Older Adults' and Family Caregivers' Technological Arrangements on Risk of Institutionalization
Yijung K. Kim1, Shannon Ang2 & Karen L. Fingerman1
1Texas Aging & Longevity Center, The University of Texas at Austin
We examined whether different family-level arrangements of internet use may affect the risk of institutionalization among older Medicare beneficiaries using multinominal logistic regression and inverse-probability weighted Cox proportional hazard models.
A total of 15% of care recipients moved from the community to a residential facility (i.e., assisted living, nursing home) between 2015 and 2020.
The most prevalent technological arrangement in 2015 was the one where neither the care recipient nor their caregiver reported using the internet (44%).
Relatively disadvantaged older care recipients (e.g., people of color, fewer years of education, less income, worse cognitive functioning) and caregivers (e.g., older, fewer years of education) were more likely to be in a non-internet use arrangement.
Older adults who were internet users and had a family caregiver who also used the internet in their caregiving tasks had a much lower risk of relocation.
The internet can be an important resource for older adults to age in place, potentially helping them to seek health information, boost self-management of chronic conditions, facilitate social connections, and buy goods and services. Dynamics in internet use between older adults and their family caregivers may affect both parties involved, but existing studies typically treat them as separate entities. We analyzed the National Health and Aging Trends Study (2015-2020) and National Study on Caregiving (2015) to show that sociodemographic characteristics of older adults and their family caregivers, as well as older adults’ level of cognitive functioning, mostly contributed to the differences in how families used the internet. Findings from the Cox regression model, weighted by the inverse probability of selection into technological arrangements show that having both the care recipient and the caregiver use the internet leads to the best outcome in terms of aging in place. By accounting for caregivers’ technology use in their caregiving tasks, this study foremost contributes to the efforts to describe the heterogeneity of the digital divide in later life.
Community-dwelling older adults can face considerable challenges while trying to live independently, including staying safe, socially connected, and performing certain activities of daily living on a regular basis1. The internet can be an important resource for older adults to age in place, but health-related difficulties, lack of access and knowledge in the use of technologies preclude many older adults from using the internet2-4. Support from family members may play an important role in older adults’ internet use by setting up and configuring technology, maintaining online security, and solving technical difficulties1,5. Family caregivers’ internet use is also relevant for community-dwelling older adults. Care recipients benefit when their family caregivers use computers, smartphones, and other electronic means to seek health information and make appointments with a health care provider, and coordinate care activities6-7. Approximately half of unpaid caregivers in 2020 used software or went online to help their care recipients, ranging from tracking the care recipient’s finances to searching for services, aids, facilities, or other help9.
To identify groups especially vulnerable to being digitally excluded, this project considers a set of sociodemographic and health characteristics that may be associated with the older care recipients’ own internet use and whether their family caregivers utilize the internet in their caregiving tasks (e.g., to shop, order medicines, or do banking on behalf of the care recipient.
We also examined four categories of technological arrangements between older care recipient and their family caregivers (i.e., no internet use, only caregiver use, only care recipient use, both internet use) and asks how these arrangements may affect older care recipients’ risk of relocation to a residential facility (e.g., assisted living, nursing home).
Caregivers’ and Care-recipients’ Characteristics and Technological Arrangements
Technological Arrangements and Institutionalization Risks
Figure 1. Cox Survival model estimates of older adults’ risk of relocation to a residential facility between 2015-2020 (in months) by different types of technological arrangements.
Peek, S. T., Luijkx, K. G., Rijnaard, M. D., Nieboer, M. E., van der Voort, C. S., Aarts, S., van Hoof, J., Vrijhoef, H. J., & Wouters, E. J. (2016). Older adults' reasons for using technology while aging in place. Gerontology, 62(2), 226-237.