Respite services utilization and self-rated health of older family caregivers in the United States: Differences between young-old and old-old caregivers

Study Aim/Purpose:  This study aimed to examine respite service use and its relationship to self-rated health of older family caregivers in the United State and how this relationship might differ by their age.

Summary of Methods: Authors conducted a cross-sectional study using data from the nationally representative 13^th National Survey of Older Americans Act Participants, which had a sample  of 926 older family caregivers. The survey asked caregivers whether they use in-home respite, day care respite, and/or overnight respite. Self-reported health of the caregivers was measured by asking respondents to rate their health on a 5-point Likert scale from poor to excellent. Control variables included the caregiver’s demographics, whether the caregiver reported any health problems, physical conditions, or disabilities that affects the care they can provide, and the physical health of care recipients (i.e., medical conditions, activities of daily living [ADL] assistance needs, and instrumental activity of daily living [IADL] assistance needs). Caregiver stress was also a control variable, measured with three scaled questions on self-rated emotional stress, physical strain, and financial hardship.

Caregiver age was a dichotomous variable to differentiate the effects of age, with the young-old group being ages 65 to 74 and the old-old group ages 75 or over. The authors used sample t-tests and chi-squared tests to measure differences between young-old and old-old caregivers in self-reported health and respite use, and all the control variables. They then used multi-linear regression analysis with four models to examine the associations between the use of each type of respite service and the caregiver’s self-reported health, as well as the moderating effects of caregiver age.

Summary of Results: No significant difference was observed in the use of the three types of respite services, but more young-old caregivers used all three types of respite services than their old-old counterparts. Young-old caregivers were less likely to have medical/health problems, but their care recipients tended to have greater assistance needs for ADL and IADL. Though not statistically significant, the young-old caregivers experienced more emotional and financial stress and less physical strain than the old-old caregivers. With regard to the control variables, the findings indicated older caregivers who were nonwhite, had lower educational levels, had more health problems, cared for people who had more medical conditions, and experienced financial hardship tended to report worse self-rated health.

Results of the multi-linear regression found that using in-home respite and day care respite were positively associated with self-rated health, but using overnight respite was not. The health benefit of day care respite was more prominent for old-old caregivers than their young-old counterparts.

Study Limitations (as cited by authors):  The authors discuss three different study limitations. First, given that the national survey provides cross-sectional data, they recognize that causal relationships between respite service use and self-rated health of caregivers cannot be detected. Second, they explain that respite service use was measured only by a single question with a dichotomous measure (yes or no). Thus, there was no information about length of respite use, satisfaction with each respite service or dosage of respite used. Third, they recognize that the survey is limited in its ability to describe racial and ethnic differences. Due to the small number of non-Whites in the national survey sample, all racial minorities were combined into one group for analysis.

Authors’ Discussion/Conclusions:  Overall, the authors recognize that the study findings strongly support the need for increased access to respite services through policies and funding supports. They emphasize that both practice and policy should take into account age-related differences in respite preferences and the health effects of respite for older family caregivers. For example, they recommended that government financial support and promotional efforts for respite services for old-old caregivers should encourage use of day care respite. Additionally, the authors suggested that social work practitioners help older caregivers select the type of respite services that best met their individual needs and have positive impacts on their health.