HwaJung Choi (
Michele Heisler is a professor in the Departments of Internal Medicine and of Health Behavior and Health Education, University of Michigan; the medical director of Physicians for Human Rights (PHR), in New York, New York; and a research scientist at the Center for Clinical Management Research, in Ann Arbor, Michigan.
Health Aff (Millwood). 2021 Sep;40(9):1359-1367. doi: 10.1377/hlthaff.2021.00280.
Despite the important role that family members can play in dementia care, little is known about the association between the availability of family members and the type of care, informal (unpaid) or formal (paid), that is actually delivered to older adults with dementia in the US. Using data about older adults with dementia from the Health and Retirement Study, we found significantly lower spousal availability but greater adult child availability among women versus men, non-Hispanic Blacks versus non-Hispanic Whites, and people with lower versus higher socioeconomic status. Adults with dementia and disability who have greater family availability were significantly more likely to receive informal care and less likely to use formal care. In particular, the predicted probability of a community-dwelling adult moving to a nursing home during the subsequent two years was substantially lower for those who had a co-resident adult child (11 percent) compared with those who did not have a co-resident adult child but had at least one adult child living close (20 percent) and with those who have all children living far (23 percent). Health care policies on dementia should consider potential family availability in predicting the type of care that people with dementia will use and the potential disparities in consequences for them and their families.
尽管家庭成员在痴呆症护理中可以发挥重要作用,但对于美国痴呆症老年人实际接受的家庭成员可用性与护理类型(非正式(无偿)或正式(有偿))之间的关联,知之甚少。我们使用来自健康与退休研究的数据来研究痴呆症老年人,发现与男性相比,女性的配偶可用性显著降低,但成年子女可用性较高;与非西班牙裔白人相比,非西班牙裔黑人的配偶可用性显著降低,但成年子女可用性较高;与社会经济地位较高的人相比,社会经济地位较低的人的配偶可用性显著降低,但成年子女可用性较高。有痴呆症和残疾的成年人,如果家庭中有更多的可用成年人,他们更有可能接受非正式护理,而不太可能使用正式护理。特别是,与没有共同居住的成年子女但有至少一名成年子女居住在附近的人(20%)和所有子女都居住在远处的人(23%)相比,有共同居住的成年子女的社区居住成年人在随后两年内搬入养老院的预测概率要低很多(11%)。痴呆症的医疗保健政策应考虑潜在的家庭可用性,以预测痴呆症患者将使用的护理类型,以及他们及其家庭的潜在差异。