Document Type


Date of Degree

Fall 2016

Degree Name

PhD (Doctor of Philosophy)

Degree In

Health Services and Policy

First Advisor

Wolinsky, Fredric D.

First Committee Member

Mueller, Keith J.

Second Committee Member

Ayyagari, Padmaja

Third Committee Member

Arora, Kanika

Fourth Committee Member

Buckwalter, Kathleen C.


Family and friends provide substantial daily assistance to older adults with disabilities, but little is known about how that caregiving impacts the health of older adults. Using survey data on a nationally-representative sample of older adults and their caregivers, matched with Medicare claims, I explored several aspects of the relationship between caregiving and the health of older adults receiving care. I relied largely on Andersen’s behavioral model, which describes health services use as a product of predisposing, enabling, and need characteristics.

I found that 33%-37% of older adults with unmet care needs at one point in time still have them one year later. I also found frequent change in the composition of older adults’ networks of caregivers. Having a formal caregiver was associated with lower odds of unmet care needs for women; conversely, men receiving care from a spouse had three times lower odds of unmet care needs than those receiving care from a non-spousal caregiver.

Some caregivers use services such as respite care, training, and support groups, but some caregivers lack access to desired services. I found that caregivers reporting unmet service need were more likely to be Black and Hispanic, while service use was higher among caregivers providing help on a regular schedule. Care-recipient health and function was associated with both service use and unmet service need, but available measures of local caregiver service supply were not.

Older adults frequently seek care in emergency departments (EDs), but this care may not always be necessary or desirable. I hypothesized, but did not find, that caregiver service use was associated with care-recipient ED use. Instead, chronic health conditions and other need factors were the strongest predictors of ED use. I found that care-recipients of male caregivers had lower rates of ED utilization for reasons that were urgent and not preventable. I also found that care-recipients of adult children had lower rates of non-urgent ED utilization than care-recipients of more distantly-related or unrelated caregivers.

These findings suggest that unmet care needs might be reduced by improving access to formal care for older women with functional limitations and monitoring unmarried older men. In addition, improving service access for Black and Hispanic caregivers, and for caregivers who provide unscheduled care, could reduce caregivers’ unmet service need. Finally, targeting training and support services to male spousal caregivers could improve access both to needed daily care and to emergency care. Future research should focus on replicating these analyses after more data become available and on developing alternate measures of caregiver service supply.

Public Abstract

Many adults age 65 and older require daily assistance from caregivers, including family and friends. Little is known about the relationship between the nature of this assistance, characteristics of caregivers, and older adults’ health.

Older adults’ needs for assistance are not always met. I found substantial persistence in older adults’ unmet care needs over one year, and frequent year-to-year change in the caregivers assisting each older adult. Older women reported fewer unmet needs when receiving care from a professional caregiver, while men reported fewer unmet needs when receiving care from their spouse.

Caregivers have uneven access to potentially useful services, such as training. I found that Black and Hispanic caregivers were more likely to seek services without using them, as were caregivers without a regular caregiving schedule. The supply of local services was not generally related to caregivers’ service use.

Finally, I found that caregivers’ use of services was not related to the emergency department use of their older adults receiving care. Older adults receiving care from their adult children or male caregivers had fewer emergency department visits, but these were for different types of visits.

These findings suggest that older women would benefit from greater access to professional caregiving, while older unmarried men should be frequently monitored. Caregiver services should be scheduled, designed, and marketed to meet the needs of diverse caregiver populations. These services should not be expected to reduce health care spending. Future research should develop new measures of the supply of caregiver services.


caregiver supports, caregiving, functional limitations, long-term care, long-term supports and services, older adults


xi, 126 pages


Includes bibliographical references (pages 118-126).


Copyright © 2016 Andrew Joseph Potter