Daily living assistance for older adults : unmet needs and informal care

Abstract

Many older adults are experiencing unmet needs for assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Such unmet needs might threaten older adults’ physical and psychosocial well-being. A systematic review would help to develop a comprehensive picture regarding the health consequences of unmet ADL/IADL needs. Moreover, the influence of unmet ADL needs on two of the crucial dimensions of older adults’ well-being—self-rated health and life satisfaction—has not been fully investigated. Furthermore, meeting the ADL/IADL needs of community-dwelling older adults relies predominantly on family care, but family caregivers experience various difficulties when performing different caregiving activities. Understanding the caregiving activity patterns among family caregivers of older adults is, therefore, necessary to provide appropriate support to help them to meet care recipients’ needs better and to ease their burden. This thesis aims to (i) systematically review the health consequences of unmet ADL/IADL needs among older adults; (ii) examine the associations of changes in unmet ADL needs with the self-rated health and life satisfaction of community-dwelling older adults; and (iii) identify the caregiving activity patterns for family caregivers of older adults and explore the characteristics and burden of caregivers with different patterns. First, a systematic review was conducted to review the health consequences of unmet ADL/IADL needs. Second, based on the four latest waves of the Chinese Longitudinal Health Longevity Study, linear mixed models were performed to address how the changes in unmet ADL needs were associated with self-rated health and life satisfaction from baseline to follow-up. Finally, using the data from a cross-sectional survey on the profiles of family caregivers of older adults in Hong Kong, a latent class analysis was conducted to classify family caregivers according to their routine involvements in 17 daily caregiving activities. Multinomial logistic regression and multiple linear regression were used to explore the characteristics of the classes and their levels of caregiver burden. The systematic review showed that unmet ADL/IADL needs might be associated with higher risks for fall, greater psychological distress, increased healthcare utilisation, and higher mortality. Results from data analyses of 1914 older adults showed that an occurrence of unmet ADL needs was associated with a decline in self-rated health and life satisfaction from baseline to follow-up, while a recovery of unmet ADL needs was related to a rise in self-rated health and life satisfaction from baseline to follow-up. Based on 932 family caregivers, five caregiving activity patterns were identified. Family caregivers with different caregiving activity patterns exhibited varied characteristics and were experiencing different levels of caregiver burden, with those with an All-Round Care (High Demand) pattern encountering the highest burden. The occurrences of unmet ADL needs had small to medium negative effects on self-rated health and life satisfaction. Therefore, this thesis emphasises the importance of adequately meeting older adults’ needs for daily living. More comprehensive and coordinated long-term care services for older adults are advocated, alongside prioritised and targeted support for their family caregivers, which is possible with the identification of caregiving activity patterns.