Diverse Care Networks and Unmet Care Needs of Older Adults in a Changing America

Abstract

This dissertation consists of three papers that examine the complexity, dynamics, and stratification in care networks and unmet care needs of older adults in a changing America. For generations, most older Americans have been cared for by loved ones at home in their time of need. However, with sweeping demographic and family changes during the last several decades, care provision by immediate family (typically spouse and adult children) can no longer be assumed. Despite growing public interests in other alternatives beyond the spouse and adult children, limited research attention has been directed toward the provision of care by increasingly diverse care networks. The first paper develops a care network typology that captures the multidimensionality of care networks with a combination of different types of care, including informal care from the spouse, children, extended kin, and nonkin caregivers, formal caregiving from professional services, and self-care with assistive technologies. At the same time, demographic and family transitions are experienced unevenly across racial and ethnic groups, making minority older adults more vulnerable to structurally restricted care networks than older whites. Also, research on racial/ethnic differences in caregiving often emphasizes the role of cultural values in shaping care networks among specific subgroups of the aging population. Drawing from explanations that focus on both structural and cultural elements, the second paper investigates to what extent, racial/ethnic differences in care networks could be explained by structural and cultural factors separately, and further explores how they jointly shape diverse care networks across different racial and ethnic groups of older adults. The third paper questions whether some compositions of care networks are more effective in serving the needs of older adults, and whether others are more likely to lead to unmet care needs. Moreover, I explore how the perceived association between care networks and unmet care needs is further conditioned by race/ethnicity and gender. In the context of the declining availability of traditional caregivers, this dissertation can contribute to the understanding of which other alternatives are available and provide evidence on whether they can adequately meet the needs of older adults.