Determinants of the supply of informal care to the frail elderly

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Social Sciences


Vernon L. Greene


caregiving, elderly

Subject Categories

Geriatric Nursing


Informal care provided by family and friends is important in maintaining the impaired elderly in the community, reducing their risk of institutionalization, and promoting autonomous living. Thus, this source of care is an important consideration in planning and developing community long-term care policies and programs. The potential of this source of care as a long-term care resource is limited, however, considering the lack of information concerning the relative importance of factors that affect the provision of this type of care.

The purpose of the study is to explore the role of informal caregivers in the care of community-dwelling frail elderly people and to determine the role of predisposing, enabling, and need factors in explaining the variability of care provided.

This study uses data from the National Long Term Care Channeling Demonstration (NLTCCD) to model, cross-sectionally, informal service provision among caregivers to the frail elderly, using the Andersen behavioral model of health services utilization as an analytical framework. Applicants to the NLTCCD were a relatively frail elderly population assessed to be at high risk of nursing home use. A multivariate prediction model of aggregate assistance was specified and estimated with supply of care (measured as average hours of informal care per day) as the dependent variable.

In predicting informal care supply, all three factors (predisposing, enabling, and need) were found to be influential. Major factors were found to be ethnicity (Hispanic caregivers provided greater levels of care), living arrangements (co-residence resulting in greater care levels), geographic location (rural caregivers providing more care), employment status (with employed caregivers providing less care), and the elder's level of functional disability (greater functional impairment being associated with increasing care). Controlling for the effect of gender (and other factors that could be correlated with gender), the relationship of the caregiver to the elderly care recipient was also important in determining supply.

The results point out the importance of the enabling component of the Andersen model in explaining variability in informal care. Based on study findings, recommendations were made for policy and nursing practice in caring for frail, community-residing elders.


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