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The COVID-19 pandemic poses specific risks to vulnerable population groups. Informal carers for older adults are especially at risk of increased strain, as support from social networks and professional care services is no longer available or in short supply. Already before the pandemic, caring was unequally distributed within societies, with women and people in lower socio-economic status groups bearing a higher risk of caring strain. In this article, we propose a conceptual framework of (unequal) caring strain during the pandemic. We then summarise the state of empirical research, suggest questions for future studies and outline implications for social policy.

Objectives To examine how intergenerational support varies by parents’ living arrangements and whether there are gender differences in received support in Puerto Rico. Methods Data come from the 2006–2007 Puerto Rican Elderly and Health Conditions Project, a representative longitudinal study of adults aged 60 and older in Puerto Rico (n = 2,288). We examined the association between parents’ living arrangements (alone, with spouse/partner only, with children) and their receipt of functional (help with errands/housework/transport) and health (help when sick) support from children, and whether parents’ gender moderates the association. Results Intergenerational coresidence was associated with higher odds of receiving functional and health support than living alone. Women were more likely than men to receive both forms of support. Parents’ gender significantly moderated the association between living arrangements and receiving health support—men living with their partners were less likely to receive health support from children than women in similar living arrangements. These associations persisted when analyses were restricted to those with disability. Discussion Our findings suggest that parents’ receipt of support from children is conditioned upon their living arrangement and gender, even when their functional health is jeopardized. We discuss these results in relation to the heterogeneous influence of living arrangements for older adults’ support needs and provide suggestions for policy and directions for future research in rapidly aging Puerto Rico.

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60 + years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.

The pilot study "Health and Support in Times of Corona" (TU Dortmund University) collected data on support and well-being of individuals aged 40 plus years in the light of the first wave of the COVID-19 pandemic from May to July 2020.The aim was to study the social and mental effects of the pandemic. We focused on individuals living in private households aged 40 years and older. Participants were asked about pandemic-related changes in receiving and providing support (e.g. personal care, help with household chores), problems arising in taking care of older persons and changes in well-being.We conducted descriptive and multivariate analyses to show how support changed, problems with support came up and well-being changed in the light of the pandemic and how all this was related.Due to the pandemic older respondents in particular were no longer able to provide the necessary support for others. Especially women reported problems in taking care of older individuals. We found a decrease in well-being for all respondents but most significantly for women and individuals aged 80 years and older. Moreover, problems in the provision of care due to the pandemic and lower well-being were clearly linked.Our study showed significant changes in support patterns and well-being due to the COVID-19 pandemic. A substantial part of the respondents reported more loneliness and lower life satisfaction compared to before the pandemic, especially women supporting others. In these pandemic times, informal caregiving is severely hampered. Future pandemic-related measures should be carefully planned bearing such issues in mind.HINTERGRUND: Die Pilotstudie „Gesundheit und Unterstützung in Zeiten von Corona“ (Technische Universität Dortmund) erhob vom Mai bis Juli 2020 Veränderungen von Unterstützung und Wohlbefinden Älterer infolge der COVID-19-Pandemie.Ziel war es, empirische Erkenntnisse zu den sozialen und mentalen Folgen der Pandemie für in Privathaushalten lebende Personen der Altersgruppe 40+ Jahre zu gewinnen. Betrachtet wurden durch die Pandemie bedingte Änderungen im Erhalt und im Leisten von Unterstützung (u. a. persönliche Pflege, Hilfe im Haushalt) und Betreuungsprobleme sowie Veränderungen des Wohlbefindens.Mithilfe deskriptiver und multivariater Analysen wurde untersucht, wie sich im Zuge der Pandemie Unterstützungsmuster änderten, ob Betreuungsprobleme entstanden, und ob sich in diesem Zuge des Wohlbefinden (Lebenszufriedenheit und Einsamkeit) veränderte.Im Zuge der Pandemie zogen sich insbesondere Ältere und Hochaltrige aus der Unterstützung für andere zurück. Frauen berichteten häufiger von Betreuungsproblemen mit älteren Angehörigen. Das Wohlbefinden verringerte sich insgesamt, am deutlichsten aber bei Frauen und Hochaltrigen. Die multivariaten Analysen verdeutlichen, dass Betreuungsprobleme mit älteren Angehörigen im Zuge der Pandemie mit geringerem Wohlbefinden einhergingen.Unsere Pilotstudie zeigt deutliche Änderungen in Unterstützungsmustern und im Wohlbefinden der Befragten. Viele berichten von mehr Einsamkeit und geringerer Lebenszufriedenheit als vor der Pandemie – insbesondere Frauen, die Unterstützungsleistungen für andere erbringen. Sorgearbeit wird durch die Pandemie und die Maßnahmen zu ihrer Bekämpfung erschwert. Zukünftige Kontaktbeschränkungen sollten mit Bedacht eingesetzt werden und dies im Blick haben.

Objectives We assess gender moderation in the association between partner care arrangements and individuals’ well-being, and the extent to which gender differences vary across European care contexts. Methods We use 2015 data from the Survey of Health, Ageing and Retirement in Europe for 3,465 couples aged 50+, where at least 1 partner receives care. We assess gender differences in individuals’ life satisfaction and depressive symptoms across 5 partner care arrangements: solo-; shared formal; shared informal; outsourced formal; and outsourced informal care. We explore heterogeneity in the gendered associations across 4 care contexts: Northern, Western, Southern, and Eastern Europe. Results Sharing care with formal providers is associated with lower well-being among women than men, with a significant well-being “penalty” among Southern European women with partners in shared formal care. Outsourcing partner care to informal providers is associated with higher well-being than other care arrangements for men across care contexts, but with lower well-being for women in Southern Europe. Discussion Policies to support caregivers’ well-being need to be sensitive to the coordination of formal and informal caregiving support for men and women in their respective care contexts.

Disclosing socioeconomic differences in informal care provision is increasingly important in aging societies as it helps to identify the segments of the population that may need targeted support and the types of national investments to support family caregivers. This study examines the association between individual-level socioeconomic status and informal care provision within the household. We also examine the role of contextual factors, income inequality, and the generosity of social spending, to identify how macro-level socioeconomic resource structures shape individuals��� provision of care to household members. We use pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1, 2, 4, 5, 6) and the English Longitudinal Study of Ageing (ELSA, waves 2, 3, 4, 6, 7). Poisson regression multilevel models estimate the associations between household socioeconomic status (education, income, and wealth), and country socioeconomic resources (income inequality and social spending as a percentage of GDP), and the likelihood of older adults��� informal care provision within the household. Results indicate that lower individual socioeconomic resources���education, income, and wealth���were associated with a higher incidence of older adults��� informal care provision within the household. At the macro-level, income inequality was positively associated while social spending was negatively associated with older adults��� care provision within the household. Our findings suggest that socioeconomically disadvantaged groups are more likely to provide informal care, which may reinforce socioeconomic inequalities. At the national level, more equitable resource distribution and social spending may reduce intensive family caregiving., European journal of ageing;Vol. 18. 2021

ZusammenfassungÄltere Menschen sind während der Covid-19-Pandemie einem höheren Risiko ausgesetzt, schwer zu erkranken oder zu sterben. Sie werden daher in der Pandemiebekämpfung als besonders zu schützende Gruppe aufgefasst und sind in hohem Maße von Kontaktbeschränkungen betroffen. Gleichzeitig hatten ältere Menschen bereits vor der Pandemie einen erhöhten Unterstützungsbedarf, der durch die Pandemie verstärkt wurde, da viele alltägliche Tätigkeiten mit einem höheren Risiko einer Ansteckung verbunden sind. Hinzu kommt, dass Ältere oftmals selbst Unterstützung leisten, die wegen der Kontaktbeschränkungen nicht fortgesetzt werden kann. Der Beitrag zeigt die Veränderung von Versorgung und Unterstützung Älterer in Deutschland vor dem Hintergrund der Pandemie auf. Zunächst werden die politischen Entscheidungsprozesse auf Bundesebene beschrieben, um anschließend die Rolle der Kommunen einzuordnen. Danach wird der Forschungsstand zur Versorgung und Unterstützung von älteren Menschen sowie zu der von ihnen geleisteten Unterstützung aufgezeigt. Daran schließt sich die Darstellung der Ergebnisse einer eigenen Studie an. Der quantitative Teil der Studie befasst sich mit Veränderungen der Unterstützungsmuster im privaten Bereich, während der qualitative Teil die Identifikation besonders belasteter Gruppen, entstandene Versorgungslücken und mögliche Maßnahmen zur Vorbereitung auf zukünftige Pandemien beleuchtet. Die Ergebnisse der Studie zeigen, dass sich soziale informelle Unterstützungsleistungen im Zuge der ersten Covid-19-Welle in vielen Fällen verändert haben und dass pflegende Angehörige sowie Menschen mit chronischen Krankheiten, mit Pflegebedarf und/oder sehr hohen Alters als besonders belastete Gruppen einzustufen sind.

Background Brazil is among the countries hit hardest by COVID-19, and older adults are among the vulnerable groups. Intergenerational coresidence and interdependence among family members, both prevalent in Brazil, likely increase social and physical contact and thus potential infection. Methods Using nationally representative data from the COVID-19 module of the Brazilian National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios), collected between July and November of 2020, we examined the association between living arrangements and exposure to and testing for COVID-19 among 63,816 Brazilians aged 60 years and older. We examine whether living arrangements influence self-reported COVID-19 symptoms as an indicator of subjective health assessment, testing as an indicator of health care service use, and a positive COVID-19 test result as an objective indicator of exposure to the disease. Results Living arrangements shape older adults’ vulnerabilities to COVID-19 exposure and testing. Specifically, those living alone were more likely to report having symptoms and having had a test for COVID-19. However, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19. Those with symptoms were more likely to test, regardless of their living arrangement. Among older adults without symptoms, those living alone had a higher probability of testing than those living in multigenerational or skipped-generation households. Conclusions Overall, our findings suggest that coresidence with younger family members puts older adults’ health at risk in the context of COVID-19. As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.

Background Global commitments to reduce cardiovascular disease (CVD) burden by 2025 will require data on CVDs from lower income countries. This study aimed to estimate the prevalence of angina, and its association with hypertension, diabetes, and depression, in six low- and middle-income countries (LMICs). Methods Data from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 from China, Ghana, India, Mexico, Russia and South Africa were utilized. Multivariable logistic regression methods were used to examine the factors associated with angina. Results A total of 31,443 respondents aged 50 years and over were included in these analyses. The prevalence of angina was highest in Russia (39%), lowest in China (8%), and consistently higher in women than men. Angina was comorbid with chronic conditions and depression but patterns varied across countries. Depression was negatively associated with angina among older adults in Ghana but was positively associated with angina in all other countries. Hypertension was associated with increased odds of angina among older adults in China (OR 1.9; 95% CI 1.59–2.25), India (OR 1.4; 95% CI 1.14–1.78) and Russia (OR 3.7; 95% CI 2.33–6.00). Diabetes was associated with higher odds of angina in China (OR 1.6; 95% CI 1.15–2.15), Russia (OR 2.5; 95% CI 1.57–3.87), and South Africa (OR 4.1; 95% CI 2.49–6.88). Conclusions CVD is a significant contributor to disease burden in LMICs. Angina was often co-morbid with other conditions, therefore compelling health systems to develop longer-term integrated care systems to address co- and multi-morbidity.

This study examined rural-urban differences in health visits among older Thais utilizing Andersen's model. Data were drawn from the 2011 Survey of Older Persons in Thailand of adults 50 years and older (N = 56,435). Logistic regression models examine individuals' predisposing, enabling, and health need factors for explaining older adults' health care use. Approximately 50% of older adults sought health care but urban dwellers were more likely than rural dwellers to seek health care (54.8% vs. 49.7%). Predisposing factors and health needs narrow the rural-urban gap while enabling factors widened the gap in health visits. The receipt of financial support from children presented a significant moderating effect in the rural-urban divide of health care use. Despite Thailand's universal access to health care, geographic inequity in health care utilization withstands. Findings suggest investments in education, income security, social participation, and healthy lifestyle promotion can improve health care utilization. Furthermore, results suggest a need for continued investigation of the role of family support in bridging the rural-urban divide in the health of older Thais.

Originality: This is the first population-based study within the Caribbean to examine gendered patterns of grandparent caregiving and the association with grandparents’ well-being. The findings of this study suggest that grandparent caregiving is beneficial to the well-being of older Jamaican men and women. This study challenges assumptions of gender norms that typically do not position men to be involved in caregiving roles, and to derive satisfaction from such roles, within Caribbean households. The authors suggest more attention should be given to interventions to encourage men to be actively involved in family caregiving.

Objectives No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between “childlessness” (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes. Methods Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648). Results Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures. Discussion We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.

Objectives Due to increasing care needs and decreasing care potentials, research around informal caregiving gains attention. Relatively new - but of utmost importance - is the role of socioeconomic inequalities in care and wellbeing. Although caregiving can be rewarding, a growing body of research shows that informal caregiving often has negative consequences for individuals' wellbeing. Theoretically, we expect these negative outcomes to be more pronounced among caregivers with lower socioeconomic resources. The current study examines socioeconomic inequalities in the consequences of caregiving inside the household for life satisfaction. Methods We draw on longitudinal data from the Survey of Health, Ageing, and Retirement in Europe (SHARE waves 2, 4, 5, and 6). We estimated pooled ordinary least squares and fixed-effects regression models to examine the consequences of informal care provision within the household for individuals' life satisfaction, and whether household wealth moderates this relationship, controlling for individuals' sociodemographic and health characteristics. Results Care provision inside the household was negatively associated with older adults' life satisfaction. The longitudinal analyses accordingly show that the uptake of care led to declines in life satisfaction. Differentiating by socioeconomic background, we find that caregivers with higher socioeconomic resources in terms of wealth generally experienced higher life satisfaction. Our longitudinal analyses on wellbeing declines reveal, however, that these mechanisms did not significantly differ by socioeconomic status of the caregiver. Discussion Our findings suggest the need for increased investments in support services for informal caregivers to mitigate caregiving burdens, irrespective of socioeconomic status, and enhance later life wellbeing.

Rapid fertility declines in Latin American and Caribbean countries since the 1960s have contributed to smaller family sizes among the current cohorts of older adults. This may have mental health implications in these societies as the family unit is highly valued as a source of social support. Utilising data from the 2000 Survey of Health, Well-being and Aging in Latin America and the Caribbean (SABE), this study examines the association between parental status, marital status and the likelihood of experiencing depressive symptoms among adults 60 years and older in seven cities within Latin America and the Caribbean (N = 9,756): Buenos Aires, Bridgetown, São Paulo, Santiago, Havana, Mexico City and Montevideo. Results from multivariate logistic regressions indicate that parental status is not significantly associated with depressive symptoms. Nonetheless, unmarried older adults, both those living alone and those living with others, are more vulnerable to experiencing depressive symptoms than their married counterparts. Marriage is especially protective for older adults in Havana and Montevideo. Older adults’ perceived income adequacy significantly moderates the relationship between marital status and depressive symptoms. Other significant covariates, such as experiencing disability and comorbidity, showed positive associations with depressive symptoms. While families may still represent a critical component for the mental health of older adults, broader investments in health across the lifespan are needed to improve individual psychological wellbeing.

Childless older adults may be at risk for poorer health cross-nationally, yet most studies on this topic analyze only a small number of countries and only 1 or 2 health outcomes. To our knowledge, two papers exist that explore associations between childlessness and multiple indicators of health using data from a large number of regionally diverse countries (e.g., 20 countries from North America, Asia, and Europe), but neither study includes an examination of socioeconomic resources. The level of health risk faced by childless older adults is likely to be distinctly shaped by older adults’ socioeconomic resources (e.g., education, income, wealth). Associations between childlessness, socioeconomic resources, and health may also differ by country context. Using harmonized, cross-national data for adults aged 50 and older across 20 high- and middle-income countries (United States (HRS), European Union (SHARE), Mexico (MHAS), and China (CHARLS) from the Gateway to Global Aging data repository), we explore if and how individual-level socioeconomic resources (income, education, wealth) moderate associations between childlessness and five health indicators (self-rated health, ADL limitations, IADL limitations, chronic conditions, and depression). Results suggest that associations between childlessness and health outcomes vary by individual socioeconomic resources in some country contexts, but not in others. We discuss these findings in light of the impact of individual-level socioeconomic resources on older adults’ support options and health outcomes cross-nationally.

INTRODUCTIONLatin American and Caribbean countries are ageing rapidly but countries differ in their pace of demographic transition with Barbados and Cuba classified as very advanced while Argentina, Uruguay, Chile, Brazil, and Mexico are at an advanced stage (Saad, 2011). There are, however, some common patterns in the ageing process; older adults are disproportionately female and increasingly represented in urban areas (United Nations (UN), 2009; Huenchuan, 2010). Countries in the region also share a commonality of population movement, typically younger cohorts, through internal intra-urban, and international, migration (Cerrutti and Bortencello, 2003; Nam, 2009). As shown in Table 1, international migration is more common within Mexico and Cuba, relative to other countries in this study.This geographic separation can present challenges for older adults as the family unity, typically adult children secondary to a spouse, is the main source of support for older adults (Rawlins, 1999; Cavlo and Williamson, 2008; Agree and Glaser, 2009). Within Latin America and the Caribbean however, as in other developing regions, migration is often a household-based economic strategy (Chamberlain, 1999; Jelin and Diaz-Munoz, 2003), as a means of meeting the household's material needs. Few studies, however, have examined the role of geographic proximity for support transfers to older adults in the region (De Vos, Solis, and Montes de Oca, 2004; De Vos, 2012; Quashie and Zimmer, 2013; Quashie, 2015; Lorca and Ponce, 2015).Further distance between parents and children may, however, be more or less important for upward flows of economic support to older adults, depending on the nature of institutional support for older adults, and the overall economic contexts in their place of residence. Latin American and Caribbean countries differ considerably in their standards of living and formal systems of income protection for older adults (Mesa-Lago, 2008). As shown in Table 1, the countries under study differed in their levels of socio-economic development in the year 2000, the period of data collection. Barbados showed the highest GDP per capita at $US 11,658, and Cuba, the lowest at $US 2,750, in 2000. Although not directly related to GDP per capita, pension coverage for older adults also differs across countries with Uruguay, Brazil, and Barbados having the highest levels of pension coverage, largely due to their combination of contributory and non-contributory pension systems, while Mexico reported the lowest (Pettinato and Diaz-Cassou, 2005; Arza, 2012). In Cuba, following the collapse of the Soviet Union, the elderly were among the poorest social groups in the decade of the 1990s, due to economic instability and contractions in social welfare (Mesa-Lago and Vidal-Alejandro, 2010).Despite country-level differences in efforts to mitigate gender differences in later life economic security, gender disparities in labour force participation and gender differences in the statutory ages of pension entitlement unequivocally influence gender gaps in pension coverage. In all countries, women have lower rates of pension coverage relative to men. Of all the countries in this study, for which data are available, Mexico has the widest, and Uruguay the smallest, gender gap in pension coverage (Arza, 2012).The intersection of these trends in population ageing and population mobility, within diverse economic and social welfare contexts, present different possibilities for family based intergenerational relations across the region.Research on intergenerational family support, and its gendered dimensions, within Latin America and the Caribbean is expanding. The existing research, however, has mostly focused on single countries (Camarano, Kanso, Mello, and Pasinato, 2005; Gomes, 2007; Lorca and Ponce, 2015), coresidence (De Vos 2000; Andrade and De Vos 2002; VanWey and Cebulko, 2007), and with few exceptions (Saad, 2005; Glaser et al. …

Identification of sarcopenia in lower- and middle-income countries (LMICs) is limited by access to technologies that assess muscle mass. We investigated associations between two functional measures of sarcopenia, grip strength and gait speed (GS), with functional disability in adults from six LMICs. Data were extracted from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) for adults (≥ 65 years) from China, Mexico, Ghana, India, Russia and South Africa (n = 10,892, 52.8% women). We calculated country-specific prevalence of low grip strength, slow GS (≤ 0.8 m/s), and both measures combined. Using multivariable negative binomial regression, we separately assessed associations between low grip strength, slow GS, and both measures combined, with the WHO Disability Assessment Schedule 2.0, accounting for selected socioeconomic factors. In women, low grip strength ranged from 7 in South Africa to 51% in India; in men, it ranged from 17 in Russia to 51% in Mexico. Country-specific proportions of slow GS ranged from 77 in Russia, to 33% in China. The concomitant presence of both was the lowest in South Africa and the highest in India (12.3% vs. 33%). Independent of age, those with both low grip strength and slow GS had between 1.2- and 1.5-fold worse functional disability scores, independent of comorbidities, low education, and low wealth (all country-dependent). Low grip strength, slow GS, and the combination of both, were all associated with higher levels of functional disability, thus indicating these objective measures offer a reasonably robust estimate for potential poor health outcomes.

We assess socioeconomic inequalities in informal care provision and its consequences for the wellbeing of informal caregivers. The literature states that a lower socio economic status (SES) is linked to a higher probability to give care (at higher intensities) which then leads to a higher caregiving burden. People with lower SES additionally have fewer resources to alleviate caregiving pressures. Thus, they are likely to experience decreased wellbeing compared to those with higher SES. Our analyses based on data from SHARE and ELSA confirm, that individuals with lower SES are indeed more likely to provide care all over Europe. They also report a lower wellbeing than people with higher SES, even if controlling for further important influences. In the next step we investigate longitudinally, if taking over care responsibilities leads to a wellbeing decline and if this decline is more pronounced for people with lower SES.

Data from the 2011 Survey of Older Persons in Thailand examines the association between preparations for old age (financial, health, caregiving, living arrangements, and spiritual) and three measures of well-being: financial satisfaction, life satisfaction, and physical health. The study further explores the role of social stratification and the gendered nature of these relationships. The sample ( N = 10,235) is restricted to adults 60 years and above, who are retired and answered the survey independently. Multivariate logistic regression analyses indicate that different forms of preparation are positively associated with post-retirement well-being for men and women but socioeconomic resources are positively associated with all three well-being outcomes. Furthermore, for women, there are significant negative interaction effects of income and financial preparation on life satisfaction, as well as negative interaction effects of disability and caregiver preparation on self-rated health. Implications for long-term care, socioeconomic inequality, and gender inequality in paid labor are discussed.

Purpose Barbados is at a very advanced stage of population aging. Health care services are designed to ensure universal access for all Barbadians but the contributing factors for older adults’ health care utilization are not well explored. This chapter examines gender differences in the correlates of seeking medical care among older adults in Barbados. Methodology/approach Logistic regression models were applied to data drawn from the 2000 Survey of Health, Well-Being and Aging of Older Adults in Latin America and the Caribbean (SABE), Bridgetown sample (n = 1,068). Findings Health needs, based on chronic conditions, were positively associated with seeking medical care for men and women. Different forms and directions of intergenerational support were associated with men and women seeking care. Among men, receiving financial support was positively associated with seeking care. Among women, providing financial support was associated with lower odds of seeking care while receiving instrumental support was associated with higher odds of seeking care. Research limitations/implications Medical care is only one form of health care use and there is no specification of the nature of care or consultation. The sample is cross-sectional and limited to older adults in urban areas. The relative importance of enabling factors and health needs, especially, may differ across time and space within Barbados. Originality/value The study contributes to the literature on health care utilization among older adults within developing countries and highlights the pertinence of family relations influencing gender differences in health care utilization.

This study assesses the probability that an older person in Bridgetown, Barbados receives financial, functional and/or material support from their adult children according to the proximity of their nearest child, adjusting for demographic and socio-economic factors. As in many countries of the developing world, older Barbadians receive much of their support from adult children. Population ageing, smaller family sizes and high rates of out-migration may be placing stress on systems of formal and informal support within the country. Yet, very little research has examined determinants of support within the Caribbean let alone Barbados, one of the most rapidly ageing countries in the region. Data (N = 1,248) come from the 2000 Pan American Health Organization Survey on Health, Well-being and Ageing in Latin America and the Caribbean (SABE). Multivariate logistic regression analyses highlight the overwhelming importance of co-residence in the receipt of informal support transfers. Although there is a lower probability of receiving support as distance to nearest child increases, several indicators of vulnerability, such as having a disability, increases support probabilities among those whose nearest children live outside the neighbourhood. The results have implications for current and future cohorts of older adults in the region given the combination of declining fertility, persistent migration and population ageing within a broader context of social protection systems across the region.

This study examines the likelihood that older adults and their children in Bridgetown, Barbados engage in exchanges of financial, functional, and material support and the extent to which gender influences transfers. Data come from the 2000 Survey of Health, Well-Being and Aging in Latin America and the Caribbean (SABE) of Bridgetown, Barbados N = 3876 children, representing 1135 families. Multivariate logistic regression models examine the demographic and economic situations of both older and younger cohorts that encourage or constrain intergenerational exchanges. Results confirm, as in many developing countries, a higher proportion of older Barbadians receive rather than provide support. Gender differentiation in support transfers depends on the type of support examined and the living arrangements of parents and children. Support exchanges are highly conditioned by the socioeconomic circumstances of both generations but gender stratification in the labor market does not appear to mediate support exchanges. These findings suggest some flexibility in gender systems with respect to intergenerational support within Barbado.

This paper examines whether intergenerational transfers from a non-coresident child is conditioned by the proximity of their siblings to their parents and the wealth of the household in Mexico City. Data come from the 2000 Survey of Health, Well-Being and Aging of older adults (SABE) of Mexico City, N = 3779 children representing 957 families. Logistic regression results show that the specific location of non-coresident children is unrelated to the odds of providing support but having a coresident sibling is positively associated with support provision. Moreover, parents in middle wealth quintiles are most likely than those in lower and upper wealth quintiles, to receive financial support from non-coresident children with a coresident sibling. The research extends our understanding of family support in Mexico by examining the possible negotiation among siblings to meet the needs of their parents. This type of negotiation is likely to become increasingly important in light of unstable social protection systems for both older and younger cohorts.

The Caribbean is undergoing rapid population ageing. Increasing proportions and numbers of older persons require states to strengthen institutional systems of care and support, and to re-frame the roles of older adults in society in order to mitigate the health and socio-economic challenges associated with ageing. The health of older adults is of primary concern as increasing longevity is typically associated with increased morbidity and disability due to chronic diseases. Research on the health of older adults within the Caribbean region is burgeoning with much attention given to patterns and correlates of chronic conditions such as obesity and hypertension, and based on a limited number of countries, for which data are available. Many aspects of older adults’ health and quality of life, however, remain unexplored such as dementia and factors associated with ageing well.

Rapid fertility declines within Latin American and Caribbean countries since the 1960s have contributed to smaller family sizes among the current cohorts of older adults, and increased the likelihood that future cohorts will not have children. This can have implications for mental health in later life in societies where the family unit is highly valued as a source of welfare. Drawing on data from the 2000 Survey of Health, Well-Being and Aging in Latin America and the Caribbean (SABE), this study examines the association between parental status and the likelihood of experiencing depressive symptoms among older adults 60 years and over in seven cities of Latin America and the Caribbean (N=9756). Estimates from logistic regressions are provided for pooled data, and disaggregated by sex and city. Findings show that compared to the childless, older adults with two or more children had lower odds of experiencing moderate to severe depressive symptoms. Having multiple children was shown to be especially protective to older women in Buenos Aires and Havana, and to older men in Montevideo. Other significant covariates such as being unmarried, uneducated, having no access to independent income, experiencing disability and comorbidity were each positively associated with depression. While children may represent a critical component of the welfare mix for older adults, increasing longevity and changes in family structures that accompany population ageing require broader investments in education and health across the life course to improve individual psychological wellbeing, regardless of family status.