Based on the Andersen behavioral model of health service utilization, this study examined the association of unmet care needs with SCN characteristics (gender, relationship type) to help understand the role of SCN in family caregiving in later life.
Methods: A cross-sectional study was conducted using 2015 National Health and Aging Trend Study (NHATS) and National Study of Caregiving (NSOC). The sample includes 1062 community-dwelling older adults, 1062 primary caregivers, and 1419 secondary caregivers.
Older adults reported unmet care needs in the past 30 days with activities of daily living (ADL; eating, dressing, bathing, and toileting), mobility (getting off bed, getting around inside, getting around outside), and instrumental activities of daily living (IADL; cooking, laundry, shopping, banking, managing medication).
Based on the extant literature, we conducted logistic regression models to examine the association of unmet care needs with three SCN characteristics: having female in SCN, having close relatives in SCN, and having caregiver with same gender of older adults. We adjusted for covariates, including predisposing factors (sociodemographics of older adults and primary caregivers), need factors (health status of older adults), and enabling factors (care intensity of primary caregiver and SCN).
Results: In all, 42% of older adults reported at least one type of unmet care need (27.5% mobility, 16.5% ADL, 12.9% IADL). Having a female in the SCN is related to more unmet needs with mobility (OR: 2.32, 95%CI: 1.31, 4.12) and ADL (OR: 2.10, 95%CI: 1.27, 3.47). Having close relatives in SCN is related to more unmet needs with mobility (OR: 2.41, 95%CI: 1.06, 5.44). None of the three SCN characteristics were associated with unmet IADL needs. Other factors, such as older adults' sociodemographics, health status, and care intensity of both primary and secondary networks were also found related to one or multiple unmet care needs.
Conclusions and Implications: The findings of this study indicate that SCN characteristics are associated with care quality of older adults. Contrary to prior findings that having females and spouses as primary caregivers is associated with fewer unmet care needs, we found having female and close relatives in the SCN is associated with more unmet care needs. This study emphasizes assessing detailed characteristics of SCN when assessing care quality in research and practice. Future work should include longitudinal approaches that attend to cross-sectional design limitations.