Context Projected demographic shifts in the US population over the next 50 years
will cause families, health care practitioners, and policymakers to confront
a marked increase in the number of people with disabilities living in the
community. Concerns about the adequacy of community support are particularly
salient to women, who make up a disproportionate number of disabled elderly
people and who may be particularly vulnerable because they are more likely
to live alone with limited financial resources.
Objective To address gender differences in receipt of informal and formal home
Design, Setting, and Participants Nationally representative survey conducted in 1993 among 7443 noninstitutionalized
people (4538 women and 2905 men) aged 70 years or older.
Main Outcome Measure Number of hours per week of informal (generally unpaid) and formal (generally
paid) home care received by survey participants who reported any activity
of daily living (ADL) or instrumental activity of daily living (IADL) impairment
(n = 3109) compared by gender and living arrangement and controlling for other
Results Compared with disabled men, disabled women were much more likely to
be living alone (45.4% vs 16.8%, P<.001) and much
less likely to be living with a spouse (27.8% vs 73.6%, P<.001). Overall, women received fewer hours of informal care per
week than men (15.7 hours; 95% confidence interval [CI], 14.5-16.9 vs 21.2
hours; 95% CI, 19.7-22.8). Married disabled women received many fewer hours
per week of informal home care than married disabled men (14.8 hours; 95%
CI, 13.7-15.8 vs 26.2 hours; 95% CI, 24.6-27.9). Children (>80% women) were
the dominant caregivers for disabled women while wives were the dominant caregivers
of disabled men. Gender differences in formal home care were small (2.8 hours
for women; 95% CI, 2.5-3.1 vs 2.1 hours for men; 95% CI, 1.7-2.4).
Conclusion Large gender disparities appear to exist in the receipt of informal
home care for disabled elderly people in the United States, even within married
households. Programs providing home care support for disabled elderly people
need to consider these large gender disparities and the burden they impose
on families when developing intervention strategies in the community.