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Health services use by older people with disabilities in Spain: do formal and informal care matter?

Published online by Cambridge University Press:  03 November 2008

JESÚS ROGERO GARCÍA ,
MARÍA-EUGENIA PRIETO-FLORES  and
MARK W. ROSENBERG
JESÚS ROGERO GARCÍA
Affiliation:
Institute of Economics, Geography and Demography, Spanish Council for Scientific Research, Madrid, Spain.
MARÍA-EUGENIA PRIETO-FLORES
Affiliation:
Institute of Economics, Geography and Demography, Spanish Council for Scientific Research, Madrid, Spain.
MARK W. ROSENBERG
Affiliation:
Department of Geography, Queen's University, Kingston, Ontario, Canada.
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Abstract

As people grow older in late life, their need for help with the activities of daily living increases. In Spain, those who need such help constitute about 20 per cent of the population aged 65 or more years. Support may be from formal care, informal care or both, and the type has different consequences for care receivers and their social networks. The aim of this paper is to examine the relationship between informal and formal care and the use of health services among older people in Spain. Using a sample of 1,148 respondents aged 65 or more years from the Spanish National Health Survey of 2003, we analysed the association between the sources of care (formal, informal, both, or no care) and the frequency of three types of health-care utilisation: hospitalisation, emergency services and medical consultations. After controlling for sex, age, level of difficulty in the activities of daily living, self-perceived health status, and social class, it was found that older people with disabilities who received neither informal nor formal care were more likely to consult physicians than those who received informal care, but that there were no significant relationships between the type of care and health-services utilisation. The findings provide new information about the consequences of the different types of care of older people with disabilities, and suggest specifically that informal care substitutes for some tasks usually done by health professionals.

Keywords

health servicesinformal careformal caredisabled older peopleSpain
Type
Research Article
Information
Ageing & Society , Volume 28 , Issue 7 , October 2008 , pp. 959 - 978
Copyright
Copyright © 2008 Cambridge University Press

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References

Abellán García, A. and Esparza Catalán, C. 2006. Las personas mayores con dependencia [Older people with dependencies]. In Puyol Antolín, R. and Abellán García, A. (eds), Envejecimiento y dependencia. Una mirada al panorama futuro de la población española [Old Age and Dependency: A Prospective View of the Spanish Population]. Mondial Assistance, Madrid, 53–72.Google Scholar
Andersen, R. M. 1995. Revisting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36, 1, 1–10.CrossRefGoogle Scholar
Andersson, A., Levin, L.-A. and Emtinger, B. G. 2002. The economic burden of informal care. International Journal of Technology Assessment in Health Care, 18, 1, 46–54.Google ScholarPubMed
Bazo, M. T. and Domínguez-Alcón, C. 1996. Los cuidados familiares de salud en las personas ancianas y las políticas sociales [Family health care for older people and social policies]. Revista Española de Investigaciones Sociológicas, 73, 43–56.CrossRefGoogle Scholar
Blandford, A. and Chappell, N. 1991. Informal and formal care: exploring the complementarity. Ageing & Society, 11, 3, 299–317.Google Scholar
Bowling, A. 1995. Measuring Health. Open University Press, Buckingham, England.Google Scholar
Brouwer, W. B. F., Van Exel, N. J. A., Van den Berg, B., Van den Bos, G. A. M. and Koopmanschap, M. A. 2005. Process utility from providing informal care: the benefit of caring. Health Policy, 74, 85–99.CrossRefGoogle ScholarPubMed
Curtis, J. R., Wenrich, M. D., Carline, J. D., Shannon, S. E., Ambrozy, D. M. and Ramsey, P. G. 2001. Understanding physicians' skills at providing end-of-life care: perspectives of patients, families, and health care workers. Journal of General Internal Medicine, 16, 1, 41–9.Google ScholarPubMed
Davey, A. and Patsios, D. 1999. Formal and informal community care to older adults: comparative analysis of the United States and Great Britain. Journal of Family and Economic Issues, 20, 3, 271–99.CrossRefGoogle Scholar
Defensor, del Pueblo 2000. La Atención Sociosanitaria en España: Perspectiva Gerontológica y Otros Aspectos Conexos [Social and Health Care in Spain: Gerontological and Related Aspects]. Instituto de Mayores y Servicios Sociales [Institute for Older People and Social Services] (IMSERSO), Madrid, 304.Google Scholar
Dosman, D., Keating, N. and Fast, J. 1998. Costs of Direct Services Provided by Formal and Informal Caregivers to Seniors in Residential Continuing Care. Research on Ageing. Policies and Practice, Edmonton, Alberta.Google Scholar
Durán, M. A. 2003. La Aportación De Las Mujeres A La Economía Y A La Sociedad De La Comunidad De Madrid [The Contribution of Women to the Economy and Society of the Community of Madrid]. Dirección General de la Mujer, Ministerio de Trabajo y Asuntos Sociales, Madrid.Google Scholar
Durán, M. A. 2002. Los Costes Invisibles de la Enfermedad [The Invisible Costs of Illness]. Fundación BBVA, Bilbao, Spain.Google Scholar
Dwyer, J. W., Lee, G. R. and Jankowski, T. B. 1994. Reciprocity, elder satisfaction, and caregiver stress and burden: the exchange of aid in the family caregiving relationship. Journal of Marriage and the Family, 56, 1, 35–43.CrossRefGoogle Scholar
Eales, J., Keating, N. and Fast, J. 2001. Analysis of the Impact of Federal, Provincial and Regional Policies on the Economic Well-Being of Informal Caregivers of Frail Seniors. Research on Ageing Policies and Practice, Edmonton, Alberta.Google Scholar
Evashwick, C., Rowe, G., Diehr, P. and Branch, L. 1984. Factors explaining the use of health care services by the elderly. Health Services Research, 19, 3, 357–82.Google ScholarPubMed
Fast, J. E., Williamson, D. L. and Keating, N. C. 1999. The hidden costs of informal elder care. Journal of Family and Economic Issues 203, 3, 301–26.CrossRefGoogle Scholar
Fernández, E., Schiaffino, A., Badia, X., Rajmil, L. and Segura, A. 1999. Gender inequalities in health and health care services use in Catalonia (Spain). Journal of Epidemiology and Community Health, 53, 4, 218–2.CrossRefGoogle ScholarPubMed
Fernández-Mayoralas, G., Rodríguez, V. and Rojo, F. 2000. Health services accessibility among the Spanish elderly. Social Science and Medicine, 50, 1, 17–26.CrossRefGoogle ScholarPubMed
Fillenbaum, G. G. 1995. Activities of daily living. In Maddox, G. (ed.), The Encyclopedia of Aging. Second edition, Springer Publishing Company, New York. 7–9.Google Scholar
Folbre, N. and Bittman, M. (eds) 2004. Family Time: The Social Organization Of Care. Routledge, London.Google Scholar
Garson, D. 2006. Logistic Regression. Website syllabus notes, Course PA 765, Quantitative Research in Public Administration, North Carolina State University, Raleigh, North Carolina. Available online at http://www2.chass.ncsu.edu/garson/PA765/logistic.htm [Accessed December 2007].Google Scholar
Gènova Maleras, R., Álvarez Martín, E. and Morant Ginestar, C. 2006. Carga de enfermedad y tendencias de morbilidad de la población española [Burden of illness and morbidity trends in the Spanish population]. In Puyol Antolín, R. and Abellán García, A. (eds), Envejecimiento y Dependencia. Una Mirada al Panorama Futuro de la Población Española [Old Age and Dependency: A Prospective View of the Spanish Population]. Mondial Assistance, Madrid, 91–108.Google Scholar
Guallar-Castillón, P., Redondo Sendino, A., Banegas, J. R., Lopez-Garcia, E. and Rodriguez-Artalejo, F. 2005. Differences in quality of life between women and men in the older population of Spain. Social Science and Medicine, 60, 6, 1229–40.CrossRefGoogle ScholarPubMed
Harlton, S.-V., Fast, J. and Keating, N. 1998. Defining eldercare for policy and practice: perspectives matter. Family Relations, 47, 3, 281–8.CrossRefGoogle Scholar
Herlitz, C. 1997. Distribution of informal and formal home help for elderly people in Sweden. The Gerontologist, 37, 1, 117–24.CrossRefGoogle ScholarPubMed
Hooper, J. 2006. The New Spaniards. Second edition, Penguin, London.Google Scholar
Instituto de Mayores y Servicios Sociales (IMSERSO) 2002. Envejecer en España: II Asamblea Mundial sobre el Envejecimiento [Old Age in Spain: The Second World Assembly on Ageing]. IMSERSO, Madrid.Google Scholar
Instituto de Mayores y Servicios Sociales 2004. Libro Blanco de la Dependencia [White Book of Dependency]. Ministerio de Trabajo y Asuntos Sociales, Madrid.Google Scholar
Instituto de Mayores y Servicios Sociales 2005. Cuidados a las Personas Mayores en los Hogares Españoles: El Entorno Familiar [Care of Older People in Spanish Households: The Family Context]. IMSERSO, Ministerio de Trabajo y Asuntos Sociales, Madrid.Google Scholar
Instituto de Migraciones y Servicios Sociales (ed.) 2005. Las Personas Mayores en España. Informe 2004 [Older Persons in Spain: 2004 Report]. IMSERSO, Madrid.Google Scholar
Instituto Nacional de Estadística (INE) 2002. Encuesta sobre Discapacidades, Deficiencias y Estado de Salud 1999 [Survey of Disabilities, Impairment and Health Status]. INE, Madrid.Google Scholar
Instituto Nacional de Estadística 2003. Encuesta Nacional de Salud: Metodología [National Health Survey: Methodology]. INE, Madrid.Google Scholar
Katz, S. 1983. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721–7.CrossRefGoogle ScholarPubMed
Kouzis, A. C. and Eaton, W. W. 1998. Absence of social networks, social support and health services utilization. Psychological Medicine, 28, 6, 1301–10.CrossRefGoogle ScholarPubMed
Linden, M., Horgas, A. L., Gilberg, R. and Steinhagen-Thiessen, E. 1997. Predicting health care utilization in the very old: the role of physical health, mental health, attitudinal and social factors. Journal of Aging and Health, 9, 1, 3–27.CrossRefGoogle ScholarPubMed
Litwin, H. 1997. Support network type and health service utilization. Research on Aging, 19, 3, 274–99.CrossRefGoogle Scholar
McDowell, I. and Newell, C. 1987. Measuring Health: A Guide to Rating Scales and Questionnaires. Oxford University Press, New York.Google Scholar
Ministerio de Sanidad y Consumo 2006. Plan de Calidad para el Sistema Nacional de Salud [Quality Plan for the National Health System]. Ministerio de Sanidad y Consumo, Madrid, 91.Google Scholar
Montoro, J. 1999. Las consecuencias psicosociales del cuidado informal a personas mayores [Psychosocial consequences of informal care-giving to older people]. Revista Internacional de Sociología, 23, 7–29.Google Scholar
Nissel, M. and Bonnerjea, L. 1982. Family Care of the Handicapped Elderly: Who Pays? Policy Studies Institute, London.Google Scholar
Noro, A. M., Hakinnen, U. T. and Laitinen, O. J. 1999. Determinants of health service use and expenditure among the elderly Finnish population. European Journal of Public Health, 9, 33, 174–80.CrossRefGoogle Scholar
Puime, Á. O. 2004. La atención a la dependencia asociada al envejecimiento. Necesidades no cubiertas [Attention to dependency associated with old age: unmet needs]. Encuentros Multidisciplinares, 16, 6, 59–66.Google Scholar
Rabinowitz, J., Feldman, D., Gross, R. and Boerma, W. 1998. Which primary care physicians treat depression? Psychiatric Services, 49, 1, 100–2.CrossRefGoogle ScholarPubMed
Raphael, D. (ed) 2004. Social Determinants of Health: Canadian Perspectives. Canadian Scholars' Press, Toronto, Ontario.Google Scholar
Raschick, M. and Ingersoll-Dayton, B. 2004. The costs and rewards of caregiving among aging spouses and adult children. Family Relations, 53, 3, 317–25.CrossRefGoogle Scholar
Redondo-Sendino, Á., Guallar-Castillón, P., Ramón Banegas, J. and Rodríguez-Artalejo, F. 1999. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health, 6, 155.CrossRefGoogle Scholar
Regidor, E. 2001. La clasificación de la clase social de Goldthorpe: marco de referencia para la propuesta de medición de clase social del grupo de trabajo de la Sociedad Española de Epidemiología [Goldthorpe's social class classification: a framework of reference for the proposal of a social class measure by a Working Group of the Spanish Society of Epidemiology]. Revista Española de Salud Pública, 75, 13–22.CrossRefGoogle Scholar
Rodríguez Rodríguez, P. 2006. El apoyo informal como destinatario de los programas de intervención en situaciones de dependencia [Infomal care as a target of intervention programmes for dependency situations]. Documentación Social, 141, 123–44.Google Scholar
Ross, C. J. 1997. Contemporary Spain: A Handbook. Arnold, London.Google Scholar
Sancho Castiello, M. and Díaz Martín, R. 2006. La oferta de servicios sociales. El impacto de la futura ley de dependencia [Social services supply: the impact of the imminent Law of Dependence]. In Puyol Antolín, R. and Abellán García, A. (eds), Envejecimiento y Dependencia. Una Mirada al Panorama Futuro de la Población Española [Old Age and Dependency: A Prospective View of the Spanish Population]. Mondial Assistance, Madrid, 202–19.Google Scholar
Schaie, K. W., Boron, J. B. and Willis, S. L. 2005. Everyday competence in older adults. In Johnson, M. L. (ed.), The Cambridge Handbook of Age and Ageing. Cambridge University Press, Cambridge, 216–28.CrossRefGoogle Scholar
Schellhorn, M., Stuck, A. E., Minder, C. E. and Beck, J. C. 2000. Health services utilization of elderly Swiss: evidence from panel data. Health Economics, 9, 533–45.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Starrels, M. E., Ingersoll-Dayton, B., Dowler, D. W. and Neal, M. B. 1997. The stress of caring for a parent: effects of the elder's impairment on an employed, adult child. Journal of Marriage and the Family, 59, 4, 860–72.CrossRefGoogle Scholar
Ungerson, C. 1987. Policy is Personal: Sex, Gender, and Informal Care. Tavistock, London.Google Scholar
Van Houtven, C. H. and Norton, E. C. 2004. Informal care and health care use of older adults. Journal of Health Economics, 23, 6, 1159–80.CrossRefGoogle ScholarPubMed
Walker, A. J., Pratt, C. C. and Eddy, L. 1995. Informal caregiving to ageing family members: a critical review. Family Relations, 44, 4, 402–411.CrossRefGoogle Scholar
Wan, T. T. H. 1987. Functionally disabled elderly: health status, social support, and use of health services. Research on Aging, 9, 1, 61–78.CrossRefGoogle ScholarPubMed
Willmot, P. 1986. Social Networks, Informal Care, and Public Policy. Policy Studies Institute, London.Google Scholar
Wilson, K. and Rosenberg, M. W. 2002. Exploring the determinants of health for First Nations peoples in Canada: can existing frameworks accommodate traditional activities? Social Science and Medicine, 55, 112017–31.CrossRefGoogle ScholarPubMed
Wimo, A., Strauss, E. v., Nordberg, G., Sassi, F. and Johansson, L. 2002. Time spent on informal and formal care giving for persons with dementia in Sweden. Health Policy, 61, 255–68.CrossRefGoogle ScholarPubMed
Wolinsky, F. D., Mosely, R. R. II and Coe, R. M. 1986. A cohort analysis of the use of health services by elderly Americans. Journal of Health and Social Behavior, 27, 3209–19.CrossRefGoogle ScholarPubMed