Study finds elderly women with disabilities given less home care than men

December 18, 2000

Ann Arbor, MI - Women, the traditional family caregivers, may not be given the attentive care they often provide others when their physical condition worsens in old age, a new University of Michigan study finds.

Surprisingly, the U-M research team found that elderly women with disabilities - whether married or single - received fewer hours of care from family members than their male counterparts.

The study, published today in The Journal of the American Medical Association and led by Steven Katz, M.D., M.P.H., U-M associate professor of internal medicine, investigated the gender differences in receipt of informal home care - generally described as care that is unpaid and administered by family members - for elderly men and women with disabilities.

"In the next 50 years, more and more disabled elderly people will be living in communities where they need the support of friends and family," Katz said. "This also leaves healthcare providers and health policymakers with the responsibility of finding the best ways to meet their needs. This study aims to provide more information about who needs help most."

Fellow project researcher Kenneth Langa, M.D., Ph.D., assistant professor of internal medicine and a faculty associate in the U-M Institute for Social Research, said that over the next 40 to 50 years, the number of older people will continue to increase, while the number of grown children available to help take care of them will continue to decrease.

"And because medical advances will mean that older people won't be as sick, more of them will remain in the community longer and need informal care to compensate for the disabilities that come with old age and chronic diseases, like Alzheimer's disease and diabetes," Langa says. "The motivation of the study was to try and get a sense of who's getting help from families and, as we age as a society over the next generation, to see if there are individuals who are at higher risk of having unmet needs."

The researchers carefully examined the results of surveys from 3,109 elderly Americans to find out the state of informal care for these people who often require some assistance in their day-to-day lives.

The results showed that, generally, women receive about one-third fewer hours of informal home care than their male counterparts - a large gender disparity. Even married women with disabilities received many fewer hours of care than older men with wives still living. Disabled married women received about 80 percent more informal home care hours than disabled women living alone, while disabled men received about 230 percent more care than disabled men living alone.

"This may mean that even if a woman is living with a spouse, that doesn't mean that all of her care needs are being met," Katz said.

The results suggested that this disparity was likely due to sociocultural factors - women as traditional caregivers - rather than physical limitations of the husbands. Women's traditional roles include that of nurturing mother and housekeeper, whereas men's traditional role is that of provider.

Of the 21 million people in the United States age 70 and older, about 8.6 million have disabilities such as difficulty walking across the room, the inability to pick up or take prescriptions, or make meals, Katz said. Women make up the largest percentage of disabled elderly people because they tend to live longer than men do. Nearly half of disabled women live alone as compared to 17 percent of men. Nearly three-quarters of disabled men live with a spouse.

Older women also are more likely to have limited financial resources, Katz said. The study showed that nearly 1.3 million women with disability age 70 and older living alone had a net worth of less than $30,000. That compares to 180,000 men age 70 and older - one-seventh the number of women - with disability who were living alone and had a net worth of less then $30,000, Katz said.

"There are more women out there with unmet need, living alone and poor," Katz added.

Interestingly, but not surprisingly, the study also found that female children were the most likely to be the primary caregivers of disabled women, whereas wives played the primary care role for disabled men. Children played an important caregiving role even among married disabled women.

The data for the study were taken from the large Health and Retirement Study, funded by the National Institute on Aging and conducted by the U-M's Institute for Social Research. In the survey program, 20,000 adults from across the U.S. are interviewed every two years about their economic status, health, family information, and how much time people spend with them.

The data for this study were taken from the 1993 survey because subsequent Health and Retirement Study surveys did not address the amount of care given by spouses. Langa said the 2000 survey - the results of which are not yet available - did include the question regarding care by a spouse.

Prior studies addressing informal care of the elderly used smaller samples from isolated areas. Because of the national scope of the survey, the researchers believe this study provides a true representative snapshot of the care of older people with disabilities across the U.S.

"The big message is that we, as physicians, are being asked to identify populations that are vulnerable with regard to disability," Katz said. "This study shows that providers can't assume that their female patients are getting everything they need."
Mohammed Kabeto, M.S., U-M health science research associate, also contributed to this study.

University of Michigan Health System

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