Contact: Steven J. Katz, MD, MPH
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Disabled Elderly Women Receive Less Home Care Than Men
Elderly women more likely to provide care for husbands, more likely to receive care from children

CHICAGO -- Disabled elderly women living in the community receive about one-third fewer hours of informal home care than their male counterparts, and many disabled elderly married women serve as caregivers to their spouses, according to an article in the December 20 issue of The Journal of the American Medical Association (JAMA).

Steven J. Katz, M.D., M.P.H., and colleagues from the University of Michigan, Ann Arbor, analyzed data from a nationally representative survey conducted at the University of Michigan in 1993 to determine sex differences in receipt of informal (generally unpaid) and formal (generally paid) home care. A total of 4,538 women and 2,905 men aged 70 and older took part in the survey. None of the study participants lived in institutions. The study sample included 3,109 respondents who were disabled, defined as reporting that during the prior month they had difficulty or were receiving help with at least one activity of daily living (ADL), such as eating or bathing, or with an instrumental activity of daily living (IADL), such as taking medication, or preparing meals.

According to background information cited in the study, projected demographic shifts in the U.S. population over the next 50 years are expected to result in a marked increase in the number of elderly people living in the community who must cope each day with disabilities associated with aging and chronic disease. Women make up a disproportionate number of disabled elderly people in the community because they live longer than men. Disabled women living in the community may be particularly vulnerable to unmet needs because many of them live alone with limited resources. Even disabled women in married households may be vulnerable to unmet needs because they may be more likely than men to be in a caregiver role themselves.

The authors report that the disabled elderly women they surveyed were more likely than men to be living alone (45.4 percent, compared with 16.8 percent of men living alone). Women were much less likely to be living with a spouse (27.8 percent, compared with 73.6 percent of men living with spouses). The women were also older, reported less net worth than men, and received less informal care.

"Overall, women received fewer hours of informal care per week than men [15.7 hours per week for women, compared with 21.2 hours per week for men]," the authors write.

"Married disabled women received many fewer hours per week of informal home care than married disabled men [14.8 hours per week for women, compared with 26.2 hours for men]," they continue.

The authors suggest that husbands of disabled spouses may be less able to provide care because they may be less prepared to fulfill the social role function of caregiving rather than be limited by disability.

The use of formal (generally paid) home care was much lower than informal care, and there was little difference between men and women in receipt of formal care. "Adjusted weekly hours of formal care were 2.8 hours for women and 2.1 hours for men," the authors write.

The study found children, especially female children, played a dominant role in the care of disabled women, whereas wives played the dominant role in the care of disabled men. "Among all disabled women, 44.6 percent reported receiving informal care from one or more children vs. 22.8 percent of disabled men, and more than 80 percent of these children were daughters, daughters-in-law, or granddaughters," the authors write. "By contrast, only 11.1 percent of disabled women reported any informal care from a spouse, compared with 43.8 percent of disabled men."

"Because disabled elderly women rely heavily on children for support, especially female children, the family burden and stress associated with caring for a disabled woman should be the subject of further study," the authors suggest.

"Programs providing home care support to elderly people need to consider these large sex disparities and consequences on the burden on the family when developing and targeting intervention strategies in the community," they conclude.

(JAMA. 2000; 284:3022-3027)

Editor's Note: Dr. Katz was a Robert Wood Johnson Foundation Generalist Faculty Scholar and co-author Kenneth M. Langa, M.D., Ph.D., was a Robert Wood Johnson Foundation Clinical Scholar during the time this work was completed. The authors thank the National Institute on Aging for providing funding support for the Health and Retirement Study and the Asset and Health Dynamics Among the Oldest Old Survey, data from which was used in this analysis.

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This release is reproduced verbatim and with permission from the American Medical Association as a service to reporters interested in health and behavioral change. For more information about The Journal of the American Medical Association or to obtain a copy of the study, please contact the American Medical Association's Science News Department at (312) 464-5374.