Social inequalities and the wellbeing of family caregivers across European care regimes
Keywords:gender, care relations, SES, Europe, later life, SHARE, ELSA
Objective: In Europes' ageing societies, informal care is increasingly critical for fulfilling the care needs of older people. Social inequalities in informal care are, however, still poorly understood, and the (differential) wellbeing consequences of caregiving remain unclear.
Background: To this end, we provide an overview of empirical results, methodological challenges, and open questions originating from our research project IN-CARE (2019-22) that set out to assess inequalities in care and wellbeing in different care regimes. In this article, we focus on social gradients in informal care and its impact on wellbeing across European care contexts from the perspective of caregivers.
Method: Based on the data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study (ELSA) we applied different regression techniques and estimated fixed-effects models.
Results: We find a socio-economic gradient in informal care and wellbeing. Yet, we do not find socio-economic differences in the effects of caregiving on caregivers’ wellbeing across European countries with different LTC policies. Also, we observe strong gender differences in the association of caregiving with caregivers’ wellbeing within the population of 50+, which depend on different care arrangements and care regimes.
Conclusion: We conclude that gender is still the central inequality dimension in informal caregiving, linked to many other inequality dimensions, and strongly dependent on different care contexts. Thus, when designing social policies, multiple cross-level interactions and path dependencies should be considered.
Abel, J., Walter, T., Carey, L.B., Rosenberg, J., Noonan, K., Horsfall, D., Leonard, R., Rumbold, B., & Morris, D. (2013). Circles of care: Should community development redefine the practice of palliative care? BMJ Supportive & Palliative Care, 3(4): 383–388. DOI: https://doi.org/10.1136/bmjspcare-2012-000359
Albertini, M., & Pavolini, E. (2017). Unequal inequalities: The stratification of the use of formal care among older Europeans. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 72(3): 510–521.
Anttonen, A., & Sipilä, J. (1996). European social care services: Is it possible to identify models? Journal of European Social Policy, 6(2): 87–100. DOI: https://doi.org/10.1177/095892879600600201
Bertogg, A., & Strauss, S. (2020). Spousal care-giving arrangements in Europe. The role of gender, socio-economic status and the welfare state. Ageing and Society, 40(4): 735–758. DOI: https://doi.org/10.1017/S0144686X18001320
Bonaccio, M., Di Castelnuovo, A., de Gaetano, G., & Iacoviello, L. (2020). Socioeconomic gradient in health: Mind the gap in ‘invisible’ disparities. Annals of Translational Medicine, 8(18): 1200–1200. DOI: https://doi.org/10.21037/atm.2020.04.46
Börsch-Supan, A., Brandt, M., Hunkler, C., Kneip, T., Korbmacher, J., Malter, F., et al. (2013). Data resource profile: the Survey of Health, Ageing and Retirement in Europe (SHARE). International Journal of Epidemiology, 42(4): 992–1001. DOI: https://doi.org/10.1093/ije/dyt088
Brandt, M., Kaschowitz, J., & Quashie, N.T. (2022). Socioeconomic inequalities in the wellbeing of informal caregivers across Europe. Aging & Mental Health, 26(8): 1589–1596. DOI: https://doi.org/10.1080/13607863.2021.1926425
Broese van Groenou, M., & De Boer, A. (2016). Providing informal care in a changing society. European Journal of Ageing, 13(3): 271–279. DOI: https://doi.org/10.1007/s10433-016-0370-7
Broese van Groenou, M., Jacobs, M., Zwart-Olde, I., & Deeg, D.J.H. (2016). Mixed care networks of community-dwelling older adults with physical health impairments in the Netherlands. Health & Social Care in the Community, 24(1): 95–104. DOI: https://doi.org/10.1111/hsc.12199
Calasanti, T., & King, N. (2007). Taking ‘women’s work’ ‘like a man’: Husbands’ experiences of care work. The Gerontologist, 47(4): 516–527. DOI: https://doi.org/10.1093/geront/47.4.516
Eggers, T., & Grages, C. (2023). Social risks of family carers in the context of welfare state policies. Working paper.
Eggers, T., Grages, C., Pfau-Effinger, B., & Och, R. (2020). Re-conceptualising the relationship between de-familialisation and familialisation and the implications for gender equality – the case of long-term care policies for older people. Ageing and Society, 40(4): 869–895. DOI: https://doi.org/10.1017/S0144686X18001435
Esping-Andersen, G. (1999). Social foundations of postindustrial economies. Oxford Univ. Press. DOI: https://doi.org/10.1093/0198742002.001.0001
Floridi, G., Quashie, N.T., Glaser, K., & Brandt, M. (2022). Partner care arrangements and well-being in mid- and later life: The role of gender across care contexts. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 77(2): 435–445. DOI: https://doi.org/10.1093/geronb/gbab209
Frericks, P. (2023). Familial long-term care and its coverage in European pension systems. Working paper.
Frericks, P., Jensen, P.H., & Pfau-Effinger, B. (2014). Social rights and employment rights related to family care: Family care regimes in Europe. Journal of Aging Studies, 29: 66–77. DOI: https://doi.org/10.1016/j.jaging.2013.12.002
Gomez-Leon, M., Evandrou, M., Falkingham, J., & Vlachantoni, A. (2019). The dynamics of social care and employment in mid-life. Ageing and Society, 39(2): 381–408. DOI: https://doi.org/10.1017/S0144686X17000964
Haggard, S., & Kaufman, R.R. (2008). Development, democracy, and welfare states: Latin America, East Asia, and Eastern Europe. Princeton University Press. DOI: https://doi.org/10.1515/9780691214153
Harper, S. (2014). Economic and social implications of aging societies. Science, 346(6209): 587–591. DOI: https://doi.org/10.1126/science.1254405
Heidemann, R., Brandt, M., & Lazarevic, P. (2023, forthcoming). Healthy aging around the globe? Possibilities and challenges in international comparative research on aging. Research Handbook on the Sociology of Ageing.
Herlofson, K., & Brandt, M. (2020). Helping older parents in Europe: The importance of grandparenthood, gender and care regime. European Societies, 22(3): 390–410. DOI: https://doi.org/10.1080/14616696.2019.1694163
Hess, M., Schmitz, W., Naegele, L., & Stiemke, P. (2023). You will take care of me when I am old: Norms on children’s caregiver obligations – An analysis with data from the European Values Study. Journal of Family Research, 35.
Jivraj, S., & Nazroo, J. (2014). Determinants of socioeconomic inequalities in subjective well-being in later life: a cross-country comparison in England and the USA. Quality of Life Research, 23(9): 2545–2558. DOI: https://doi.org/10.1007/s11136-014-0694-8
Jolanki, O., Eskola, P., & Aaltonen, M. (2023). People with memory illness and their spouses as actors in the world of hybrid care model in Finnish elder care – positioning analysis. Working paper.
Kaschowitz, J., & Brandt, M. (2017). Health effects of informal caregiving across Europe: A longitudinal approach. Social Science & Medicine, 173: 72–80. DOI: https://doi.org/10.1016/j.socscimed.2016.11.036
Kröger, T., Puthenparambil, J.M., & van Aerschot, L. (2019). Care poverty: Unmet care needs in a Nordic welfare state. International Journal of Care and Caring, 3(4): 485–500. DOI: https://doi.org/10.1332/239788219X15641291564296
Leitner, S. (2003). Varieties of Familialism: The Caring Function of the Family in Comparative Perspective. European Societies, 5(4): 353–375. DOI: https://doi.org/10.1080/1461669032000127642
Lewis, J. (1992). Gender and the Development of Welfare Regimes. Journal of European Social Policy, 2(3), 159–173. https://doi.org/10.1177/095892879200200301Liu, Z., Heffernan, C., & Tan, J. (2020). Caregiver burden: A concept analysis. International Journal of Nursing Sciences, 7(4): 438–445. DOI: https://doi.org/10.1016/j.ijnss.2020.07.012
Pearlin, L.I., Mullan, J.T., Semple, S.J., & Skaff, M.M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5): 583–594. DOI: https://doi.org/10.1093/geront/30.5.583
Pinquart, M., & Sörensen, S. (2000). Influences of socioeconomic status, social network, and competence on subjective well-being in later life: A meta-analysis. Psychology and Aging, 15(2): 187–224. DOI: https://doi.org/10.1037/0882-7918.104.22.168
Pinquart, M., & Sörensen, S. (2006). Gender differences in caregiver stressors, social resources, and health: An updated meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(1): P33–P45. DOI: https://doi.org/10.1093/geronb/61.1.P33
Quashie, N.T., Wagner, M., Verbakel, E., & Deindl, C. (2022). Socioeconomic differences in informal caregiving in Europe. European Journal of Ageing, 19: 621–632. DOI: https://doi.org/10.1007/s10433-021-00666-y
Renyi, M., Gaugisch, P., Hunck, A., Strunck, S., Kunze, C., & Teuteberg, F. (2022). Uncovering the complexity of care networks – towards a taxonomy of collaboration complexity in homecare. Computer Supported Cooperative Work (CSCW). DOI: https://doi.org/10.1007/s10606-022-09433-8
Roland, K.P., & Chappell, N.L. (2019). Caregiver experiences across three neurodegenerative diseases: Alzheimer’s, Parkinson’s, and Parkinson’s with Dementia. Journal of Aging and Health, 31(2): 256–279. DOI: https://doi.org/10.1177/0898264317729980
Saraceno, C. (2016). Varieties of familialism: Comparing four Southern European and East Asian welfare regimes: Journal of European Social Policy, 26(4): 314–326. DOI: https://doi.org/10.1177/0958928716657275
Saraceno, C., & Keck, W. (2011). Towards an integrated approach for the analysis of gender equity in policies supporting paid work and care responsibilities. Demographic Research, 25: 371–406. DOI: https://doi.org/10.4054/DemRes.2011.25.11
Schmid, T., Brandt, M., & Haberkern, K. (2012). Gendered support to older parents: Do welfare states matter? European Journal of Ageing, 9(1): 39–50.1 DOI: https://doi.org/10.1007/s10433-011-0197-1
Schmitz, A., & Brandt, M. (2022). Health limitations, regional care infrastructure and wellbeing in later life: A multilevel analysis of 96 European regions. Social Indicators Research, 164: 693-709. DOI: https://doi.org/10.1007/s11205-022-02967-w
Schmitz, H., & Westphal, M. (2017). Informal care and long-term labor market outcomes. Journal of Health Economics 56: 1–18. DOI: https://doi.org/10.1016/j.jhealeco.2017.09.002
Steptoe, A., Breeze, E., Banks, J., & Nazroo, J. (2013). Cohort profile: The English Longitudinal Study of Ageing. International Journal of Epidemiology, 42(6): 1640–1648. DOI: https://doi.org/10.1093/ije/dys168
Tough, H., Brinkhof, M.W., Siegrist, J., Fekete, C., & SwiSCI Study Group. (2020). Social inequalities in the burden of care: A dyadic analysis in the caregiving partners of persons with a physical disability. International journal for equity in health, 19(1): 3. DOI: https://doi.org/10.1186/s12939-019-1112-1
United Nations. (2016). Briefing Paper: Growing need for long-term care: Assumptions and realities. https://www.un.org/development/desa/ageing/news/2016/09/briefing-paper-growing-need-for-long-term-care-assumptions-and-realities/ [retrieved July 13, 2022]
Verbakel, E. (2014). Informal caregiving and well-being in Europe: What can ease the negative consequences for caregivers? Journal of European Social Policy, 24(5): 424–441. DOI: https://doi.org/10.1177/0958928714543902
Verbakel, E., Glaser, K., Amzour, Y., Brandt, M., & Broese van Groenou, M. (2022). Indicators of familialism and defamilialization in long-term care: A theoretical overview and introduction of macro-level indicators. Journal of European Social Policy, online first. DOI: https://doi.org/10.1177/09589287221115669
Verbakel, E., Metzelthin, S.F., & Kempen, G.I.J.M. (2018). Caregiving to older adults: Determinants of informal caregivers’ subjective well-being and formal and informal support as alleviating conditions. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 73(6): 1099–1111.
Wagner, M., & Brandt, M. (2018). Long-term care provision and the well-being of spousal caregivers: An analysis of 138 European regions. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 73(4): e24–e34. DOI: https://doi.org/10.1093/geronb/gbx133
Wallace, S.P. (1990). The no-care zone: Availability, accessibility, and acceptability in community-based long-term care. The Gerontologist, 30(2): 254–261. DOI: https://doi.org/10.1093/geront/30.2.254
WHO. (2021). Decade of healthy ageing. Baseline report. https://www.who.int/publications/i/item/9789240017900 [retrieved July 13, 2022]
Wilkinson, R.G., & Pickett, K.E. (2009). Income inequality and social dysfunction. Annual Review of Sociology, 35: 493–511. DOI: https://doi.org/10.1146/annurev-soc-070308-115926
How to Cite
This work is licensed under a Creative Commons Attribution 4.0 International License.