, Strobl C (2012) A new variable importance measure for random forests with missing data. Stat Comput. doi: 10.1007/s11222-012-9349-1.Google Scholar
- Haug MR, Ford AB, Stange KC, et al. (1999) Effect of giving care on caregiver’s health. Research on Aging 21:515–538.Google Scholar
- Heitmueller A, Inglis K (2007) The earnings of informal carers: wage differentials and opportunity costs. J Health Econ 26:821–841. doi: 10.1016/j.jhealeco.2006.12.009.PubMedCrossRefGoogle Scholar
- Hothorn T, Zeileis A (2009) partykit: A Toolkit for Recursive Party-tioning. http://R-forge.R-project.org/projects/partykit/.
- Hothorn T, Hornik K, van de Wiel MA, Zeileis A (2006a) A Lego System for Conditional Inference. The American Statistician 60:257–263. doi: 10.1198/000313006X118430.CrossRefGoogle Scholar
- Hothorn T, Hornik K, Zeileis A (2006b) Unbiased Recursive Partitioning: A Conditional Inference Framework. Journal of Computational and Graphical Statistics 15:651–674. doi: 10.1198/106186006X133933.Google Scholar
- Keady J, Nolan M (1996) Behavioural and instrumental stressors in Dementia (BISID): refocussing the assessment of caregiver need in dementia. J Psychiatr Ment Health Nurs 3:163–172.PubMedCrossRefGoogle Scholar
- Kofahl C, Arlt S, Mnich E (2007) “For Better or for Worse…” Differences and Similarities of Caring Spouses and Other Family Caregivers in the German Survey of the Project EUROFAMCARE. Zeitschrift für Gerontopsychologie & -psychiatrie 20:211–225.Google Scholar
- Kofahl C, Lüdecke D, Döhner H (2009) Der Einfluss von Betreuungsbedarf und psychosozialen Determinanten auf Belastung und Wohlbefinden von pflegenden Angehörigen alter Menschen. Ergebnisse aus der deutschen Teilstichprobe des Projekts EUROFAMCARE. Pflege & Gesellschaft 3:236–253.Google Scholar
- Kurz A (2011) Psychosoziale Interventionen bei demenziell Erkrankten und deren Angehörigen. Versorgungsforschung für demenziell erkrankte Menschen.Google Scholar
- Lamura G, Döhner H, Kofahl C (2008) Family Carers of Older People in Europe. A Six-Country Comparative Study. LIT Verlag, Hamburg.Google Scholar
- Lamura G, Mnich E, Wojszel B, et al. (2006) The experience of family carers of older people in the use of support services in Europe: selected findings from the EUROFAMCARE project. Z Gerontol Geriatr 39:429–442. doi: 10.1007/s00391-006-0416-0.PubMedCrossRefGoogle Scholar
- Lee R (2011) The outlook for population growth. Science 333:569–573. doi: 10.1126/science.1208859.PubMedCrossRefGoogle Scholar
- Lüdecke D, Mnich E, Kofahl C (2008) Characteristics of the sample. In: Döhner H, Kofahl C, Lüdecke D, Mnich E (eds) Family Care for Older People in Germany. Results from the European Project EUROFAMCARE. LIT Verlag, Hamburg, pp 107–124.Google Scholar
- MacDonald A, Dening T (2002) Dementia is being avoided in NHS and social care. BMJ 324:548.PubMedCrossRefGoogle Scholar
- Mahoney FI, Barthel DW (1965) Functional Evaluation: The Barthel Index. Md State Med J 14:61–65.PubMedGoogle Scholar
- McKee K, Philp I, Lamura G, et al. (2003) The COPE Index—a first stage assessment of negative impact, positive value and quality of support of caregiving in informal carers of older people. Aging & Mental Health 7:39–52.CrossRefGoogle Scholar
- McKee K, Balducci C, Krevers B, et al. (2008) The EUROFAMCARE Common Assessment Tool (CAT)—Item and scale development and description. In: Lamura G, Döhner H, Kofahl C (eds) Supporting Family Carers of Older People in Europe. Empirical Evidence, Policy Trends and Future Perspectives. LIT Verlag, Hamburg, pp 49–73.Google Scholar
- Mestheneos E, Triantafillou J (2005) Supporting Family Carers of Older People in Europe—The Pan-European Background Report. LIT Verlag, Münster.Google Scholar
- Mittelman MS, Ferris SH, Shulman E, et al. (1996) A family intervention to delay nursing home placement of patients with Alzheimer disease. A randomized controlled trial. JAMA 276:1725–1731.PubMedCrossRefGoogle Scholar
- Nagy K, Reiczigel J, Harnos A, et al. (2010) Tree-Based Methods as an Alternative to Logistic Regression in Revealing Risk Factors of Crib-Biting in Horses. Journal of Equine Veterinary Science 30:21–26. doi: 10.1016/j.jevs.2009.11.005.CrossRefGoogle Scholar
- Pfaff H (2011) Pflegestatistik 2009. Pflege im Rahmen der Pflegeversicherung—Deutschlandergebnisse. 31.Google Scholar
- Pinquart M, Sorensen S (2003) Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta analysis. J Gerontol B Psychol Sci 58B:453–460.Google Scholar
- R Development Core Team (2009) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.Google Scholar
- Rauch U (2000) Unnahbare Helfer: Pflegende Angehörige. Pflegen ambulant 11:24–28.Google Scholar
- Rothgang H, Borchert L, Müller R, Unger R (2008) GEK-Pflegereport 2008: Schwerpunktthema: Medizinische Versorgung in Pflegeheimen. Asgard, Sankt Augustin.Google Scholar
- Schneekloth U, Wahl H-W (2005) Möglichkeiten und Grenzen selbständiger Lebensführung in privaten Haushalten (MuG III). Integrierter Abschlussbericht. Bundesministerium für Familien, Senioren, Frauen und Jugend, Berlin.Google Scholar
- Schulz R, Beach SR (1999) Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. Journal of the American Medical Association 282:2215–2219.PubMedCrossRefGoogle Scholar
- Shahly V, Chatterji S, Gruber MJ, et al. (2012) Cross-national differences in the prevalence and correlates of burden among older family caregivers in the World Health Organization World Mental Health (WMH) Surveys. Psychol Med 1–15. doi: 10.1017/S0033291712001468.Google Scholar
- Statistisches Bundesamt (2009) Bevölkerung Deutschlands bis 2060: 12. koordinierte Bevölkerungsvorausberechnung. Wiesbaden.Google Scholar
- Statistisches Bundesamt (2011) Pflegestatistik 2009. Statistisches Bundesamt, Wiesbaden.Google Scholar
- Strasser H, Weber C (1999) On the Asymptotic Theory of Permutation Statistics. Mathematical Methods of Statistics 8:220–250.Google Scholar
- Taggart L, Truesdale-Kennedy M, Ryan A, McConkey R (2012) Examining the support needs of ageing family carers in developing future plans for a relative with an intellectual disability. J Intellect Disabil 16:217–234. doi: 10.1177/1744629512456465.PubMedCrossRefGoogle Scholar
- World Health Organization (1998) WHO Info Package: Mastering depression in primary care (Version 2.2). WHO, Geneva.Google Scholar