Ageing without Children – it’s an inequalities issue

Read any report on inequalities on ageing and you’ll see many of the same things: the adverse impact of being isolated with poor support networks, loneliness, having poor health and a low income. Certain groups will be highlighted as being particularly at risk, carers for example, people from the LGBT communities, people with disabilities. However, one group you will hardly ever see mentioned despite being over represented in many of the above at risk categories is people ageing without children. Approximately 90% of older LGBT people don’t have children, people ageing without children are 30% more likely to be carers and that 85% of people with disabilities do not have children yet this common factor is not seen as being important. Organisations do not systematically record data on whether older people have children or not and so we often wind up in circular arguments, with people saying that there is a lack of data on people ageing without children and that without data new policy/approaches cant be formulated but also as there is no data, it cant be that much of an issue so there’s no need for new policy/approaches. The strange thing is that there is plenty of data, research and evidence on the experiences of people ageing without children from universities across Europe, USA, China, japan, India, Australia and many other countries.  We have looked at this research extensively and summarised the main points below

  • There is very mixed evidence as to what extent people ageing without children have access to unpaid care because they have wider social networks. There is disagreement both about 1. Whether people ageing without children do have wider social networks and 2. To what extent they can be relied on for unpaid care. There is general agreement that even when individuals ageing without children do have a large & strong social network, they can rely on them for low level help but when their care needs become more intense and help is needed more frequently these networks do not substitute for support from adult children and tend to fall away.
  • People ageing without children are more likely to use formal care services and to go into residential care at an earlier age and lower level of dependency.
  • Access to formal care is often curated by adult children; when weighting is brought into play non parents are not more likely to use formal care than parents, not because they don’t need it but because it is harder for them to navigate the processes required.
  • There is mixed evidence on the psychological wellbeing of older people without children with some studies showing little difference between them and parents and others showing high levels of depression and anxiety. It is suspected that the differences are dependent on the route to being without children in old age and whether it was a choice.
  • Single people ageing without children especially single men are at a higher level of disadvantage in accessing unpaid care and informal support compared to those with a partner.
  • Single men  without childrentend to have lower levels of income than fathers, poorer social networks and poorer health.
  • People ageing without children are more likely to live alone and are 25% more likely to live institutional care.
  • Individuals ageing without children are between 26%-31% more likely to be caring for their elderly parents.
  • Individuals ageing without children have worse health, worse health behaviours and higher mortality rates than parents.
  • There are more older people needing care than adult children able to supply it.
  • The rise of the “beanpole” family – smaller families with multiple generations means that there are fewer siblings and therefore nephews/nieces. It cannot be assumed that nephews/nieces will be able to take on the support of older relatives along with their own parents.

The above needs to be placed within the context of UK health and social care policy. Successive Governments have failed to manage both the issue of both how to fund social care and ensure that what is provided is of a good quality. This coupled with the austerity programme of reduced public spending has resulted in fewer people receiving social care and Government policy insofar as it exists has been to focus on families doing more. Little attention has been paid to those older people who have no children or other family to help and support them in later life.

There is no current evidence to suggest that criteria to access social care will be loosened or that there will be a significant boost in social care spending during the lifetime of this Parliament. Despite the fallout from the so-called dementia tax, Government is likely to focus policy on individuals with assets funding their own care rather than raising taxes nationally.

Impact

Rising numbers of people ageing without children will have an impact on the health and social care system

  1. Over the next 20/30 years there will be unprecedented numbers of people without children reaching oldest old age. Policy and planning focused on older people being supported by their children/grandchildren in later life will not meet this need and risks leaving individuals ageing without children dangerously unsupported.
  2. Smaller families in general means that wider family networks cannot be depended on to “step” in the absence of children
  3. Wider unpaid care networks do not substitute for children as health declines meaning that there will be a greater reliance on formal care services at a time when they have never been under such intense pressure. Public spending reductions and difficulties in recruiting and retaining staff mean that residential care homes are closing, private sector providers are handing back contracts and voluntary organisations are struggling to cope with the additional demand on their services which have in turn also faced cuts.
  4. If people ageing without children continue to display poor health behaviours and have poorer health, they are more likely to need care as the need for care is predicated by poor health not by age.

References

  1. A growing care gap? The supply of unpaid care for older people by their adult children in England to 2032

Pickard L 2013 http://eprints.lse.ac.uk/51955/1/Pickard_Growing%20care%20gap_2015.pdf

  1. Payback time? Influence of having children on mortality in old age Modig K et al 2016

http://jech.bmj.com/content/71/5/424

  1. Effect of childlessness on nursing home and home healthcare use Aykan H 2003

https://www.ncbi.nlm.nih.gov/pubmed/12822693

  1. Unequal Inequalities: The Stratification of the Use of Formal Care Among Older Europeans

Albertini M, Pavolini E 2015

https://academic.oup.com/psychsocgerontology/article/72/3/510/2631882/Unequal-Inequalities-The-Stratification-of-the-Use

  1. Childless older adults Dykstra P 2015

http://www.familiesincontext.eu/wp-content/uploads/2014/04/Dykstra-Childless_older_adults-encyclopedia.pdf

  1. Coping strategies for happy childless aging. An explorative study in Poland. Abramowska-Kmon A et al 2016

http://epc2016.princeton.edu/uploads/160488

  1. Childlessness at the end of life: evidence from rural Wales Wenger GC 2009

https://www.cambridge.org/core/journals/ageing-and-society/article/childlessness-at-the-end-of-life-evidence-from-rural-wales/DA012D72A391978D3B98CF658492B412

  1. Social contacts and receipt of help among older people in England: are there benefits of having more children? Grundy & Read 2012

https://www.elsa-project.ac.uk/publicationDetails/id/6419

  1. Patterns and Determinants of Social Service Utilization: Comparison of the Childless Elderly and Elderly Parents Living With or Apart From Their Children Choi N 1994

https://academic.oup.com/gerontologist/article-abstract/34/3/353/583829

  1. The actual and expected availability of informal caregivers: Childless people versus parents in the US

Albertini M et al 2015

http://paa2015.princeton.edu/abstracts/150899

  1. How Does Childlessness Affect Older Americans’ Health Status and Behavior? Plotnick R 2011

https://www.pdx.edu/sites/www.pdx.edu.econ/files/Childlessness_and_health_PSU.pdf

  1. Informal care for older people provided by their Adult children: projections of supply and demand To 2041 in England Pickard L 2008

http://www.pssru.ac.uk/pdf/dp2515.pdf

  1. Childlessness and support networks in later life: a new public welfare demand? Evidence from Italy Albertini & Mencarini 2011

http://www.carloalberto.org/assets/working-papers/no.200.pdf

  1. No children in later life, but more and better friends? Substitution mechanisms in the personal and support networks of parents and the childless in Germany Schnettler & Wöhler 2015

https://www.cambridge.org/core/journals/ageing-and-society/article/no-children-in-later-life-but-more-and-better-friends-substitution-mechanisms-in-the-personal-and-support-networks-of-parents-and-the-childless-in-germany/9A897BA0DC89525022A8342D6D478F75

  1. Loneliness and Depression in Middle and Old Age: Are the Childless More Vulnerable? Koropeckyj-Cox 2002

http://parc.pop.upenn.edu/sites/parc.pop.upenn.edu/files/parc/PARCwps96-02.pdf

  1. How important is parenthood? Childlessness and support in old age in England Wenger GC et al 2000

https://www.cambridge.org/core/journals/ageing-and-society/article/how-important-is-parenthood-childlessness-and-support-in-old-age-in-england/577C868A1CD9C1B6F4A98FD79222A149

An AWOC take on “Care”

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