The Association of Secondary Care Network Characteristics with Unmet Care Needs of Community-Dwelling Older Adults

Background and Purpose: Family and other unpaid caregivers account for 80% of long-term care for older adults. Older adults receive support from a network of informal caregivers including a primary caregiver and one or more secondary caregivers who provide less frequent care than the former. Extant caregiving literature indicates that 30% of older adults have unmet care needs. Therefore, it is necessary to examine characteristics of secondary care networks (SCN), how they are associated with unmet care needs of older adults, and potential mechanisms that may affect care quality. Previous work examined the relationship between size and care intensity of informal caregiver network and unmet care needs, but few have examined characteristics of SCN, such as gender and relationship type.

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.