Daniel Lüdecke

The Impact of Sociodemographic Factors on the Utilisation of Support Services for Family Caregivers of Elderly Dependents – Results from the German Sample of the EUROFAMCARE Study

Objectives: As in nearly all European countries, demographic developments in Germany have led to both a relative and an absolute increase in the country’s elderly population. The care and support needed by these people is primarily provided by relatives or friends and close acquaintances within the home environment. The major challenges for society are to sustain, promote and support these informal resources. In order to achieve this, it is crucial that family caregivers are provided with situation-specific services that support them and relieve their burden of care. The major challenges for society are therefore to sustain, promote and support informal resources and to provide the opportunity for the use of services aimed at assisting and relieving the burden of family caregivers. Methods: In the context of the EUROFAMCARE study, 1,003 family caregivers from Germany were interviewed at home about their experiences using a standardized questionnaire. Included in the study were primary caregivers providing at least four hours of personal care or support per week to a relative aged 65 years or older. Subjects solely providing financial support were excluded. In this paper, a linear regression analysis has been conducted to analyse impact of sociodemographic factors on the utilisation of support services. Results: The family caregivers were 54 years on average (SD=13.4), 76% of them were female. The dependent elderly were 80 years on average (SD=8.3), and 69% of them were women. 60% of them were receiving long-term care insurance benefits. Use of support services aimed directly at family caregivers is very low. After including certain services aimed primarily at those in need of care but also often serving as a source of relief for family caregivers, the percentage of caregivers using support services increased slightly. Among sociodemographic characteristics, caregivers’ gender and education level have the greatest influence on services use. Other influential factors are caregivers’ perception of their caregiving burden and their assessment of the dependent family member’s need for assistance and support.

Emotional reactions toward people with dementia – results of a population survey from Germany

BACKGROUND Emotional reactions toward people with disorders are an important component of stigma process. In this study, emotional reactions of the German public toward people with dementia were analyzed. METHODS Analyses are based on a national mail survey conducted in 2012. Sample consists of persons aged 18 to 79 years living in private households in Germany. In all 1,795 persons filled out the questionnaire, reflecting a response rate of 78%. Respondents were asked about their emotional reactions and beliefs about dementia. RESULTS A vast majority of the respondents expressed pro-social reactions, i.e. they felt pity, sympathy, and the need to help a person with dementia. Dementia patients rarely evoked anger (10% or less). Between 25% and 50% of the population showed reactions indicating fear. Respondents who had contacts with a person having dementia or had cared for a dementia patient tended to show less negative reactions (fear, anger) and more pro-social reactions. Respondents who showed pronounced fearful reactions were less likely to believe that dementia patients had a high quality of life, were less willing to care for a family member with dementia at home, and were more skeptical about early detection of dementia. Comparison with the results of another study suggests that fearful reactions toward persons with dementia are much more pronounced than in the case of depression, and less pronounced than in the case of schizophrenia. CONCLUSIONS Fearful reactions toward people with dementia are quite common in the German general public. To reduce fear, educational programs and contact-based approaches should be considered.

Socioeconomic status and health-related quality of life among patients with prostate cancer 6 months after radical prostatectomy: a longitudinal analysis

Objectives To identify the associations between socioeconomic status (SES) and health-related quality of life (HRQOL) and the explanatory contribution of disease, patient and healthcare factors among patients with prostate cancer. Design Prospective cohort study. Setting and participants In all, 246 patients from 2 hospitals in Hamburg/Germany who underwent radical prostatectomy completed a questionnaire shortly before discharge from hospital and again 6 months later. Outcome measures HRQOL as assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C-30 including global quality of life, 5 functional scales and 9 symptom scales/items. Generalised estimating equations were calculated to analyse longitudinal data. Results Lower SES measured by income, education and occupational status is significantly associated with lower HRQOL 6 months after treatment. This especially holds true for the functional scales. After introducing disease, patient and healthcare factors, associations remain significant in the majority of cases. The explanatory contribution of patient factors such as comorbidity or psychosocial characteristics and of healthcare factors is slightly stronger than that of disease factors. Conclusions We identified strong social inequalities in HRQOL among patients with prostate cancer 6 months after surgery, in Germany. The underlying causes could not be sufficiently identified, and further research regarding these associations and their explanatory factors is needed.

The impact of care on family and health-related quality of life of parents with chronically ill and disabled children

Abstract Purpose: Parents of disabled and/or chronically ill children are more vulnerable regarding their health compared to parents of healthy children. This study examines how far the burden of care is associated with health-related quality of life (QoL) in parents, across different illnesses and disabilities. Moreover, it is unclear whether and to which extent familial resources can explain the association between parents’ care burden and health. Method: Data stem from a survey with the German Children’s Network, a self-help umbrella organization of parents and families of chronically ill and disabled children. Data collection was conducted nationwide with a standardized online questionnaire, which included children’s diagnoses and severity, burden of care, family and socioeconomic status, health-related QoL (SF-12) and family impact (Impact on Family Scale, IFS). 1567 parents participated. Results: A higher burden of care is associated with higher risks for poor health-related QoL. Especially, social impact and financial burden, which are both associated with care, can help to explain these associations. Conclusions: Future interventions should focus not only on the affected child but also on the whole family system and its social integration, as this seems likely to relief parents from burden of care. Therefore, a sustainable cooperation of health care institutions and professionals with self-help groups and parental initiatives is recommended. Implications for Rehabilitation Parents of disabled and chronically ill children are a vulnerable group regarding their health-related quality of life. A higher burden of care is associated with less social contacts, higher financial burden and higher help-needs in the household, which significantly contribute to higher health risks. Rehabilitation should take these constraints into account and put a stronger focus on the family of disabled and chronically ill children to support their inclusion. A sustainable and formally anchored collaboration with self-help and patient groups is recommended.

Income, financial barriers to health care and public health expenditure: A multilevel analysis of 28 countries

International studies have repeatedly shown that people with lower income are more likely to experience difficulties to access medical services. Less is known on why these relations vary across countries. This study investigates whether the association between income and financial barriers to health care is influenced by national public health expenditures (PHE, in % of total health expenditure). Data from the International Social Survey Programme (2011) was used (28 countries, 23,669 respondents). Financial barriers were assessed by the individual experience of forgone care due to financial reasons. Monthly equivalent household income was included as the main predictor. Other individual-level control variables were age, gender, education, subjective health, insurance coverage and place of living. PHE was considered as a macro-level predictor, adjusted for total health expenditure. Statistically significant associations between income and forgone care were found in 21 of 28 examined countries. Multilevel analyses across countries revealed that people with lower income have a higher likelihood to forgo needed medical care (OR: 3.94, 95%-CI: 2.96-5.24). After adjustments for individual-level covariates, this association slightly decreased (OR: 2.94, 95%-CI: 2.16-3.99). PHE did not moderate the relation between income and forgone care. The linkage between health system financing and inequalities in access to health care seems to be more complex than initially assumed, pointing towards further research to explore how PHE affects the redistribution of health resources in different health care systems.

Income and functional limitations among the aged in Europe: a trend analysis in 16 countries

Background Analyses are focused on 3 research questions: (1) Are there absolute and relative income-related inequalities in functional limitations among the aged in Europe? (2) Did the absolute and relative income-related inequalities in functional limitations among the aged change between 2002 and 2014? (3) Are there differences in the changes of income-related inequalities between European countries? Methods Data stem from 7 waves (2002–2014) of the European Social Survey. Samples of people aged 60 years or older from 16 European countries were analysed (N=63 024). Inequalities were measured by means of absolute prevalence rate differences and relative prevalence rate ratios of low versus high income. Meta-analyses with random-effect models were used to study the trends of inequalities in functional limitations over time. Results Functional limitations among people aged 60 years or older declined between 2002 and 2014 in most of the 16 European countries. Older people with a low income had higher rates of functional limitations and elevated rate ratios compared with people with high income. These inequalities were significant in many countries and were more pronounced among men than among women. Overall, absolute and relative income-related inequalities increased between 2002 and 2014, especially in Ireland, the Netherlands and Sweden. Conclusions High-income groups are more in favour of the observed overall decline in functional limitations than deprived groups. Results point to potential income-related inequalities in compression of morbidity in the recent past in Europe.

For better or worse : Factors predicting outcomes of family care of older people over a one-year period. A six-country European study

Objectives Demographic change has led to an increase of older people in need of long-term care in nearly all European countries. Informal carers primarily provide the care and support needed by dependent people. The supply and willingness of individuals to act as carers are critical to sustain informal care resources as part of the home health care provision. This paper describes a longitudinal study of informal care in six European countries and reports analyses that determine those factors predicting the outcomes of family care over a one-year period. Methods Analyses are based on data from the EUROFAMCARE project, a longitudinal survey study of family carers of older people with baseline data collection in 2004 and follow-up data collection a year later in six European countries (Germany, Greece, Italy, Poland, Sweden, and the United Kingdom), N = 3,348. Descriptive statistics of the sample characteristics are reported. Binary logistic random-intercept regressions were computed, predicting the outcome of change of the care dyad’s status at follow-up. Results Where care is provided by a more distant family member or by a friend or neighbour, the care-recipient is significantly more likely to be cared for by someone else (OR 1.62) or to be in residential care (OR 3.37) after one year. The same holds true if the care-recipient has memory problems with a dementia diagnosis (OR 1.79/OR 1.84). Higher dependency (OR 1.22) and behavioural problems (OR 1.76) in the care-recipient also lead to a change of care dyad status. Country of residence explained a relatively small amount of variance (8%) in whether a care-recipient was cared for by someone else after one year, but explained a substantial amount of variance (52%) in whether a care-recipient was in residential care. Particularly in Sweden, care-recipients are much more likely to be cared for by another family or professional carer or to be in residential care, whereas in Greece the status of the care dyad is much less likely to change. Discussion The majority of family carers continued to provide care to their respective older relatives over a one-year period, despite often high levels of functional, cognitive and behavioural problems in the care-recipient. Those family carers could benefit most from appropriate support. The carer/care-recipient relationship plays an important role in whether or not a family care dyad remains intact over a one-year period. The support of health and social care services should be particularly targeted toward those care dyads where there is no partner or spouse acting as carer, or no extended family network that might absorb the caring role when required. Distant relatives, friends or acquaintances who are acting as carers might need substantial intervention if their caregiving role is to be maintained.

ggeffects: Tidy Data Frames of Marginal Effects from Regression Models.

Results of regression models, like estimates, are typically presented as tables that are easy to understand. Sometimes pure estimates are not helpful and difficult to interpret. This is especially true for interaction terms in logistic regression or even more complex models, or transformed terms (quadratic or cubic terms, polynomials, splines), where the estimates are no longer interpretable in a direct way. In such cases, marginal effects are far easier to understand. In particular, the visualization of marginal effects makes it possible to intuitively get the idea of how predictors and outcome are associated, even for complex models.

Social relationships and GP use of middle-aged and older adults in Europe: a moderator analysis

Objectives This paper investigates (1) how social relationships (SRs) relate to the frequency of general practitioner (GP) visits among middle-aged and older adults in Europe, (2) if SRs moderate the association between self-rated health and GP visits, and (3) how the associations vary regarding employment status. Methods Data stem from the Survey of Health, Ageing and Retirement in Europe project (wave 4, 56 989 respondents, 50 years or older). GP use was assessed by frequency of contacts with GPs in the last 12 months. Predictors were self-rated health and structural (Social Integration Index (SII), social contact frequency) and functional (emotional closeness) aspects of SR. Regressions were used to measure the associations between GP use and those predictors. Sociodemographic and socioeconomic factors were used as covariates. Additional models were computed with interactions. Results Analyses did not reveal significant associations of functional and structural aspects of SR with frequency of GP visits (SII: incidence rate ratio (IRR)=0.99, 95% CI 0.97 to 1.01, social contact frequency: IRR=1.04, 95% CI 1.00 to 1.07, emotional closeness: IRR=1.02, 95% CI 1.00 to 1.04). Moderator analyses showed that ‘high social contact frequency people’ with better health had more statistically significant GP visits than ‘low social contact frequency people’ with better health. Furthermore, people with poor health and an emotionally close network showed a significantly higher number of GP visits compared with people with same health, but less close networks. Three-way interaction analyses indicated employment status specific behavioural patterns with regard to SR and GP use, but coefficients were mostly not significant. All in all, the not employed groups showed a higher number of GP visits. Conclusions Different indicators of SR showed statistically insignificantly associations with GP visits. Consequently, the relevance of SR may be rated rather low in quantitative terms for investigating GP use behaviour of middle-aged and older adults in Europe. Nevertheless, investigating the two-way and three-way interactions indicated potential inequalities in GP use due to different characteristics of SR accounting for health and employment status.

How Do Socioeconomic Factors Influence the Amount and Intensity of Service Utilization by Family Caregivers of Elderly Dependents

Objectives In the course of demographic change, there is both a relative and an absolute increase in countries’ elderly population. Care and support needed by older dependent people are primarily provided by relatives or friends within the home environment. Family caregivers can be supported by specific services aiming to relieve their burden of care. The EUROFAMCARE project provides an overview of the situation of family caregivers of elderly dependents in Europe in terms of the existence, awareness, availability, use, and acceptance of support services. This article provides results of the German survey.