Gender differences in primary home caregivers of older relatives in a Mediterranean environment: A cross-sectional study

Highlights

• There were gender differences in subjective burden.

• The relationship between gender and objective burden (the intensity of care and the care recipients needs) varies among different environments.

• The findings support the idea that kinship moderates the relationship between gender and subjective burden.

Abstract

A cross-sectional study was developed in Spain to analyse gender differences in intensity of care, care recipient needs and subjective burden, as well as the moderating effects of kinship on the relationship between gender and subjective burden. A probabilistic sample of 200 primary caregivers (100 male and 100 female) of older relatives was interviewed by expert nurses. Socio-demographic data and several scales regarding objective and subjective burden were used to collect data. Descriptive statistics, Student's t-test, ANOVA and multiple linear regression were used to analyse the data. There were gender differences in subjective burden, with female caregivers having more subjective burden than male caregivers, but not in objective burden (intensity of care and care recipients’ needs). Kinship moderated the relationship between gender and subjective burden, as gender differences were found in spouses (wives had more subjective burden than husbands) but not in offspring.

Introduction

The increase in life expectancy in industrialised countries extends the aging process and can lead to high levels of disability and long-term needs in older people (OECD, 2009). In these countries, the bulk of care for older people is provided by the family, specifically by women in the family (Colombo, Llena-Nozal, Mercier, & Tjadens, 2011). Therefore, most caregivers of older dependents are female relatives.

Provision of informal care to older dependent relatives can be detrimental to the caregiver's health (Pinquart & Sorensen, 2003a). In addition, several systematic reviews (Miller and Cafasso, 1992, Pinquart and Sorensen, 2006; Vitaliano, Zhang, & Scanlan, 2003) have demonstrated higher intensity of care and more negative consequences in the emotional health of caregivers (e.g., subjective burden, depression and poorer perception of health) in female caregivers. Thus, informal caregiving may represent two forms of gender inequality: the higher participation of female caregivers and their greater risk for the negative consequences.

None of the aforementioned systematic reviews was conducted in a Mediterranean environment. Several pan-European studies (Kraus et al., 2010, OECD, 2005; Pommer, Woittiez, & Stevens, 2007; Mestheneos & Triantafillou, 2005) have shown the existence of a specific model of informal care in southern European countries. This model has been called the Mediterranean model of informal care (Kraus et al., 2010; Pommer, Woittiez & Stevens, 2007). Spain, Italy, Portugal and Greece were included in this model (Pommer et al., 2007). The characteristics of the Mediterranean model of informal caregiving are: a) a positive attitude of the family towards their older dependent relatives' care and therefore high family involvement in care (in both coverage and services); this positive attitude is called familism (Knight & Sayegh, 2010); b) beliefs and values regarding women's care obligations that lead to high female participation in informal caregiving; c) almost no participation of female caregivers in the labour market; and d) lower levels of formal caretaking (also in terms of coverage and services), to some extent caused and maintained by the family attitudes towards caregiving (Kraus et al., 2010, Mestheneos and Triantafillou, 2005, OECD, 2005, Pommer et al., 2007). Therefore, it is important to determine whether findings from previous reviews are consistent with the situation in a Mediterranean context.

The findings of a previous study (Del-Pino-Casado, Frias-Osuna, Palomino-Moral, & Martinez-Riera, 2012) were inconsistent with previous reviews (Miller and Cafasso, 1992, Pinquart and Sorensen, 2006, Vitaliano et al., 2003). Specifically, the study (Del-Pino-Casado et al., 2012) showed no statistically significant gender differences in intensity of care, whereas subjective burden was found to differ between men and women, and this difference was statistically significant. Therefore, the authors concluded that cultural diversity can influence the relationship between gender and intensity of care. Similar findings regarding gender and intensity of care have been shown in populations with high familism and high female participation in caregiving (Lai, Luk, & Andruske, 2007; Hsiao,2010; Akpinar, Kucukguclu, & Yener, 2011).

Nevertheless, to prove these findings in the Mediterranean context, regarding cultural variations in the relationship between gender and intensity of care, the study must be replicated in a gender-balanced sample that provides enough statistical power for supporting this lack of differences, what is the main objective of this research. Furthermore, we attempted to expand these findings with an analysis of gender differences in care recipients’ needs. The analysis of gender differences in intensity of care and care recipients’ needs allowed us to understand better the process of informal care and to establish the role of gender as a predictor of the negative consequences of caregiving.

Regarding gender differences in subjective burden, Pinquart and Sorensen’s review (2006) showed high heterogeneity among studies. These authors concluded that the heterogeneity could be due to several moderators, such as kinship. Pinquart and Sorensen (2006) found that women were more likely to report behavioural problems and cognitive impairment than men in samples with a low proportion of spouses, but the study did not analyse whether gender differences in subjective burden occurred in both spouses and children. Therefore, further research on the effects of kinship on the relationship between gender and subjective burden are needed, and the current study has attempted to serve this purpose.

Basing on previous findings, we tested the following hypotheses:

H1

There are gender differences in the intensity of care given as well as in the care recipients’ needs.

H2

There are gender differences in subjective burden.

H3

Kinship moderates the relationship between gender and subjective burden.