Abstract
Support to frail elders is of international and growing importance. This article compared receipt of assistance with ADL limitations, home health help, any assistance received, and unmet needs in functionally impaired individuals aged 70 years old or older in the United States (n = 1847, 80% women, M age = 80 years) and Great Britain (n = 1203, 57% women, M age = 78 years). Informal and formal assistance levels were higher in Great Britain, and rates of unmet need did not differ across ADL domains measured. Receipt of formal and informal care were associated positively, which is consistent with both supplementary and complementary perspectives on the formal-informal care interface. Few individuals in either country received formal services alone. Results suggest that community-based formal support does not substitute for family help. Implications for family and economic policy are discussed.
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Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208-220.
Andersen, R., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Millbank Memorial Fund Quarterly, 51(1), 95-124.
Arber, S., Gilbert, G. N., & Evandrou, M. (1988). Gender, household composition and receipt of domiciliary services by elderly disabled people. Journal of Social Policy, 17(2), 153-175.
Béland, F. (1989). Patterns of health and social service utilization. Canadian Journal on Aging, 8, 19-33.
Branch, L. G., & Jette, A. M. (1983). Elders' use of informal long-term care assistance. The Gerontologist, 23(1), 51-56.
Branch, L., Jette, A., Evashwick, C., Polansky, M., Rowe, G., & Diehr, P. (1981) Toward understanding elders' health service utilization. Journal of Community Health, 7(2), 80-92.
Branch, L. G., Wetle, T. T., Scherr, P. A., Cook, N. R., Evans, D. A., Hebert, L. E., Masland, E. N., Keough, M. E., & Taylor, J. O. (1988). A prospective study of incident comprehensive medical home care use among the elderly. American Journal of Public Health, 78(3), 255-259.
Cantor, M. H. (1979). Neighbors and friends: An overlooked resource in the informal support system. Research on Aging, 1(4), 434-463.
Cantor, M. H. (1980). The informal support system: Its relevance in the lives of the elderly. In E. T. Borgatta & N. G. McCluskey (Eds.), Aging and Society (pp. 131-144). Beverly Hills, CA: Sage.
Cantor, M. H. (1991). Family and community: Changing roles in an aging society. The Gerontologist, 31(3), 337-346.
Chappell, N. L., & Guse, L. W. (1989). Linkages between informal and formal support. In K. S. Markides & C. L. Cooper (Eds.), Aging, stress, and health (pp. 219-237). New York: Wiley.
Chappell, N. L. (1992). Informal support and aging. Toronto: Butterworths.
Chappell, N. L., & Blandford, A. (1991). Informal and formal care: Exploring the complementarity. Ageing and Society, 11(3), 299-315.
Clark, R. F. (1996). Home and community-based care for the elderly: The U.S. example. Canadian Journal on Aging, 15, 91-102.
Clarke, L. (1995). Family care and changing family structure: Bad news for the elderly? In I. Allen & E. Perkins (Eds.), The future of family care for older people (pp. 19-49). London: HMSO.
Coulton, C., & Frost, A. K. (1982). Use of social and health services by the elderly. Journal of Health and Social Behavior, 23(4), 330-339.
Davey, A., Femia, E. E., Shea, D. G., Zarit, S. H., Sundström, G., Berg, S., & Smyer, M. A. (1999). How many elders receive assistance? A cross-national comparison. Journal of Aging and Health, 11(2), 199-220.
Denton, M. (1997). The linkages between informal and formal care of the elderly. Canadian Journal of Aging, 16, 30-50.
Evashwick, C., Rowe, G., Diehr, P., & Branch, L. (1984). Factors explaining the use of health care services by the elderly. Health Services Research, 19(3), 357-382.
Evers, A., & Svetlik, I. (1993). Balancing pluralism: New welfare mixes in care for the elderly. Aldershot: Avebury.
Femia, E. E., Davey, A., Shea, D. G., Zarit, S. H., Berg, S., Sundström, G., & Smyer, M. A. (1997, November). Formal and informal help for people at risk of institutionalization in the United States and Sweden. Paper presented at the Annual Scientific Meeting of the Gerontological Society of America, Cincinnati, OH.
Grundy, E., & Harrop, A. (1992). Co-residence between adult children and their elderly parents in England and Wales. Journal of Social Policy, 21(3), 325-348.
Horowitz, A. (1985). Family caregiving to the frail elderly. In M. P. Lawton & G. Maddox (Eds.), Annual review of gerontology and geriatrics (pp. 194-246). New York: Springer.
Jani-Le Bris, H. (1993). Family care of dependent older people in the European Community. Dublin: European Foundation for the Improvement of Living and Working Conditions.
Jette, A. M. (1994). How measurement techniques influence estimates of disability in older populations. Social Science & Medicine, 38(7), 937-942.
Kemper, P. (1992). The use of formal and informal home care by the disabled elderly. Health Services Research, 27(4), 421-451.
Kivett, V. R. (1985). Consanguinity and kin level: Their relative importance to the helping network of older adults. Journal of Gerontology, 40(2), 228-234.
Litwak, E. (1985). Helping the elderly: The complementary roles of informal networks and formal systems. New York: Guilford.
Litwak, E., & Kulis, S. (1987). Technology, proximity, and measures of kin support. Journal of Marriage and the Family, 49(3), 649-661.
MaloneBeach, E. E., Zarit, S. H., & Spore, D. L. (1992). Caregivers' perceptions of case management and community-based services: Barriers to services use. Journal of Applied Gerontology, 11, 146-159.
McAuley, W. J., & Arling, G. (1984). Use of in-home care by very old people. Journal of Health and Social Behavior, 25(1), 54-64.
Means, R. & Smith, R. (1994). Community: Policy and practice. London: MacMillan.
Mindel, C. H., Wright, R., & Starrett, R. A. (1986). Informal and formal health and social support systems of Black and White elderly: A comparative cost approach. The Gerontologist, 26, 279-285.
Mishra, R. (1990). The welfare state in capitalist society: Policies of retrenchment and maintenance in Europe, North America and Australia. Hemel Hempstead: Harvester Wheatsheaf.
Noelker, L. S., & Bass, D. M. (1989). Home care for elderly persons: Linkages between formal and informal caregivers. Journal of Gerontology, 44, S63-S70.
Office of Population Censuses and Surveys Social Survey Division, General Household Survey, 1994–1995 [computer file]. Colchester, Essex: The Data Archive [distributor], 13 May 1996, SN: 3538.
Organization for Economic and Cooperative Development. (1994). Caring for frail elderly people: New directions in care (Social Policy Studies No. 14). Paris: Author.
Organization for Economic and Cooperative Development. (1996a). Caring for frail elderly people: Policies in evolution (Social Policy Studies No. 19). Paris: Author.
Organization for Economic and Cooperative Development. (1996b). Ageing in OECD countries: A critical policy challenge (Social Policy Studies No. 20). Paris: Author.
Office of Population Censuses and Surveys. (1996). Living in Britain: Results from the 1994 General Household Survey. London: HMSO.
Penning, M. J. (1990). Receipt of assistance by elderly people: Hierarchical selection and task specificity. The Gerontologist, 30(2), 220-227.
Penning, M. J., & Chappell, N. L. (1990). Self-care in relation to informal and formal care. Ageing and Society, 10(1), 41-59.
Pezzin, L. E., Kemper, P., & Reschovsky, J. (1996). Does publicly provided home care substitute for family care? Experimental evidence with endogenous living arrangements. Journal of Human Resources, 31(3), 650-676.
Richards, E., Wilsdon, T., & Lyons, S. (1996). Paying for long-term care. London: IPPR.
Shanas, E. (1979). The family as a SOCIAL support system in old age. The Gerontologist, 19(2), 169-174.
Silverstein, M., & Litwak, E. (1993). A task-specific typology of intergenerational family structure in later life. The Gerontologist, 33(2), 258-264.
Soldo, B. J., Agree, E. M., & Wolf, D. A. (1989). The balance between formal and informal care. In M. G. Org & K. Bond (Eds.), Aging and health care (pp. 193-216). New York: Routledge.
Soldo, B. J., Wolf, D. A., & Agree, E. M. (1990). Family, households, and care arrangements of frail older women: A structural analysis. Journal of Gerontology, 45, S238-S249.
Soldo, B. J., Hurd, M. D., Rodgers, W. L., & Wallace, R. B. (1997). Asset and Health Dynamics Among the Oldest Old: An overview of the AHEAD study. Journal of Gerontology, 52B, 1-20.
Stoller, E. P. (1983). Parental caregiving by adult children. Journal of Marriage and the Family, 45, 851-858.
Stoller, E. P. (1989). Formal services and informal helping: The myth of service substitution. Journal of Applied Gerontology, 8, 37-52.
Stoller, E. P., & Earl, L. L. (1983). Help with activities of everyday life: Sources of support for the noninstitutionalized elderly. The Gerontologist, 23, 64-70.
Stoller, E. P., & Pugliesi, K. L. (1991). Size and effectiveness of informal helping networks: A panel study of older people in the community. Journal of Health and Social Behavior, 32(2), 180-191.
Tennstedt, S. L., Crawford, S. L., & McKinlay, J. B. (1993). Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care. The Millbank Quarterly, 71(4), 601-624.
Tennstedt, S. L., & McKinlay, J. B. (1989). Informal care for frail older persons. In M. G. Ory & K. Bond (Eds.), Aging and health care (pp. 145-161). London: Routledge.
Tennstedt, S. L., McKinlay, J. B., & Kasten, L. (1994). Unmet need among disabled elders: A problem in access to community long term care? Social Science and Medicine, 38(7), 915-924.
Tester, S. (1996). Community care for older people. Basingstoke: MacMillan.
Van Nostrand, J. F. (1996). The focus of long-term care in the United States: Nursing home care. Canadian Journal on Aging, 15, 73-90.
Victor, C. R. (1991). Health and health care in later life. London: Open University.
Walker, A., & Maltby, T. (1997). Ageing Europe. Buckingham: Open University Press.
Wistow, G. (1996). The changing scene in Britain. In T. Harding, B. Meredith, & G. Wistow (Eds.), Options for Long Term Care: Economic, Social and Ethical Choices (pp. 61-79). London: HMSO.
Zarit, S. H., & Eggebeen, D. J. (1995). Parent-child relationships in adulthood and old age. In M. H. Bornstein (Ed.), Handbook of parenting: Vol. 1, Children and parenting (pp. 119-140). Mahwah, NJ: Erlbaum.
Zarit, S. H., Davey, A., Edwards, A. B., Femia, E. E., & Jarrott, S. E. (1998). Family caregiving: Research findings and clinical implications. In A. S. Bellack & M. Hersen (Series Eds.) & B. A. Edelstein (Vol. Ed.), Comprehensive clinical psychology: Vol. 7. Clinical geropsychology (pp. 499-523). Oxford, UK: Elsevier Science.
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Davey, A., Patsios, D. Formal and Informal Community Care to Older Adults: Comparative Analysis of the United States and Great Britain. Journal of Family and Economic Issues 20, 271–299 (1999). https://doi.org/10.1023/A:1022957426159
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DOI: https://doi.org/10.1023/A:1022957426159