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Socio-medical characteristics Socio-medical characteristics of the dependent older of the dependent older

people living people living in six European countriesin six European countries B. Bien, B. Wojszel, M. Rybaczuk, P. Czekanowski, P.

Błędowski, B. Synak, W. Pędich

for the EUROFAMCARE group: Germany: Döhner H. (Project Coordinator), Kofahl C., Luedecke D., Mnich E. (Hamburg) and Rothgang H., Becker R. (Bremen); Greece: Mestheneos E. (PI), Triantafillou J. (PI), Prouskas C., Mestheneos K.; Italy: Lamura G. (PI), Balducci C., Melchiorre M.G., Quattrini S., Spazzafumo L.; Poland: Bien B. (PI), Wojszel B.,

Synak B., Czekanowski P., Bledowski P.; Sweden: Öberg B. (PI), Krevers B., Johansson S.L.;

United Kingdom: McKee K. (PI), Barber L., Brown J., Nolan M.

„„Family Support for Dependent Older People in Europe“Family Support for Dependent Older People in Europe“VII International Long Term Care Conference, Toruń,

21-23 of September 2004

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Background The “demographic transition”“demographic transition” , as a shift from high

fertility and high mortality, to low fertility and low mortality, results in increasing life expectancyincreasing life expectancy.

The “epidemiological transition”“epidemiological transition” shows the change from a predominance of infectious diseases, with high maternal and child mortality, to a predominance of predominance of chronic disease in old agechronic disease in old age.

An effect of chronic disorders causes a limitation in functional abilities. Inability to perform ADL leads to “dependencydependency” - the need for human help (or care), coming mainly from family members - caregivers

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Prerequisites: Situation of family carers Situation of family carers can be classifiedcan be classified on domains on domains

rrelating toelating to (1) (1) cared-for personscared-for persons; (2) carers’ own ; (2) carers’ own conditions or characteristics; as well as (3) to conditions or characteristics; as well as (3) to surroundings or external conditions surroundings or external conditions (i.e. infrastructure of (i.e. infrastructure of supporting services);supporting services);

Socio-medical differences between the compared Socio-medical differences between the compared disabledisabledd and dependent older people in each country and dependent older people in each country may influence or explain the differences in results from may influence or explain the differences in results from those countries;those countries;

Common methodological approach applied in Common methodological approach applied in the the EUROFAMCARE study should enable reading the EUROFAMCARE study should enable reading the results as results as representativerepresentative for each for each of the six core of the six core countrcountriesies involved involved (to some exten(to some extentt for Europe?), for Europe?), as as well as allowwell as allowinging comparisons between countriescomparisons between countries

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Aims of the presentation: Who are the dependent older people in six

European countries? How do they differ between themselves in

relation to: -age structure, gender, civil status;-living conditions;-domains of required help or support, -cognitive or behavioural disorders,-level of dependency in term of I-ADL, mobility and P-ADL

Do these differences influence the family caregivers’ situation? [for further analysis]

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Definition of Dependency, Study design & Methodology

Proxy information about disabled >65 year old persons were collected from “family member providing more than four hours of care/support a week”;

Representativeness for countries (through the recruitment of the family carers - living in a priori chosen and defined urban and rural areas/sites of each country - carried out with saturation method);

Comparability between six European countries (common: mode of carers’ recruitment, numbers of national samples, protocol of study, tool applied)

Age Structure of ELDERS (in%)

38,333,3 29 26,2

19,8 18

32,7 45,341,9 46,3

45,3 44,6

2921,4

29,1 27,534,9 37,4

65-74 75-84 85+

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Cared for sample: women by age group & Total (in%)

44

535960,5

6567

61,5

757666

727657,6

68,569,364,7

7172,9

0

10

20

30

40

50

60

70

80

PL ITA GRE UK GER SWE

65-74 75+ TOTAL

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Civil Status of ELDERS (in%)

2,9

37,629,931,232,937,239,156,4

55,662,463,66051,85638,5

2,84,81,20,75,9

1,72,543,66,453,22,6

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SWE GRE UK ITA PL GER Total

singledivorcedwidowedmarried

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ELDERS’ place of residence in relation to F.Carer (in%)

8,5

18,1

31,825,6

47,736,739,145,345,450,768,5

13,92,9

10,22,215,4

5,9

17,723

2021,5

15,711,1 34,9

24,530,9

18,114,5

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PL GRE SWE ITA UK GER Total

driving distancewalking distancethe same buildingthe same household

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Place where Elders usually live (in%)

4,82,1

93,183,887,791,496,198,799,8

109,84,5

3,71,20,2 6,22,54,10,20,10

0%

20%

40%

60%

80%

100%

PL GRE ITA UK GER SWE Total

sheltered housing, other

care home

at home

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Who do the cared for persons live with?

19,8

21,1

24,2

36,3

38,8

40,9

3,9

1,3

16,2

12,3

16,6

21,7

25,3

46,6

30,7

25,4

6,6

63

46,7

45,9

21,7

20,8

0,2

8,6

0,1

0,2

3,3

0,6

0,2

0.8

0% 20% 40% 60% 80% 100%

Poland

Italy

Greece

Sweden

UK

Germany

alone institiution with partner onlywith paid carer only with family or others

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Mean number of peopleliving with cared for person:

3,25

2,55 2,43

1,91 1,861,62

0

0,5

1

1,5

2

2,5

3

3,5

Poland Greece Italy UK Germany Sweden

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Main reasons for care in six EU Countries (in % of prevalence, and Max. Min.)

2,23,9

9,7

18,9

23,8

38,4

2,5%UK4,9%UK

29,5%ITA

19%SWE

28%PL

43,6%PL

1%PL2,2%GRE

9,7%SWE

4,9%PL5,8%GRE

18,6%ITA

0

5

10

15

20

25

30

35

40

45

50

Physical ilness/disability

Age-relateddecline

Memory/cognitivedisorders

Mobilityproblems

Sensoryproblems

Psychologicalproblems

TOTAL in six countries

Maximun

Minimum

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Requirement for help in various tasks (in % of prevalence, and Max. Min.)

35,7

65,6

78,578,879,8

82,189,491,1 52,8%GRE

78,2%ITA

88,3%GRE94,2%ITA91,7%ITA94,4%ITA95,5%ITA95,4%ITA

12,8%SWE

46,2%PL

65,5%UK70,5%UK67,4%UK

72,2%GRE

84%SWE86,3%GRE

0

10

20

30

40

50

60

70

80

90

100

Average in six countries Maximun Minimum

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Needs for Financial support by cared for persons [in %]

52,8

41,637,7

34,4 31,8

12,8

0

10

20

30

40

50

60

Financial Support

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Cognitive disorders (in%)

9,8

47,936,4

39,428,737,438,441,843,945,8

14,4

15,711,512,5

15,712,118,47,7

9,520

11,214,87,1

41,640,831,229,228,7

0%

20%

40%

60%

80%

100%

GRE UK PL ITA SWE GER Total

memory impairment & behaviour disorders

mild memory disorders

behavioural disorders without memory impairment

no problems

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Dependency of the cared for persons (Carer’s subjective perception) [in%]

33,8

103,76,78,912,41314,9

25,7

23,522,923,825,124,234,5

38,532,52039,431,6

31,2

30,534,337,937,3

23,131,2

19,4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

PL GRE UK ITA GER SWE Total

Severely dependent

Moderately dependent

Slightly dependent

Independent

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I-ADL score (min 0; max 12)& percentile distribution (n=5893)

49,3

21,9

28,8

42,6

23,7

33,7

39,4

23

37,6

32

25,6

42,4

31,7

23,2

45,1

31,1

21,2

47,7

39,2

23

39,2

PL UK GRE SWE GER ITA TOTAL

<=3 (severe).6-4 (moderately)>=7 (slightly)

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P-ADL: Barthel score (min 0;max100) & percentile distribution (N=5707;in%)

41,8

37,3

20,9

31,7

33,6

34,7

29,2

41,3

29,5

22,2

33,6

44,2

20,7

45,7

33,6

17,4

33,3

49,3

27,3

37,3

35,4

PL GRE UK ITA SWE GER TOTAL

<66 (severe)

66-90 (moderately)

>90 (slightly)

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Summary of early findings (1): In general, the cared-for older people in Europe show

similarity in terms of age structure, gender, civil status, cohabitation model and level of disability; however significant differences between countries are observed.

In all of the countries studied (to a lesser extent in Sweden) the majority of the cared-for persons were women, persons in advanced old age, widowed and living at home.

The most significant socio-demographic features differentiating the compared communities were: 1) the cared for persons’ cohabitation (with or apart from family)2) the number of persons living in the same household. Living together with numerous family is most typical in Poland and to a less extent in Greece while living apart from family predominates in other compared countries.

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Summary of early findings (2): The physical illness or disability, age-related decline,

memory/cognitive disorders or mobility problems were the main reasons for care in subjective caregivers’ opinion.

The cared-for older people show numerous and complex requirements for help and support. Amongst different kinds of need the requirement for help in terms of domestic work, emotional/social support, transportation, management of Elders’ finances, management of caring process and assistance with medication or treatment were most prevalent.

Memory and cognitive disorders were present in one third of cared-for persons in the whole sample; less often in Greece, UK and Poland and more often in Germany, Sweden and Italy.

Health status and level of disability both in subjective caregivers’ opinion as well as based on objective ADL-scales showed better indices in Poland, Greece and UK and worse in Italy, Sweden and Germany. The explanation for these differences requires further in-depth analysis.