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Associations between Family Structures, Formal Social Participation, and End-of-Life Care Quality
Mahmoud, Kafayat Oyinlade
Mahmoud, Kafayat Oyinlade
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Abstract
In this dissertation, I conducted three analytical studies examining how family structures and trajectories of formal social participation are associated with end-of-life quality among older persons in the United States, using dataset from the nationally representative National Health and Aging Trends Study. In the first study, I investigated the association between trajectories of formal social participation and overall ratings of end-of-life care quality and the moderating role of gender. My findings revealed four distinct formal social trajectory classes among older adults towards the end of life, ranging from consistently low and homogenous social participation to high-declining and heterogenous social participation, all with a general tendency to decline across time. I also found that women were less likely than men to chart, by proxy report, positive care ratings at the end of life even though they had higher levels of formal social participation, and these gender differences in end-of-life care ratings are explained more by healthcare factors than formal social participation trajectories. My second study examined whether quality of care at the end of life varies by marital status, the extent to which gender differences in the benefits of marital status to health persist till the end of life, and the extent to which formal social participation is protective for older adults across marital status. Results revealed that married older adults are more likely to be involved in higher levels of social participation compared to not married and never married older adults. Married older adults were also the most likely to have positive proximate end-of-life care ratings, followed by never married with very good care ratings, with not married older adults, charting by proxy, the poorest end-of-life care ratings. My findings also showed that towards the end of life, the gender gap in caregiving narrows as married men and women potentially become equally supportive of each other, which eases the process of navigating quality end-of-care. Results also revealed that never married women were more likely to have poorer proximate care ratings relative to never married men. A potential explanation for the poorer proximate end-of-life care ratings for never married women relative to never married men may be the heightening of the “single strain” characterized by heightened experience of the absence of a significant other, inability to participate in social activities and limited access to sources of instrumental and emotional support. Finally, my third analytical chapter analyzes whether the quality of care at the end of life varies by living arrangements, the extent to which living arrangements will mediate the relationship between formal social participation trajectories and end-of-life care quality, the extent to which gender moderates the association between living arrangements and end-of-life care quality. Results revealed that although older adults who live alone have the poorest proximate care ratings at the end of life, increased social participation could be a potential mechanism for reducing disparities experienced by this group. My results also showed that women who live with others are more likely than their male counterparts to have poorer proximate ratings of end-of-life care, especially with daughters, and a potential explanation of this could be the strained relationship dynamic between mothers and daughters relative to fathers and daughters. Finally, older adults may benefit more from having paid caregivers as opposed to families as care providers as within-gender differences revealed that women (23%) and men (16%) higher likelihood of having excellent proxy reports of end-of-life care when proxies are others than when proxies are spouses.
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2023-01-01
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University of Kansas
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Keywords
Sociology, Gerontology, End-of-life care, Family structure, Formal social participation, Older adults