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Gender Disparities in the Receipt of Home Care for Elderly People With Disability in the United States
Steven J. Katz, MD, MPH;
Mohammed Kabeto, MS;
Kenneth M. Langa, MD, PhD
JAMA. 2000;284:3022-3027.
Context 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.
Design, Setting, and Participants Nationally representative survey conducted in 1993 among 7443 noninstitutionalized people (4538 women and 2905 men) aged 70 years or older.
Main Outcome Measure 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).
Conclusion 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.
Author Affiliations: Division of General Medicine, Department of Medicine (Drs Katz and Langa), Veterans Affairs Center for Practice Management and Outcomes Research (Dr Langa), Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES) (Dr Katz and Mr Kabeto), Department of Health Management and Policy (Dr Katz), and Institute for Social Research (Drs Katz and Langa) University of Michigan, Ann Arbor.
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