Trends in the relationship between formal and informal care of older people with functional dependencies living at home in Great Britain (1980-2001)

The number of older Britons needing assistance with Activities of Daily Living (ADL) such as washing, dressing, cooking and cleaning has increased considerably in the past 25 years. Most care is provided by ‘informal unpaid’ caregivers, predominantly close relatives and friends, but some also receive assistance from health and social services or pay for help privately. This research examined ‘how’ and ‘why’ the relationship between formal and informal care for functionally dependent older people living at home in Britain changed between 1980 and 2001. Methods Data were restricted to people aged 65 and over who responded to the Elderly People in Private Households ‘trailers’ in six General Household Survey (GHS) years (1980, 1985, 1991, 1994, 1998, and 2001) and who reported at least one functional limitation (N=5,513). Seven typologies of care were constructed using combinations of Primary and Instrumental Activities of Daily Living (PADLs and IADLs) and specific source(s) of care (eg. spouse/partner, health and social services). GHS data combined with publicly available health and social services data was pooled and analysed. Government Actuary’s Department (GAD) population estimates were used to estimate the number of older people falling into each typology of care. Multivariate statistical analyses were then used to establish the most important predictors of different typologies of care over time. Results and Conclusions Increasing numbers of older people received care solely from informal caregiving networks and paid private help, with fewer numbers receiving support from health and local authorities. Individual and household predictors (eg. age group and living arrangement), period (eg. sample year) and need variables (eg. level of dependency) played a greater role than system-level (eg. community care staff) variables.