| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
| ||||||||||||||||||||||||
RESEARCH ARTICLE |
1 Brown University Center for Gerontology and Health Care Research, Providence, Rhode Island.
2 Maryland Population Research Center, University of Maryland, College Park.
Address correspondence to Julie Lima, MPH, PhD, Brown University Center for Gerontology and Health Care Research, 2 Stimson Avenue, Box G-S1, Providence, RI 02912. E-mail: Julie_Lima{at}brown.edu
 |
Abstract |
|---|
 TOP Abstract MethodsResultsDiscussionReferences |
|---|
Methods. We examined 1,218 married adults aged 52 and older from the 2000 wave of the Health and Retirement Study who received impairment-related help with at least one activity of daily living. We examined the differential likelihood that spouses served as primary caregiver and the hours of care provided by spousal primary caregivers by life stage.
Results. We found that late middle-aged care recipients were more likely than their older counterparts to receive the majority of their care from their spouse but received fewer hours of spousal care, mostly when spouses worked full time. Competing demands of caring for children or parents did not affect the amount of care provided by a spouse.
Discussion. Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age.
Key Words: Age differences • Life stage • Caregiving • Spouses • Activities of daily living
IN 2000, approximately 20% of Americans aged 55 to 64 had activity limitations that were caused by chronic conditions (Pastor, Makuc, Reuben, & Xia, 2002
). Five percent of this age group, approximately 1.4 millions Americans, reported needing assistance with daily activities as a result of a severe disability (Steinmetz, 2006). The aging of the baby boom generation along with recent trends in morbid obesity and resultant chronic conditions ensure an increase in disability among people in late middle age in the near future (McTigue et al., 2006), and recent studies have suggested that morbidity and disability prevalence are on the rise among younger groups as well (O'Rand, 2005). Yet despite these trends, there is little information on care arrangements for this growing population of adults—specifically, people who require assistance during the period of late middle age, the "transition" phase between middle age and the elder years, when activity limitations associated with a chronic condition escalate sharply (Pastor et al., 2002).
Despite substantial need, there are reasons to expect that there may be less help available to people in late middle age (i.e., those 50–64) who are "prematurely" in need of help compared to their elderly counterparts—young old (65–74) and older old adults (75 and older). What little researchers do know about the care networks of nonelderly persons is that they rely less on formal (i.e., paid or subsidized) care than those of older persons (Laplante, Harrington, & Kang, 2002). Access among nonelderly persons to Medicare, Medicaid, and the safety net of federal and state services established to provide home care, nutrition, and transportation services to those in need is limited. Medicaid, a government-funded insurance program for the poor and disabled and the primary provider of institutional and community-based long-term-care services, is only available to individuals in late middle age who meet both strict financial and disability criteria, and benefits vary considerably by state (Iezzoni, 2003). Furthermore, once qualified for Medicaid, there is a 2 year waiting period before an individual is eligible for Medicare benefits (Centers for Medicare & Medicaid Sevices, n.d.; Moon, 1996). Most middle-aged persons with chronic disease and disabilities do not meet these conditions.
Consequently, persons who require care prior to age 65 rely predominantly on informal care, that is, care provided by family members and friends, most of whom are also of working age and juggling multiple work and family obligations. More specifically, spouses of adults with care needs in late midlife are likely to bear the majority of caregiving responsibility, because nearly 70% of the general population aged 55 to 64 is married (U.S. Census Bureau, 2007).
Competing obligations may jeopardize the amount of care that spouses can provide to their partners in late midlife. Spousal caregivers to late middle-aged adults are more likely than older spousal caregivers to be dependent on continued employment to finance future retirement, access health insurance, cover living expenses, and fund their children's college education. Furthermore, many spousal caregivers in late middle age may find themselves the sole financial provider of the family as health problems and disability may limit their partners' ability to work. Unlike older spousal caregivers, those in late midlife are also part of the "sandwich generation," that is, individuals aged 45 to 64 who have children younger than 25 living at home and who are also caring for elderly parents (Williams, 2004).
Using data from the 2000 wave of the Health and Retirement Study (HRS), we aimed to investigate life-stage differences in both care arrangements and amount of help received by caregiving spouses between the late middle-aged and older populations with functional limitations. To our knowledge, this is the first study to focus specifically on the particular challenges that couples in late midlife face when one member requires care.
Who Provides Care
An extensive body of research affirms that families provide the bulk of care to frail elderly persons, with spouses serving as the primary caregiver when available (e.g., Jette, Tennstedt, & Branch, 1992; Kemper, 1988; Stone, Cafferata, & Sangl, 1987; Wolff & Kasper, 2006). Primary caregivers are those caregivers who provide the most care to an individual in need. Although specific operationalization varies from study to study, researchers most often designate the primary caregiver either by asking the care recipient directly who helps most, or by comparing the amount of time spent caregiving across all caregivers in a network. Like the more general caregiving literature, most of what researchers know about spousal caregiving in particular comes from studies on the elder population. A recent study by Wolff and Kasper using the National Long-term Care Survey and Informal Caregiver Survey provided a comprehensive view of spousal care for individuals 65 and older who received care. The authors found that when present, spouses served as the primary caregivers to their partners and provided more hours of care on average in a given time period than any other primary caregiver type. Two thirds of spousal primary caregivers to elderly adults were sole caregivers. However, competing demands such as care for dependent children and work obligations were minimal among these spousal caregivers. Less than 5% of spousal primary caregivers to elderly adults had children younger than 15 in the household, and only 8% of these spousal primary caregivers worked for pay. This seems unlikely to be the case for the spousal caregivers for nonelderly adults.
Social support theory would suggest that late middle-aged adults in need of help would rely on family members and friends in a similar order of preference, obligation, and/or availability as older adults (Messeri, Silverstein, & Litwak, 1993). In general, the strongest tie between two individuals is the tie between a married couple, followed by the tie between parents and children, siblings, other relatives, and finally nonrelatives (Rossi & Rossi, 1990). Though one might expect that couples in late middle age would be more likely to have children at home to provide for a sick parent while the other parent worked, children and young adults assume caregiving roles only under very specific circumstances and represent only a very small proportion of caregivers overall (Aldridge & Becker, 1999; Fruhauf, Jarrott, & Allen, 2006).
Spouses, therefore, are likely to be the primary caregivers to late middle-aged adults in need, whether they are employed or not. The findings of Wolff and Kasper (2006) painted a positive view of spousal caregiving for elderly adults, with limited obligations interfering with the provision of care. This depiction, as we discuss later, is clearly not representative of the experience of spousal caregivers to care recipients younger than 65.
Competing Family Obligations
Life stage affects spousal availability to provide care in terms of the likelihood of having dependent children or elderly parents to care for in addition to the ailing spouse. As Wolff and Kasper (2006) demonstrated, there were few spousal caregivers to adults aged 65 and older who had children younger than 15 living in the household. It is estimated that 17% of caregivers (not necessarily spousal caregivers) aged 55 to 64 have children younger than age 18 compared to only 2% of those 65 and older (National Alliance for Caregiving and AARP, 2004). Additionally, younger groups are more likely than older groups to have living parents. According to a recent study, approximately 38% of women aged 55 to 63 have a living parent (Henretta, Grundy, & Harris, 2001). Thus, many women in late middle age are potentially caring for both children and parents simultaneously (Grundy & Henretta, 2006). Whether these additional family obligations have a negative impact on the provision of care to a spouse is unknown.
Employment and Caregiving
There is a large literature that examines the relationship between employment and caregiving (e.g., Dentinger & Clarkberg, 2002; Ettner, 1995b; Henz, 2006; Pavalko & Henderson, 2006). Much of it focuses on the employment status of working-age adults (primarily women) providing care to elderly parents, and when nonelderly disabled persons are included as care recipients the relationship between the caregiver and care recipient is not generally emphasized (Ettner, 1995a, 1995b; Henz, 2006; Pavalko & Artis, 1997; see Dentinger & Clarkberg, 2002, for an exception). The literature indicates that both employment and caregiving suffer from competing demands. The struggle to balance caregiving and work obligations costs families billions of dollars in lost wages each year (Harrington Meyer, 2005; Wakabayashi & Donato, 2005). Conversely, although employment does not necessarily lessen the likelihood of becoming a caregiver to an elderly parent (Pavalko & Artis, 1997), it reduces the amount of care provided compared to those who do not work (Doty, Jackson, & Crown, 1998).
Although some women who provide care to their parents reduce work hours or leave the labor force altogether, spousal caregivers in late middle age may be less likely to consider those options. Private health insurance is the dominant form of health insurance for those younger than 65 and is largely tied to the continued employment (often full time) of a family member, as unsubsidized coverage is prohibitively expensive (Harrington Meyer, 2005). If one spouse is unable to work or to work full time, the other may have no choice but to continue to work full time to secure health insurance for the family. Even if the spouse who requires care does qualify for public insurance, neither Medicare nor Medicaid extends that coverage to the partner or dependents.
Premature exits from the labor force also have a significant negative impact on income security (Harrington Meyer, 1996; Pavalko & Henderson, 2006; Wakabayaski & Donato, 2005). Not only does leaving a job because of illness or caregiving responsibilities reduce the immediate flow of income to meet day-to-day expenses, but the election of early receipt of Social Security benefits prior to the full retirement age permanently reduces the amount an individual is eligible to receive by as much as 30% (Social Security Administration, n.d.). Those younger than 65 must certainly weigh the pros and cons of caregiving against the short- and long-term consequences of premature exits from the labor force. With large increases in life expectancy over the latter half of the 20th century, even those 65 to 74 must consider the possibility of living another 15 to 30 years. Finding a balance between provision of adequate amounts of care and present and future household financial security is particularly salient for spousal caregivers in midlife.
In no other caregiver–care recipient dyad is the financial well-being and health insurance status of both members so intimately connected as when the caregiver is the spouse. As such, the commitment to and need for employment may differ substantially for a spouse compared to another type of caregiver. Because the option to reduce work hours or leave the workforce altogether may not be feasible, and in some instances may be completely untenable, a shortfall in the amount of care provided to a disabled spouse is a likely consequence. To our knowledge, however, no study has specifically addressed the association between employment and hours of care provided to a spouse who requires care prior to eligibility for Medicare and Social Security.
Although we expected that the vast majority of spouses would assume the role of primary caregiver to their partner regardless of life stage, we hypothesized that there would be significant life-stage differences among individuals with similar levels of disability and associated need for care in the amount of care provided such that younger care recipients would receive less care from their spouses than older care recipients. We hypothesized that these differences would be explained in large part by life-stage differences in labor force participation and, to a lesser extent, by family obligations to other generations. We tested these hypotheses using three life stages: 52 to 64, considered here to be late middle age; 65 to 74, young old; and 75 and older, older old. Though late middle-aged adults were of most immediate concern, we considered the young-old adults to be a transitional group—eligible for Medicare, aging services, and Social Security benefits, yet still more likely to be working and have other dependents than older old adults.
|
METHODS |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
). We used the 2000 wave, in which extensive caregiving information for spousal caregivers was available. Because of this, our youngest group started at age 52, not 50.
Samples
Of the 18,149 individuals representative of the civilian noninstitutionalized U.S population aged 52 and older in the 2000 HRS, 2,259 respondents reported difficulty performing and as a result received assistance with at least one activity of daily living (ADL) or instrumental ADL (IADL). ADLs included walking, dressing, eating, bathing, toileting, and getting in and out of bed; IADLs included managing money, preparing meals, getting groceries, using the telephone, and taking medications. Questions were worded in such a way as to limit any inherent gender bias in responses to IADL questions (see Walker, Pratt, & Eddy, 1995). Of the 2,259 who received assistance with one or more ADL or IADL because of difficulty, 1,218 were married at the time of the survey and composed the analytic sample for this research. We weighted all reported statistics to be representative of the noninstitutionalized population aged 52 and older, though reported numbers of cases refer to the unweighted sample.
Measures
Outcomes
We examined two main outcomes. Among the 1,218 married respondents who received at least a minimum of care, the first outcome was whether their spouse served as their primary caregiver. The second outcome was the number of hours of care those spousal primary caregivers (n = 1,001) provided in the past month.
Respondents could name multiple caregivers. Six percent of all caregivers were missing a measure of hours of care. This was because the respondent did not provide the number of days per month that the caregiver helped out or did not provide the number of hours per day. To retain cases, we used multiple hot-deck imputation stratifying by life stage and the relationship of the caregiver to the care recipient to impute missing values (Kalton & Kasprzyk, 1986). We then assigned primary caregiver status to the person who provided the most hours of care in the month prior to the survey.
Care recipient characteristics
Life stage, measured here as age groups, was the key characteristic of interest. Though we used age as a proxy for life stage, the two are not entirely interchangeable. Life stage is tied not only to chronological age but also to societal trends, and so the timing of our data (2000) is important to remember. As we previously mentioned, we divided life stage into three groups: those 52 to 64 (38%, SE = 1.9%), 65 to 74 (27%, SE = 1.6%), and 75 and older (36%, SE = 1.5%). We refer to them, respectively, as late middle age, young old, and older old throughout.
We included as controls a number of care recipient characteristics that differ by age and are also associated with the receipt of care and thus potential confounders of the relationship of life stage and community-based care. They were gender (Allen, 1994; Katz, Kabeto, & Langa, 2000), race/ethnicity (Stommel, Given, & Given, 1998; S. P. Wallace, Levy-Storms, Kington, & Andersen, 1998), education (Desai, Lentzner, & Weeks, 2001), enrollment in Medicaid, current work status, income, and several measures of disease and morbidity.
Similar to the technique used in Katz and colleagues (2000), total household income was a five-category variable that divided the total household income for the entire HRS sample into quintiles. We measured functional impairment by counts of the number of ADLs (range = 0–6) and IADLs (range = 0–5) the care recipient reported difficulty performing, and cognitive impairment was a dichotomous indicator defined by a rating given by the interviewer as the reason for a proxied interview.
We controlled use of a wheelchair, because the use of more complex assistive devices such as wheelchairs (compared to canes) is a function of disability severity (Allen, Foster, & Berg, 2001). Other measures to further control for severity were the number of nights a respondent spent in the hospital in the 2 years prior to the survey, and the number of times in the month prior to the interview that the respondent spent more than half of the day in bed because of a health problem. Finally, we controlled the number of medical conditions, including heart condition, diabetes, stroke, lung disease, cancer, arthritis, high blood pressure, and psychiatric disorder, a measure that served as a further measure of comorbidity (R. Wallace & Herzog, 1995).
Spousal characteristics
The HRS is unique because in households with a married or partnered couple, detailed information is collected from both individuals. This allowed us to control for a number of spousal characteristics that may make it easier or more difficult for a spouse to provide care. We included measures of ADL and IADL difficulties, current work status (not working, fewer than 20 hr, 20–39 hr, 40 hr or more per week), whether the spouse was currently caring for dependent children or elderly parents, and whether the spouse was the sole caregiver.
Analytic Plan
We conducted bivariate analyses comparing care recipient and spousal characteristics by life stage. We modeled the likelihood of a person serving as the primary caregiver to his or her spouse by using multivariate logistic regression. We used ordinary least squares regression to model logged hours of care from the primary caregiver for the subset of 1,001 care recipients whose spouse served as primary caregiver in the month prior to the survey. We entered variables in blocks to determine whether particular care recipient and spousal characteristics explained age differences in care. Model 1 included life stage and controlled for care recipient sociodemographics and indicators of disease and morbidity. Model 2 added spousal gender and functional status characteristics. Model 3 added spousal competing demands. We conducted all descriptive statistics and multivariate analyses using survey procedures within Stata to adjust for the complex sampling design (Statacorp, 2003, 2005).
|
RESULTS |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
|
Spouse Characteristics by Care Recipient Life Stage
Table 2 presents spouse characteristics. By and large and regardless of life stage, when a spouse provided care, he or she served as the primary caregiver to the individual in need. However, a substantial minority of spouses did not provide any care to their loved one: 12.6% of late middle-aged adults, 16.0% of young-old adults, and 18.7% of older old adults received most of their care from someone other than their spouse. The remainder of Table 2 highlights life-stage differences in select characteristics that may have influenced the amount of care that a spouse provided.
|
Multivariate Analyses
Likelihood of spouse as primary caregiver
There were 1,218 eligible married care recipients who received help with at least one ADL/IADL in the month prior to the survey. Table 3 presents results of the logistic regression analyses examining the likelihood of a spouse becoming the primary caregiver to a husband or wife.
|
Hours of care provided by spousal primary caregiver
Among those whose spouse served as primary caregiver, the next set of analyses examined hours of care provided by the spouse in the month prior to the survey. There were 1,001 eligible individuals whose spouse served as primary caregiver. Model 1 in Table 4 presents multivariate results of the log hours of care that spouses provided as primary caregivers controlling for care recipient sociodemographic, disease, and morbidity characteristics. We can interpret coefficients derived from a log-transformed dependent variable as follows: 100 x (beta) = percent change in Y given a unit increase in X. With this in mind, spousal primary caregivers to late middle-aged adults provided 23% fewer hours of care to their partners than did spousal primary caregivers to older old adults, but spousal primary caregivers to young-old adults did not differ from those to older old adults in the amount of care they provided. The difference between the late middle-aged and the young-old groups was also significant (not shown).
|
In addition to modifying the life-stage effect, all but one of the spouse characteristics also directly affected the outcome. Men who served as primary caregivers to their spouses provided 25% more hours of care to their wives than women who served as primary caregivers to their husbands. Primary caregivers with secondary helpers provided 47% more help to their spouses than those without secondary helpers. Finally, spousal primary caregivers with IADL limitations provided fewer hours of care to their significant others compared to those without IADL limitations, but those with ADL limitations provided more hours of care compared to those without.
When we added the competing demands of caring for children or parents and employment to the model, all life-stage differences in hours of care provided were eliminated (see Model 3). Current work status drove the findings. Those who were working at least full time provided 51% fewer hours of care to their spouses than those who were not currently working. Among spousal primary caregivers to late middle-aged adults, nearly 50% worked full time or more (47%), compared to only 9% of spousal primary caregivers to young-old adults and only 3% of spousal primary caregivers to older old adults (see Figure 1). Caring for dependent children or parents did not affect the hours of care provided by spousal caregivers.
|
|
DISCUSSION |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
Close to half of spousal primary caregivers to late middle-aged adults in our study worked 40 hr or more per week. This is in stark contrast to the 9% of spousal primary caregivers to young-old adults and 3% of spousal primary caregivers to older old adults who did so. Although no other study has examined the effect of work status on care hours provided by spouses specifically, our findings are consistent with those of Doty and colleagues (1998), who examined women of working age. Furthermore, they indicate that the problem of balancing work and caregiving responsibilities is particularly salient for spousal caregivers in late midlife who may be struggling to maintain health insurance and financial stability amid caring adequately for their partner.
Some have speculated that a caregiver may work full time or more hours in order to earn enough money to pay for formal care for their relatives in need (Soldo & Hill, 1995). At least for spouses of late middle-aged adults in our study, this does not appear to be the case, as fewer than 2% of respondents with spousal primary caregivers who worked full time received any formal care at all in this study (results not shown).
More likely, spousal caregivers to late middle-aged adults work at least partly out of necessity. They are younger than the traditional retirement age, and if they have health insurance, it is likely to be employee-based health insurance (Weissman & Epstein, 1994). They are too young to qualify for Medicare, and even if their spouse requiring care meets the strict health care cost and income criteria for Medicaid eligibility, insurance coverage does not extend to themselves and dependent children (Ho, Collins, Davis, & Doty, 2005).
The deficit in care provided by spouses who worked full time is disturbing, because prior research has demonstrated an association between reduced hours of care and increased risk for unmet need (Laplante, Kaye, Kang, & Harrington, 2004). Unmet need for care in the community is associated with a number of negative consequences, including burns and falls (Allen & Mor, 1997; Laplante et al., 2004). Although further research is needed to determine whether fewer hours of care result in unmet need for late middle-aged adults or whether these caregivers are simply more efficient at providing care, prior to these analyses the vulnerability of this particular group may have easily been overlooked given the presence of a spouse in the network.
Other family obligations to children and elderly parents did not affect the amount of care given to a spouse. It is likely that the time obligations to other family members are more flexible than the time obligations of employment. Perhaps it is the time given to children or parents that is reduced when care is provided to a spouse, rather than the reverse. Or perhaps spousal caregivers reduce time spent in other activities in order to care for all family in need. The explanation of our present finding is beyond the scope of this study but deserves further attention.
Caregiver Gender
In addition to the results focusing on life-stage difference in care hours, we also found other results that deserve more research. Life-stage differences in the likelihood of receiving any spousal care are explained largely by the gender and functional status of the spouse. Specifically, men of all life stages are less likely to serve as primary caregivers to their wives, and they make up a greater proportion of caregivers to late middle-aged adults than older groups. The finding that men are less likely to serve as primary caregiver than women is widely supported in the literature (e.g., Allen, Goldscheider, & Ciambrone, 1999; Stone et al., 1987; Walker et al., 1995).
We also found that men who serve as primary caregivers to their spouses provide more hours of care than female primary caregivers, which is in contrast to a recent meta-analysis reporting that women typically provide more care than men (Pinquart & Sorensen, 2006). However, we confined the current study to care recipients' spousal caregivers only, not men as a whole, limiting the comparability of the two findings. The husbands in this study may be the exception to the rule among husbands in general by serving as primary caregivers in the first place. An alternative explanation was suggested by the recent work of Calasanti and King (2007), who stressed the importance of considering gendered roles and social context when discussing differences in caregiving by gender. From this perspective, it may be that typical household work is considered to be "caregiving" when performed by husbands whose wives performed these activities prior to their impairment, whereas only those "new" tasks specifically related to husbands' impairment are considered in time estimates when wives provide care (Dwyer & Seccombe, 1991). Thus, the context or frame of reference in which care recipients estimate hours of spousal care may be quite different by caregiver gender.
Other Influences on Spousal Care
Additionally, we found that primary caregivers with secondary helpers provide 47% more help to their spouses than those without secondary helpers, suggesting that secondary helpers do not act as a substitute for the primary caregiver to ease their burden but serve to supplement their support because the needs of the care recipient are so great. Finally, we found that spousal primary caregivers with IADL limitations provide fewer hours of care to their significant others compared to those without IADL limitations, but those with ADL limitations provide more hours of care compared to those without. This is likely because when all else is held equal, a caregiver with an ADL limitation may take longer to perform a caregiving task than a person who does not have an ADL limitation or a caregiver with an ADL limitation may be homebound and less likely to engage in noncaregiving activities.
Limitations and Future Research
Because this study was cross-sectional, we cannot make causal inferences about the relationship between work status, caregiving, and health insurance status. Longitudinal studies would provide better evidence of causality. Further research is also warranted to determine whether reduced hours of care to late middle-aged adults is associated with increases in unmet need compared to older groups. It is conceivable that although our study controlled for rich measures of disease and morbidity, we failed to capture real differences in frailty between the younger group and the older groups. Perhaps late middle-aged adults with self-care needs are more able to assist in their own care (e.g., balance more of their own weight in transferring from bed to chair) and in doing so reduce the actual amount of time it takes to help care for them effectively compared to their elderly counterparts. This has yet to be determined.
Despite these limitations and the need for further research, this study makes important contributions to the literature. To date, no study has focused on the specific dynamics of caregiving and competing responsibilities for spousal caregivers, particularly in midlife. Because of their life stage, late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by a spouse, and this study showed that they may be particularly vulnerable to unmet need for care.
A Look Toward the Future
As the baby boom generation continues to move into late middle age and the elder years, it is likely to become increasingly difficult for family members to successfully combine the responsibilities of caregiving and labor force participation. Trends in obesity and morbidity, caregiving network characteristics, and labor force participation suggest that this concern will only intensify and carry over into older life stages. Persons in late middle age are increasingly obese and likely to suffer functional limitations as a result (Sturm, Ringel, & Andreyeva, 2006). At the same time, informal caregivers are increasingly taking on the full burden of caregiving responsibilities and receiving little help from others (Wolff & Kasper, 2006). Labor force participation is projected to increase among those in late middle age in the coming decade and to potentially double among those 65 and older (Toossi, 2005).
To complicate matters, both Social Security and the Medicare program face financial challenges that threaten their staying power without substantial reforms (Hudson, 2005). Both increased life expectancies and the size of the baby boom generation will put an unprecedented strain on the Social Security system in the coming decades. Potential reforms include increasing taxes to pay for benefits, decreasing benefits, increasing the age at which a person is eligible to receive benefits, and instituting partial privatization (Herd & Kingson, 2005). Similarly, skyrocketing costs of the Medicare program, similar to health care costs in general, have also led to discussions about reforms (Moon, 2005). Like those for Social Security, potential reforms under discussion include age increases in eligibility, reductions in benefits, and higher cost sharing with the beneficiary. Any of these reforms will likely have an effect on one's flexibility to juggle work responsibilities and caregiving at any age. Respondents in our study aged 65 to 74 (young old) did not show the same reduction in care hours because of work status as caregivers of respondents in late middle age because the majority of those who still worked did so on a part-time basis. As retirement ages continue to climb and federal safety nets weaken, people with care needs who are young old may soon find themselves in the same caregiving predicament as those who are in late middle age.
Conclusions
Clearly, chronological age is not a good predictor of vulnerability to illness and disability (O'Rand, 2005). Though it has taken a backseat to other strategies in recent years, universal health insurance that recognizes vulnerability at all stages of life must seriously be considered. So, too, must caregiver support services for family members with competing obligations in midlife, as well as for older caregivers whose own health may be compromised by the demands of providing care to a disabled spouse (Ho et al., 2005). Otherwise, the benefits of medical advances that have reduced mortality from chronic diseases and injury may be diminished by poorer quality of life among people with disability and their families, at least among those without sufficient resources to purchase the care they need.
|
Acknowledgments |
|---|
J. C. Lima planned the study, conducted the statistical analyses, and wrote the manuscript. S. M. Allen supervised and helped frame the study, oversaw the analyses, and contributed substantially to the writing of the manuscript. F. Goldscheider provided guidance with the conceptualization of the study and edited this and earlier versions of the manuscript. O. Intrator provided guidance with the statistical analyses, suggesting imputation techniques and sensitivity analyses to strengthen the methods and confirm the results.
|
Footnotes |
|---|
Received for publication December 11, 2007. Accepted for publication April 22, 2008.
|
References |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
| ||||||||||||||||||||||||
| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
