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Life on the Edge: Patterns of Formal and Informal Help to Older Adults in the United States and Sweden

¹ Polisher Research Institute, Abramson Center for Jewish Life (formerly Philadelphia Geriatric Center), North Wales, Pennsylvania.
² Department of Human Development and Family Studies, Pennsylvania State University, University Park.
³ Department of Health Policy and Administration, Pennsylvania State University, University Park.
⁴ Gerontology Institute, Jönköping Univeristy, Jönköping, Sweden.
⁵ Graduate School of Arts and Sciences, Boston College, Chestnut Hill, Massachusetts.

Correspondence concerning this article should be addressed to Adam Davey, Polisher Research Institute, 1425 Horsham Road, North Wales, PA 19454-1320. E-mail: ADavey{at}abramsoncenter.org

Objectives. Our objective in this study was to compare assistance received by individuals in the United States and Sweden with characteristics associated with low, moderate, or high 1-year placement risk in the United States.

Methods. We used longitudinal nationally representative data from 4,579 participants aged 75 years and older in the 1992 and 1993 waves of the Medicare Current Beneficiary Survey (MCBS) and cross-sectional data from 1,379 individuals aged 75 years and older in the Swedish Aging at Home (AH) national survey for comparative purposes. We developed a logistic regression equation using U.S. data to identify individuals with 3 levels (low, moderate, or high) of predicted 1-year institutional placement risk. Groups with the same characteristics were identified in the Swedish sample and compared on formal and informal assistance received.

Results. Formal service utilization was higher in Swedish sample, whereas informal service use is lower overall. Individuals with characteristics associated with high placement risk received more formal and less informal assistance in Sweden relative to the United States.

Discussion. Differences suggest formal services supplement informal support in the United States and that formal and informal services are complementary in Sweden.