Developing approaches to measure dependency across different domains of need in later life: an exploration of the relationship between need and care receipt using the English Longitudinal Study of Ageing

Abstract

This thesis explores the relationship between the needs people experience in later life and the types of care they receive. The thesis provides evidence on the role of different types of care in supporting the needs of people aged 60+ in England using the English Longitudinal Study of Ageing (ELSA). The research presented adopts a number of new approaches to capturing the multi-dimensional nature of dependency by utilising a range of binary indicators of difficulty performing 10 actions related to upper and lower body mobility, 6 activities of daily living (ADL) and 7 instrumental activities of daily living (IADL). The thesis provides a detailed analysis of the prevalence of these items when considered independently and collectively in combination. A central aim of the research is to develop a more nuanced understanding of dependency to allow for the dimensionality of the needs experienced by older people living in their own homes to be considered. The thesis utilizes a number of different approaches, including simple binary and count-based indicators of need and more complex measures reflecting dependency across different domains of need. These approaches allow a more dynamic picture of dependency in later life to be considered. Using these measures, the research explores the role of different types of care in meeting different types of need. Of these, a unique application of an existing assessment tool is presented, the Indicator of Relative Need (IoRN), which is used as a framework to derive an equivalent measure – the Array of Need (AoN). Given the aim of the study is to investigate the multi-dimensional nature of dependency, various data reduction approaches are used including principal components analysis. Finally, research from similar studies is acknowledged and work from the Survey of Health, Ageing and Retirement in Europe (SHARE) study is reproduced using ELSA. The thesis suggests that when considering the dependency needs experienced by older people living in the community, it is important to be aware that this group includes both less and more dependent older people. As such, developing a better understanding of the dynamic relationship between dependency and the receipt of informal and formal care may require more suitable measurements of dependency.