Gender disparities in the receipt of home care for elderly people with disability in the United States.
BACKGROUND
Projected demographic shifts in the US population over the next 50 years will cause families, health care practitioners, and policymakers to confront a marked increase in the number of people with disabilities living in the community. Concerns about the adequacy of community support are particularly salient to women, who make up a disproportionate number of disabled elderly people and who may be particularly vulnerable because they are more likely to live alone with limited financial resources.


OBJECTIVE
To address gender differences in receipt of informal and formal home care.


METHODS
Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older.


METHODS
Number of hours per week of informal (generally unpaid) and formal (generally paid) home care received by survey participants who reported any activity of daily living (ADL) or instrumental activity of daily living (IADL) impairment (n = 3109) compared by gender and living arrangement and controlling for other factors.


RESULTS
Compared with disabled men, disabled women were much more likely to be living alone (45.4% vs 16.8%, P<.001) and much less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2 hours; 95% CI, 19. 7-22.8). Married disabled women received many fewer hours per week of informal home care than married disabled men (14.8 hours; 95% CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were the dominant caregivers for disabled women while wives were the dominant caregivers of disabled men. Gender differences in formal home care were small (2.8 hours for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4).


CONCLUSIONS
Large gender disparities appear to exist in the receipt of informal home care for disabled elderly people in the United States, even within married households. Programs providing home care support for disabled elderly people need to consider these large gender disparities and the burden they impose on families when developing intervention strategies in the community.
Katz
S J
SJ
University of Michigan Health System, Division of General Medicine, Department of Medicine, 300 N Ingalls, Suite 7E12, Box 0429, Ann Arbor, MI 48109-0429, USA. skatz@umich.edu
Kabeto
M
M
Langa
K M
KM
D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D005853:Geriatrics / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006701:Home Nursing / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012044:Regression Analysis; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology