The ‘demographic time bomb’ has obsessed many in the social care and health sector since Margaret Thatcher first coined the phrase in 1984 (Jack, 1991). The increasing numbers of people surviving into extreme old age is often described in contradictory terms as ‘a positive expression of human development and progress’ (Mullan, 2002, p27) or as causing ‘contemporary panic’ (Mullan, 2002, p26). Either way, there are implications for the provision of social care and support in older age. This study by Vlachantoni et al aimed to

examine the relationship between demographic and socio-economic characteristics, and the receipt of support from different sources by older people who report difficulty with daily activities.

Methods

Vlachantoni et al aimed to identify factors associated with receipt of informal, state and privately funded care, using data from the English Longitudinal Study of Ageing (ELSA) (wave 4). ELSA includes a sub sample of older participants in the Health Survey for England (HSE), a nationally representative survey.

The study took a further sub-sample of ELSA respondents, who had at least one problem carrying out an Activity of Daily Living (ADL, such as bathing), an Instrumental Activity of Daily Living (IADL, such as gardening) or mobility task (such as the ability to walk a quarter of a mile).

The researchers rightly identify some limitations to representativeness because of non-response, but they also describe a number of measures taken to overcome these difficulties, which increase the reliability of the results.

They tested an approach (a conceptual framework) linking receipt of informal, state and privately funded care to socio-economic and demographic factors in addition to physical or cognitive impairments.

The analysis is clearly and logically described in the article. It starts with bivariate analysis – comparing two variables, such as age and gender, and finishes with multivariate analysis, where the importance of many factors is assessed, whilst holding other factors constant (‘all other things being equal’). This is a much more powerful approach, as it takes into account the effect of all variables simultaneously.

Factors associated with receipt of informal care were split between men and women, because of the different patterns seen. Factors associated with the receipt of state or privately funded care were given for men and women together.

Findings

One the strongest findings is that problems with Activities of Daily Living (such as bathing), mobility tasks and, even more strongly, Instrumental Activities of Daily Living (such as housework) are highly associated with receiving all forms of care, particularly privately funded care. These were the factors making the different forms of care more or less likely.

Factors increasing or decreasing the likelihood of informal care for men

Increased likelihood

• Difficulties with a higher number of ADLS, IADLs, or mobility tasks
• Being married or having a partner

Decreased likelihood

• Adaptations to the home

Factors increasing or decreasing the likelihood of informal care for women

Increased likelihood

• Difficulties with a higher number of ADLS, IADLs, or mobility tasks
• Marital status (i.e. being married) or living with adult children
• Being women in the lowest fifth of the income scale compared with those in the second richest fifth
• Having a diagnosis of dementia

Factors increasing or decreasing the likelihood of state funded care

Increased likelihood

• Difficulties with a higher number of ADLS, IADLs and or tasks
• Marital status (i.e. being single)
• Use of a wheelchair, personal alarm or other care

Factors increasing or decreasing the likelihood of privately funded care

Increased likelihood

• Difficulties with a higher number of ADLS, IADLs and or tasks (made most difference for privately funded care)
• Women, single people and those not living with adult children
• Being in the more affluent groups (except those in the second fifth, for some reason )
• Having a long-term, life limiting illness (not associated with any other kind of care)
• Having home adaptations, using a personal alarm, occupational therapy or chiropody, and visiting a lunch club

Conclusion and summing up

Vlachantoni et al highlight three main findings from this study.

First is the importance of problems with ADLS, IADLS and mobility tasks, which made all forms of care more likely, outweighing age and health. The one exception was that being diagnosed with dementia had a stronger influence on women receiving informal care.

Second was that marital status and living with adult children were strong predictors of different types of care. It is possible, Vlachantoni et al suggest, that these factors interact with health and problems with ADLS, IADLS or mobility tasks, to affect receipt of all kinds of care.

Third was that different kinds of needs triggered different forms of care. For example, problems with dressing were associated more with informal and state funded care, whereas problems with housework were more associated with privately funded care. This is perhaps unsurprising: policy changes within social services have reduced the availability of these kinds of services. Vlachantoni et al suggest that such support may be best organised by voluntary groups or informally. However the state could very easily fund such provision, which may prevent deterioration in function in other areas and also be linked to mental wellbeing and the ability to remain living at home although only suggestive evidence has been found for this (Jacobs, 2009).

The main findings of the article are likely to be of great value to central and local government in planning the development of local services for older people. However, recent austerity measures may have distorted patterns of different types of care. For example, much of the informal and privately funded care may be provided because of limitations on state funded care. As financial pressures increase, future patterns of care may be affected, in different and unpredictable ways.

Link

A. Vlachantoni, R. J. Shaw, M. Evandrou and J.Falkingham, (2015) The determinants of receiving social care in later life in England, Ageing and Society 35 (2) pp.321-345 DOI: 10.1017/S0144686X1300072X [Full Text]

References

Jack, R. (1991) Social Services and the Ageing Population 1970-1990, Social Policy and Administration 25 (4) pp.284-299 [Abstract]

Jacobs, S., ChengQui, X., Reilly, S., Hughes, J. and Challis, D. (2009) Modernising social care services for older people: scoping the United Kingdom evidence base, Ageing & Society 29 (4), pp.497–538 [Abstract]

Mullan, P. (2002) The Imaginary Time Bomb: Why an Ageing Population is Not a Social Problem London: I.B.Tauris