| Abstract: | The population of adults 65+ is growing and expected to be 20% by 2030. Most older adults remain in the community as they age and will need varying degrees of assistance to avoid costly institutional care. At the same time, shifting sociodemographic and cultural trends among the generations might impact the availability and readiness of newer and younger caregiving groups to provide adequate care. In this dissertation, I characterize less-studied groups of caregivers as well as those who will be providing unpaid care to the aging population. I also explore opportunities for upstream interventions that do not depend solely on unpaid informal caregivers since unpaid informal care has been the preferred source of primary assistance for older adults in the past. The first study uses 2015-2020 Behavioral Risk Factor Surveillance System (BRFSS) data to describe the prevalence, health status, chronic illness burden and contextual factors among working age caregivers as well as those expecting to provide care. In multivariable logistic regression analyses, there were differences reported within adult age groups and for those providing care compared to those expecting to provide care. Differences were also seen for those not expecting to provide care compared to those expecting to provide care. Lastly, differences were seen within adult age groups for time spent providing minimal care compared to higher levels of care and the most intensive care compared to lower levels of care. In the second study, 2011-2019 American Time Use Survey (ATUS) data was used to conduct multivariable regression analyses in order to explore the relationship between state participation in the Affordable Care Act (ACA) Balancing Incentive Program (BIP) and weekly wages, social mobility, eldercare prevalence, and daily care across the total population and generational groups. BIP participation was marginally associated with increased weekly wages and a lower likelihood of providing daily care in the overall population. BIP was also marginally associated in one model of daily care among Gen-Xer caregivers. Sociodemographic characteristics had stronger relationships with outcomes of interest than BIP. The third study explored alternatives for older adults that may not have access to informal caregivers by conducting a cost-effectiveness analysis of the Otago Exercise Program (OEP) compared to informal caregiving on fall reduction. The Otago Exercise Program was found to be cost-effective. The electronic version of this dissertation is accessible from https://hdl.handle.net/1969.1/198582 |
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