Methods: Data were drawn from the second wave of the ELSI-Brazil, representing the Brazilian population aged 50 years and over. The final sample is restricted to 9,882 with complete data. We analyzed the prevalence of ADL and IADL disabilities and described the characteristics of the care providers. Poisson regressions were then conducted to examine which groups were more likely to provide paid care.
Results: Results show that the prevalence of ADL is 9.9% (95% CI 8.4 - 11.7), and the prevalence of IADL is 18.7% (95% CI 15.7 - 22.2). Most of the care in Brazil is provided by unpaid family members who co-reside (74.6% for ADL and 67.7% for IADL) and who do not co-reside (12% for ADL and 19% for IADL). Paid family members, caregivers, and maids represent a minority (10.1% for ADL and 8.4% for IADL). Most of the care is provided by children (48.2% for ADL and 51.0% for IADL) and partners (32.1% for ADL and 25.5% for IADL). Most of them are women, mid-age, married, literate, and receive no specific training to provide care. 17% of the caregiver have to end their work or school for providing care. Almost 90% of the main caregiver provides daily care, and when paid, most of them receive less than one monthly minimum wage. In addition, paid care is uncommon in Brazil, accounting for less than 10% of the care provision (7.5 for ADL and 5.9 for IADL). Among those with ADL and IADL limitations, paid care increases with age, and is more likely to be associated with having private health insurance, living alone, and residing in urban areas.
Conclusions and Implications: Care in Brazil is mostly provided by unpaid coresident family members, and middle-aged women predominate the caregiving role in the family. The high prevalence of ADL and IADL burdens families that devoted time and resources to care for older adults with a disability. Meanwhile, with the fast population aging and smaller family structure due to lower fertility, changes in family norms and migration, the source of informal care becomes more limited. The demand for paid care will increase among older adults with ADL or IADL needs. Although Brazil's current national health system provides universal and free health care services to the citizens, the system does not cover home-based or long-term care for disadvantaged older individuals. These findings urge the need for policymakers and stakeholders to extend formal care coverage and offer accessible and innovative support services that relieve the family caregiving burden.