OBJECTIVES:More older Americans are cohabiting with a partner. However, it is unclear whether cohabitation serves as an alternative to marriage for meeting daily needs in later life. This study examines whether receipt of partner assistance and experience of unmet care needs differ by union status and gender. METHODS:Data are from the 2012, 2016, and 2023 National Health and Aging Trends Study, including 4,283 community-dwelling older adults (aged 66+; 4,070 married, 213 cohabiting) who coreside with an opposite-sex partner and are in need of care. Outcomes include receipt of health-related assistance "care," receipt of non-health-related assistance "help," overall assistance hours, and unmet care needs. We estimate logistic and linear regression models by union status and assess differences for men vs. women. RESULTS:In adjusted models, cohabitation is not associated with receipt of care or help but is associated with fewer hours of help (-24.13; p < .05). However, cohabitation associations differ by gender (p < .05) for unmet care needs, with greater risks conferred by cohabitation for women but not men. DISCUSSION:Cohabitation functions similarly to marriage among older adults who are in need of care, for both care and help received, but cohabitors receive fewer hours than spouses from their partners. Cohabiting women experience more adverse consequences related to unmet needs than married women, with a larger gender gap in unmet care needs among cohabiting couples than among married couples. Continued tracking of the impact of cohabitation as the U.S. population continues to age is warranted.

Changing late-life disability and care patterns that may accompany population aging have profound consequences for the nation's health and related public policies. Drawing on two cross-sectional rounds of the National Health and Aging Trends Study, we examined trends among US adults ages 65 and older in 2011, when the oldest members of the baby-boom generation turned age 65, and in 2022, when about half of the generation was ages 65-74. We found increases in the percentage of adults ages 65-74 who reported activity limitations, receiving paid care in the community, and having unmet care needs. In contrast, for older age groups, we found declines in the receipt of care overall and in residential settings, particularly nursing care, without increases in unmet care needs. All else equal, had the sociodemographic and health profile of the group ages 65-74 not differed from the preceding cohort-especially in terms of increased educational attainment-the increases experienced by this age group would have been even larger. Findings portend growing challenges in caring for older US adults in the future.

As the population ages and families become increasingly diverse, more work is needed to understand expectations for families to care for older adults. In this review, we discuss the theoretical frameworks and conceptualizations used to study care expectations, summarize overarching findings about theories of care expectations and corresponding measurement, and propose future directions for research. We examined studies published between January 2011 and December 2023 that focused on the United States. There was little theoretical agreement across studies, with intergenerational solidarity's concept of familism being most prevalent. Terminology and conceptualization of care expectations varied. Most survey items or scales used broad definitions of care and/or family, focused solely on adult children, or had only one item available. Future research should include the development of family theories and more nuanced measures of expectations, specifically by caregiver role/relationship, for specific tasks, and/or the health conditions of older adults receiving care.

BACKGROUND:Rising numbers of older adults will intensify demand for unpaid care from family and friends (caregiving) and quality paid home, assisted living, or nursing home care (long-term care). With growing public desire for government support, it is important to explore older Americans (age ≥ 50) views, especially by caregiver status. PARTICIPANTS AND SETTING:Data were collected from the February-March 2024 wave of the University of Michigan National Poll on Healthy Aging (NPHA), a nationally representative survey of community-dwelling U.S. adults age ≥ 50 (n = 3216). METHODS:We conducted a cross-sectional study using weighted regression models to examine older Americans' (1) views on who should primarily pay for caregiving (government, family/older adults, or others), (2) concerns about older adults in their community being able to access quality long-term care, and (3) concerns about long-term care costs. The key predictor was whether the respondent was a caregiver of an adult ≥ age 65. RESULTS:Opinions on who should primarily pay for caregiving were evenly split between government (45%) and older adults and their families (45%). Caregivers were less likely to favor older adults and their families bearing primary financial responsibility relative to the government (RRR 0.68, p < 0.01). Most older Americans were somewhat or very concerned about quality long-term care access (80%) and costs (88%), and caregivers were more likely to be concerned about both access (b = 1.73, p < 0.001) and costs (b = 1.44, p < 0.01) than noncaregivers. CONCLUSIONS:Most older Americans are concerned about access to long-term care and costs, yet remain divided on who primarily should pay for caregiving costs. Caregivers are both more concerned about long-term care access and more likely to support the government's primary responsibility for caregiving costs than noncaregivers. Policymakers should consider more options for access to affordable, high-quality long-term care, and financial supports for caregivers.

This forum essay calls for greater sociological attention to the theoretical and empirical study of attitudes about the families and care of older adults living with Alzheimer's disease and related dementias (ADRD; dementia). Investigating these attitudes can help expand our understanding not only of the social experience of older adults with dementia, but also of family members and caregivers, as dementia is often highly stigmatized, memory loss changes relationships, and relationship dynamics influence care provision and inequalities. Attitudes and norms function at multiple levels - individual, family, and societal - and have large-scale consequences for social systems and inequality in an aging and increasingly diverse United States, where a growing number of older adults have dementia and family caregiving is normative. We briefly highlight demographic trends and interdisciplinary developments that underscore the urgency of and advantages to addressing these attitudes in sociology specifically. We conclude with a call to action and recommendations for scholars seeking to pursue related research within four relevant subfields within sociology: families, aging in the life course, stratification (race, gender, class), and medical sociology.

As the population ages and families become increasingly diverse, more work is needed to understand expectations for families to care for older adults. In this review, we discuss the theoretical frameworks and conceptualizations used to study care expectations, summarize overarching findings about theories of care expectations and corresponding measurement, and propose future directions for research. We examined studies published between January 2011 and December 2023 that focused on the United States. There was little theoretical agreement across studies, with intergenerational solidarity's concept of familism being most prevalent. Terminology and conceptualization of care expectations varied. Most survey items or scales used broad definitions of care and/or family, focused solely on adult children, or had only one item available. Future research should include the development of family theories and more nuanced measures of expectations, specifically by caregiver role/relationship, for specific tasks, and/or the health conditions of older adults receiving care.

Objectives Family and unpaid caregivers are mainstays of help with daily activities when older adults experience health problems; caregivers can also be relied on as confidants for discussing important matters. It remains unclear what characteristics of caregiving relationships may underlie caregivers' confidant status, how serving this additional role affects their psychological well-being, and whether these associations vary by the presence of dementia in older adults.Methods We used data from the 2017 National Health and Aging Trends Study and the National Study of Caregiving. Participants included 1,694 family or other unpaid caregivers of 1,126 older adults receiving self-care, mobility, or household help due to health and functioning. We estimated logistic regression models for being nominated as a confidant and linear regression models for caregivers' psychological well-being.Results Caregivers who were spouses or children and who reported more positive relationships with the older adults they provided care for were more likely to be nominated as confidants; yet the association involving relationship quality was moderated by older adults' dementia status. Being a confidant was associated with better well-being among caregivers of older adults without dementia, but not for caregivers of older adults with dementia.Discussion Caregivers of older adults with dementia tend to also be a confidant, but serving these multiple roles is only associated with positive psychological well-being for those caring for older adults without dementia. We call for more research to better understand the unique stressors that caregivers experience when serving as confidants for older adults with dementia.

INTRODUCTION:Social norms prescribe family responsibility for care of older adults. However, it is unclear how beliefs about levels of responsibility may vary. METHODS:Using the 2024 RAND American Life Panel (ALP), we test whether beliefs vary by type of relationship, including for lifelong friends, whether the older adult has dementia, and by respondent's caregiver status. RESULTS:Level of caregiving responsibility assigned is highest for spouses/partners, but biological children, stepchildren, and lifelong friends are believed to have some level of responsibility. Beliefs are relatively unchanged by impairment, except levels are higher for the family unit when the older adult has dementia. Caregivers and non-caregivers have similar beliefs with a few exceptions. DISCUSSION:An older adult's social network members are perceived to have some caregiving responsibility, with greater levels of responsibility for nuclear family. The results lend support to the application of hierarchical compensatory theory to beliefs about care responsibility.

African Americans express stronger norms of familism compared to other racial and ethnic groups in the United States. Frequently overlooked is whether attitudes toward family and/or government support for older adults varies by lifecourse stage (young adult, middle age, and older adults) among African Americans as well as by type of support. Using data from the 2001-2003 National Survey of American Life Adult Reinterview (n=1696, aged 18-90), we conducted multinomial logistic regression analyses to examine whether attitudes toward family, equal family and government, or government responsibility for financial, household chores, and personal care support to older adults varies by the lifecourse stage of African Americans- young adults (18-39), midlife (40-64), and older adults (65 and older). Findings show that older adults had a lower likelihood than young adults of endorsing equal responsibility for financial support, whereas midlife adults had a higher likelihood than young adults of endorsing mainly government responsibility for financial support to older adults. Older adults were more likely than young adults to endorse mainly government responsibility for household chores and personal care support for older adults. Our study advances the existing literature on family support norms among African Americans by showing that lifecourse stage is an important factor in attitudes toward family-based responsibility for supporting older adults, potentially due to differences in resources and awareness of the need for government involvement in different types of support.

The population caring for both an older adult and a minor child, known as “sandwiched” caregivers, is growing due to demographic shifts. Most research on the sandwiched caregivers exclusively focuses on adult children, overlooking others like neighbors or grandchildren. Moreover, little is known about sandwiched caregivers of persons living with dementia. This study compares well-being of sandwiched and non-sandwiched caregivers of individuals with and without dementia, with a focus on the role of additional help from family and friends and restriction in social activities. Data from 1,728 caregivers of 1,156 older adults were analyzed from the 2022 National Health and Aging Trends Study (NHATS) and National Study of Caregiving (NSOC). Four groups were compared: Sandwiched, Dementia (S+D); Sandwiched, No Dementia (S-D); Non-Sandwiched, Dementia (NS+D); Non-Sandwiched, No Dementia (NS-D). Linear regressions predicted caregiver well-being, adjusting for demographic and care-related variables, with social participation restriction and family/friend help as moderators. Analyses are weighted and adjusted for NHATS/NSOC's complex survey design. A majority of S+D caregivers were biological, step, or in-law children of the person with dementia (72%), followed by other relatives (21%), and unpaid caregivers like friends or neighbors (7%). Sandwiched caregivers are more likely to receive additional help, be employed, and belong to racial-ethnic minority groups relative to non-sandwiched caregivers ( p s< .001). In terms of well-being, compared to S+D caregivers, S-D caregivers had significantly higher well-being ( B  = 2.91, p  < .001), as did NS+D caregivers ( B  = 1.66, p  = .021), but not NS-D caregivers ( B  = 1.03, p  = 163). Linear regression interaction effects revealed differential impacts of social restriction on well-being across caregiver groups, such that S-D caregivers ( B  = -1.73, p  < .001) and NS+D ( B  = -1.01, p  = .013) report significantly worse well-being associated with increased participation restriction compared to S+D. Additional support from family and friends did not significantly moderate the relationship between caregiver groups and well-being. This research underscores vulnerability in well-being among sandwiched caregivers, especially those involved in dementia care. While sandwiched caregivers often have additional care support, those caring for non-dementia care recipients are particularly sensitive to restrictions in social activities due to caregiving. Interventions are needed to address the wellbeing needs of sandwiched caregivers.

BACKGROUND AND OBJECTIVES:Family members provide the bulk of assistance to older adults with care needs, but implications of family structure for unmet care needs-and differences when dementia is present-are less clear. RESEARCH DESIGN AND METHODS:We use samples of older adults with care needs from the 2015 National Health and Aging Trends Study (NHATS) and the 2017 Panel Study of Income Dynamics (PSID). We examine 2 measures that indicate whether needs are being met for self-care and mobility activities: having unassisted difficulty with at least one activity (NHATS, PSID) and experiencing any adverse consequences related to a lack of help (NHATS). In NHATS we also combine these to identify individuals with met (no unassisted difficulty; no consequences), self-met (unassisted difficulty only), under-met (any consequence only), and unmet needs (unassisted difficulty, any consequence). RESULTS:Adverse consequences were reported more often among those with dementia (43%) relative to those without (24%); in contrast, unassisted difficulty was reported by fewer older adults with dementia (68%, 70%) than without dementia (85%, 87%). Having more family members was positively associated (OR = 1.039) and having a spouse or partner was inversely associated (OR = 0.700) with experiencing adverse consequences. Having stepchildren was associated with lower odds of having unassisted difficulty (OR = 0.228, 0.531), but greater odds of unmet (relative to met) needs (RRR = 1.610). Most family associations were not moderated by dementia. DISCUSSION AND IMPLICATIONS:Adverse consequences, unassisted difficulty, and unmet need are distinct concepts, and produce different estimates and distinctive relationships with dementia and family structure.

With an aging population and projected increases in the number of older adults in need of care, especially those with chronic and progressive disease like dementia, family care is at the forefront of pressing social issues in the U.S. and worldwide. Time use data, including 24-hour time diaries (TD), daily diaries (DD), and ecological momentary assessments (EMA), may be especially helpful for shedding light on the often "invisible" care being given by American families caring for older adults. This review presents U.S. datasets that have TD, DD, or EMA available and proposes areas of future research including charting care and the impact on well-being, as well as expanding data collections.

Narrow definitions of family can constrain survey items about obligations regarding who should care for older adults. Current measurement often does not account for the increased prevalence of diverse family forms and support received among older adults. We draw on six focus groups (N = 33) of family or friends caring for older adults with trouble remembering, memory issues, or dementia to explore definitions of family, caregiving, and responsibility. Although many caregivers immediately default to traditional definitions, the breadth of "family" seen as responsible and actual care networks are often broader. In many cases, caregivers considered friends and other non-kin as family because they provided care. Furthermore, both care and obligations are shaped by family dynamics and the older adult's memory loss. Results suggest that survey measures should capture a wider range of relationship ties and dynamics to better understand family, caregiving obligations, and the tensions between them.

INTRODUCTION:The growing number of older adults with dementia could have implications for their family members, many of whom will be called upon to provide care. METHODS:Leveraging the familial design of the 2021 Panel Study of Income Dynamics, we estimate dementia prevalence among older adults, their households, immediate families, and extended families. RESULTS:About 21% of adults ages 65 and older have dementia. About 26% of both households and immediate families with an adult age 65 and older include an individual with dementia. This figure rises to 37% among extended families of older adults. Among those with older adults, less-educated households and families have higher dementia rates than do more-educated ones; extended families with racial/ethnic minorities have higher dementia rates than do their non-Hispanic White counterparts. DISCUSSION:Nearly four in 10 extended families of older adults include someone with dementia, potentially placing family members at risk of becoming caregivers. HIGHLIGHTS:We provide the first national estimates of dementia in extended families. About 26% of immediate families with an older adult include someone with dementia. Nearly four in 10 extended families of older adults include someone with dementia. Findings have implications for targeting care-related supports to families.

Objective:Time in childhood spent living apart from a biological parent or with a repartnered parent is theorized to disrupt norms of intergenerational solidarity and reduce transfers from adult children to parents. Parents' partnership status when children are grown is also expected to influence children's transfers. We estimate the probability of a past-year child-to-parent transfer as a function of childhood family structure and parents' current partnership status. Background:Changes in family structure across the life course are common and can have lasting effects on parent-child relationships. Prior research has focused on static measures of childhood family structure or focused only on parents' later-life partnerships. Method:We use dynamic measures of biological parents' partnership status and coresidence with children from birth to age 17 and parent's current partnership status to estimate the probability that a child transferred time or money to that parent in the last year (N=8,840 parent-child dyads). Data are from the 1968-2013 US Panel Study of Income Dynamics (PSID), including the 2013 Rosters and Transfers module. Results:Adult children are most likely to make transfers to a parent who is currently partnered with their other biological parent and more likely to support a currently unpartnered or repartnered mother than a father in the same status. Time in childhood spent living with a parent positively predicts adult children's transfers to that parent. Conclusion:Past and current family arrangements each contribute to adult children's likelihood of providing time or money to parents, especially for fathers.

The relationship between a parent and child is one of the most enduring relationships over the life course. Older parents may rely on their adult children for support as they age. We leverage data from the Health and Retirement Study (1998-2018) to assess the dynamics of family exchanges by examining multiple types of parent exchanges and later child behavior in parent-child dyads at the onset of a parent's health limitations. Using logistic regression models, we find overall support for reciprocity, as adult children are more likely to help parents who helped them. We find that co-residence and financial transfers, but not grandchild care and being in the will, are associated with reciprocity, but patterns vary by cohort. More recent cohorts did not apply reciprocity to co-residence or financial transfers. This study highlights the importance of tracking change across time in patterns of intergenerational exchange.

Roughly 10,000 older adults turn 65 each day, an age which many people start to rely more on government supports to help meet their needs. In the United States, programs for older adults receive strong public support, but how attitudes toward these programs have shifted over time as the population ages is unclear. Furthermore, different groups may have different views. This study uses data from the 1984 to 2022 General Social Survey (GSS), a nationally representative survey of U.S. attitudes, to estimate trends in support for government programs for older adults. Attitudes toward more spending on Social Security and retirement have been stable, with slight increases over the last 40 years. Support for more government-provided care, which includes assistance with household tasks, payment for such care, and government direct care services, has increased over the last decade. Older adults, ages 65 and older, are less likely to support government spending on programs than adults ages 18-64. Differences in political affiliation are shrinking over time for Social Security but increasing for payment for care. The popularity of these programs suggests policymakers should seek to sustain them and introduce new programs to help offset the costs of care.

Background and Objectives Latinx older adults have a higher risk of Alzheimer's disease and other chronic conditions that require caregiving. Family and unpaid care, in addition to formal care, have associated costs (e.g., missing work). Ensuring older Latinx adults have access to care will require an understanding of support for policies that tackle the provision and costs of these services. We examine Latinx attitudes and support for policies that cover the costs of long-term care in the United States.Research Design and Methods Using data from the Long-Term Care Poll 2013-2022 and the General Social Survey 2012, 2022, we assess Latinx attitudes toward who should be responsible for covering the cost of long-term care for older adults and support for policies that address the cost of long-term care.Results Over half of older Latinx adults think Medicare should take on a large responsibility for these costs, suggesting that expanding the current public health insurance programs may receive strong support. Older Latinx adults support policies that would make acquiring long-term care insurance easier. Women are less likely than men to think family should be responsible for the cost of care and more likely to favor policies that support family caregivers.Discussion and Implications Despite support for family responsibility for providing care, there is less support for the family covering care costs especially among women compared to men. Results suggest nuanced views among the Latinx population on who should bear long-term care costs and significant gender differences in these views.

An aging U.S. population means more older adults in need of care over time. Although government programs that supply financial support for older adults receive high levels of backing, social norms dictate that when it comes to care, families should be held responsible. Although families do provide most of the care older adults receive, it can often be in balance with more formal provisions such as paid care. However, there is a divide between what older people themselves feel is best compared with other groups. The authors ask, What are American attitudes toward the provision of elder care and payment for such care, how have these attitudes changed in the past decade, and are there differences by age? The authors use cross-sectional data from the 2012 and 2022 General Social Survey and find that younger adults were more likely to support government provision and payment for elder care over time.

Research on caregiving in the United States has not clearly identified the scope of the gap between care needed and care received and the changes implied by ongoing and anticipated shifts in family structure. This article examines the magnitude of contemporary gaps in care among older adults in the United States and how they are likely to evolve through 2050. We use data from the Health and Retirement Study (1998-2014) to estimate care gaps, operationalized as having difficulties with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) but not receiving care. We also estimate variation in care gaps by family structure. Then, we use data from demographic microsimulation to explore the implications of demographic and family changes for the evolution of care gaps. We establish that care gaps are common, with 13% and 5% of adults aged 50 or older reporting a care gap for ADLs and IADLs, respectively. Next, we find that adults with neither partners nor children have the highest care gap rates. Last, we project that the number of older adults with care gaps will increase by more than 30% between 2015 and 2050-twice the rate of population growth. These results provide a benchmark for understanding the scope of the potential problem and considering how care gaps can be filled.