Informal care-giving studies have largely ignored how gender and labour force participation intersect to shape filial support across diverse national contexts over time. In particular, comparative longitudinal research that explores care-giving intensity in relation to adult children’s employment status and gender remains scarce. This study addresses this gap by developing a typology of filial support and examining how care-giving patterns vary by gender and labour force participation across different country clusters in Europe and Israel.

Drawing on longitudinal data from the Survey of Health, Ageing and Retirement in Europe, we apply latent Markov models and multi-level latent class analysis to identify seven distinct filial support states, ranging from no support to very intense support. We also classify 28 countries into three clusters based on levels of involvement in filial support: low, moderate and high.

Our findings indicate significant disparities based on gender and employment status, with daughters tending to provide more intensive support than sons, even when employed. Unemployed sons in countries with moderate involvement in filial support were three times more likely to provide intensive care compared to their counterparts in countries characterized by low or higher involvement. These variations suggest that support to ageing parents is deeply shaped by gendered employment opportunities and cultural care-giving norms.

This complexity underscores the necessity for nuanced policy approaches to support care-givers effectively, considering both gender inequalities and employment contexts. Recognizing these intricate patterns of informal care can inform targeted interventions, ultimately addressing the care-giving burden within ageing societies more effectively.

To what extent should workers in physically demanding jobs be given the possibility of earlier retirement? This is one of the many pressing pension reform issues that ageing societies face. This article examines the extent to which such special treatment is supported by the general public. We uniquely combine a representative survey (2,136 respondents) with a vignette study to explore what respondents in the Netherlands consider a fair public pension age for 29 jobs that differ by level of physical demand. We also examine whether these pension ages are associated with other attributes that are important in an ageing society, such as the presence of chronic health conditions and informal care-giving responsibilities – such attributes may affect support for the special provisions for workers in physically demanding jobs – and control for stereotypical views about older workers. The findings reveal notable differences in public pension ages, indicating that workers in highly physically demanding jobs should be given the opportunity to retire earlier and those working in physically ‘light’ jobs should work slightly beyond the standard public pension age. We compare these differences to existing special retirement programmes for physically demanding or arduous jobs. Interestingly, non-work factors – namely, chronic health conditions and care-giving responsibilities – weigh more heavily in deciding a fair or reasonable public pension age. This suggests that organizations and policy makers facing an ageing society will have to deal with a broader set of problems than can be solved by offering early retirement programmes for specific jobs.

Informal care for older people living with chronic life-limiting illnesses is associated with difficulties. The informal care system built around generational values and cultural norms is steadily weakening in rural Ghana because of economic challenges, migration, urbanisation, and changing family structure. In responding to this knowledge gap, we aimed to ascertain how the immediate family, extended family and community support impact on mechanisms underlying provision of informal care for older people living with chronic life-limiting illnesses. Ethnographic interviews were conducted amongst fifteen older people; fifteen informal caregivers; ten health care professionals, after participatory observations during six months of fieldwork utilised to gather the needed data. This study is guided by altruism, empathy, responsibility, self-interest, and social values theories, which provide a very significant structure to understand care relations in rural Ghana. While we find that informal care is sustained by cultural values, it is experiencing financial and human resource challenges.

The article examines informal carers’ experiences of co-producing care, combining notions of carer roles with the strategies used by carers in their interactions and negotiations with the health and social services. The aim is to contribute to the theoretical understanding of carers’ role in co-production. On the basis of interviews with carers with a wide range of experiences, we find that they wish to be treated as co-producers, but their roles and impact depend on whether they are tasked with co-producing knowledge or co-producing care. In knowledge production, informal carers are encouraged to take active part and use their voice to further the interests and values of the person in need of support. However, their impact is conditional on their initiatives being recognised by formal caregivers and, to some extent, the person in need of support. In providing care, their efforts largely go unnoticed, and they are less likely to make their voices heard, but their room to manoeuvre appears to be greater. However, when the work of carers is not recognised, formal carers forego resources that are important to the quality and effectiveness of care. The findings, we argue, have important implications for the theory and practice of co-production.

The following is a list of learning and research resources on topics that are central to this themed section, namely the male-breadwinner and adult worker models, and their alternatives; intersectionality; the views of employers and workplace culture; the role and influence of informal care; and the tendency toward dualisation.

In this thematic issue, the authors explore family policies in seven different countries: Hungary, Hong Kong, Lithuania, Romania, Taiwan, Turkey, and the UK. A common theme is that in analysing these policies, we need to take into account more than gender, but rather we need to also consider issues such as class, poverty, religion, and the use of migrant workers. Thus, these countries have all been moving away from the traditional male breadwinner model; however, the adult-worker model is also inadequate for describing the nuances of these countries’ policies. Instead, an intersectional approach makes more sense, combining gender with the other important socioeconomic issues just mentioned.

Caregivers can play an important role in supporting and caring for people with progressive, life-threatening, or debilitating conditions. However, this supportive role can expose caregivers to various detrimental financial, physical, and psychosocial issues. When evaluating medical technologies for reimbursement decisions, health technology assessment (HTA) agencies typically focus on the treatment’s impact on patients and ignore or downplay the impact on caregivers. Including caregiver impacts within a wider societal perspective may better enable health systems to maximize health benefits from available resources. However, the lack of clear guidance or methodological recommendations from decision makers on the inclusion of caregiver impacts limits the number of HTA submissions that consider these effects. We outline a conceptual framework based on intensity and duration of caregiving to guide researchers, industry, and decision makers when developing policies for the inclusion of caregiver outcomes and justify their inclusion based on expected caregiver burden in identified circumstances.

Rapid demographic changes and heavy reliance on informal care pose significant challenges to meeting long-term care (LTC) needs in China. Understanding changes in unmet LTC needs across different times and places can inform future LTC system planning and care resource allocation, identifying emerging care needs and services gaps in different regions. Drawing on data from 6,030 urban and 5,070 rural residents in the Chinese Longitudinal Health Longevity Survey 2005–2017/18, this study investigates variations in unmet LTC needs across different age groups, periods and birth cohorts among Chinese older adults and their place-based rural–urban differences. We applied the age-period-cohort interaction model to disentangle the three temporal processes, and found that, overall, rural older adults experienced higher risk of unmet LTC needs and had larger variation in age effects, yet the age, period and cohort effects on unmet needs among rural older people differed from their urban counterparts. Although ‘younger’ older adults (aged below 85) had fewer care needs than older adults, they had a higher risk of experiencing unmet needs. The risk of having unmet needs did not change significantly over the 12 years, though unmet LTC needs were more pronounced among more-recent cohorts than previous generations, especially in urban areas. The findings contribute to the social gerontology debate regarding changing patterns in unmet LTC needs, and provide crucial policy insights, underscoring the necessity of targeted interventions to address ‘younger’ older adults’ care needs and increased investmed in the formal LTC system to tackle the escalating care gap.

The impact of health technologies may extend beyond the patient and affect the health of people in their network, like their informal carers. The National Institute for Health and Care Excellence (NICE) methods guide explicitly allows the inclusion of health-related quality of life (HRQoL) effects on carers in economic evaluations when these effects are substantial, but the proportion of NICE appraisals that includes carer HRQoL remains small. This paper discusses when inclusion of carer HRQoL is justified, how inclusion can be substantiated, and how carer HRQoL can be measured and included in health economic models. Inclusion of HRQoL in economic evaluations can best be substantiated by data collected in (carers for) patients eligible for receiving the intervention. To facilitate combining patient and carer utilities on the benefit side of economic evaluations, using EQ-5D to measure impacts on carers seems the most successful strategy in the UK context. Alternatives to primary data collection of EQ-5D include vignette studies, using existing values, and mapping algorithms. Carer HRQoL was most often incorporated in economic models in NICE appraisals by employing (dis)utilities as a function of the patient's health state or disease severity. For consistency and comparability, economic evaluations including carer HRQoL should present analyses with and without carer HRQoL.

This article uses the well-being valuation (WV) approach to estimate and monetize the well-being impacts of informal care provision on caregivers. Using nationally representative longitudinal data from the UK, the British Household Panel Survey, we address two challenging methodological issues related to the economic valuation of informal care: (i) the anticipatory nature of informal care; and (ii) the sensitivity of income estimates used in valuation. We address the anticipatory issue by focusing on well-being impacts associated with caring for a relative who had recently suffered a serious accident. We use the fixed effects filtered (FEF) estimator to estimate a “time-invariant income” coefficient free from individual fixed effects bias, which helps to partially improve the quality of the income estimate as an alternative to using instrumental variables. This estimate is used in the calculation of shadow prices of informal care. Our estimates suggest that, focusing on the first year of unanticipated care provision, those experiencing the well-being losses from providing unanticipated informal care would be willing to pay approximately £13,167 on average to avoid it.

Growing numbers of people help and support family members, friends or others due to long-term health problems, disability or older age–related needs. While care-giving can bring fulfilment and meaning to peoples’ lives, it can negatively affect individuals’ financial wellbeing. Much of the evidence in this area is quantitative, while the subjective, in-depth experience of how unpaid care decisions affect financial wellbeing remains relatively underexplored. This scoping review explores what is known about how unpaid carers experience and understand the financial consequences of providing care. It identified 35 studies containing qualitative evidence and, through thematic analysis, identified four overarching themes: (1) direct and indirect costs of caring; (2) social, cultural and institutional care and work decision-making; (3) the unequal cost of caring; and (4) personal finance and carer wellbeing. Findings indicate that unpaid caring affects financial wellbeing in multiple, overlapping ways. The financial consequences are experienced unequally, with systems, circumstances and contexts serving to exacerbate or reduce these negative effects. Crucially, our analysis reveals the paucity of qualitative research specifically focused on unpaid carers’ financial wellbeing. There is a significant gap in the literature regarding whether, and how, individuals understand the future financial implications of unpaid care-giving, or whether longer-term financial consequences are considered when making decisions about care. Future research designed to address this gap, with greater emphasis on the personal, social and structural influences on care-related financial decision-making, could offer important insights for developing policies and practices aimed at improving the financial wellbeing of carers as they age.

There is limited research on the effect of unpaid care on the public finances, and on the inequalities present when providing support to those with caring responsibilities. The aims of this research are to estimate the overall costs to the State of providing care, and to identify sub-groups of carers with relatively greater costs to the government who may need more support. We used waves eight to ten from the United Kingdom Household Longitudinal Survey and performed two-part Generalised Linear Models and Propensity Score Matching. We found that providing care is associated with excess and potentially avoidable costs to government in terms of forgone earnings-related tax revenue, welfare benefits, and health service use. Older carers have lower healthcare costs, indicating, perhaps, issues related to accessing to services due to their role (as they may neglect their own health, worry about safety and costs of public transport). Older carers were also found to have lower levels of welfare benefits, suggesting challenges associated with applying for support (such as navigating cumbersome application processes and stigma-related barriers).

Informal care plays an important role in the provision of care. However, previous research has mainly focused on middle- or older-aged informal carers and less is known about informal care among young adults, its consequences on educational achievement and employment transitions and whether this varies across country contexts. Using data from the 2009–2018 waves of the UK Household Longitudinal Study (N = 25,856) and the German Socio-Economic Panel (N = 16,666), we investigated the influence of informal care responsibilities of 17–29 year olds on their chances of achieving a university degree using logistic regression and employment transitions using Cox proportional hazard regression models. Our results revealed that young adulthood caring was negatively associated with the likelihood of obtaining a university degree, reduced the likelihood of entering employment and increased the likelihood of unemployment. These associations were more pronounced if people reported caring for more weekly hours (especially in the UK) or caring for longer durations (especially in Germany). The potential negative influence of caring in young adulthood on education was stronger for women than for men in Germany, and the influence of caring on entering unemployment was stronger for women than for men in the UK.

Malgré l’attention renouvelée de plusieurs médias sur la question des risques liés à la COVID-19 au sein de diverses communautés marginalisées au Québec, nous entendons encore très peu parler des personnes âgées immigrantes et de leurs proches. Dans cette note sur les politiques et pratiques, nous aborderons l’expérience du contexte pandémique chez les personnes âgées immigrantes montréalaises et leurs réseaux. Nous présenterons d’abord quelques données sociodémographiques sur les immigrants âgés montréalais. Nous exposerons ensuite nos constats sur les impacts de la COVID-19 sur les personnes âgées immigrantes, en particulier en ce qui concerne l’accès aux soins de la santé et aux services sociaux, la proche-aidance, l’emploi et le logement, à partir de nos travaux et de la littérature en gérontologie sociale. Nous terminerons en proposant quelques recommandations qui permettraient d’améliorer l’inclusion sociale des personnes âgées immigrantes et de leurs proches, autant en matière de politiques publiques que de pratiques sur le terrain.

Balancing caregiving duties and employment can be both financially and emotionally burdensome, especially when care is provided to a spouse at home. Caregiving subsidies can play a role in helping caregivers to cope with such duties. This paper demonstrates how providing financial respite for caregivers can influence individuals' decisions to retire early. We investigate the impact of a reform that extended long-term care (LTC) benefits (in the form of subsidies and supports) on the intention of a caregiving spouse to retire early in Spain. We subsequently examine the effect of austerity spending cuts reducing such publicly funded benefits, and we compare the estimates to the effects of an early retirement reform among private sector workers around the same time. Our preferred estimates suggest evidence of a 10pp reduction in early retirement intentions after the extension of LTC benefits even though the effect is heterogeneous by type of benefit. Consistently, austerity spending cuts in benefits are found to weaken retirement intentions. Even more importantly, our estimates suggest that cuts in caregiving subsidies exert a much stronger effect on early retirement intentions than actual early retirement reforms.

This study examines whether the gender gap in long-term care use in the Netherlands has changed between 1995 and 2016. Previous research has shown that women use more formal care services than men, while men use more informal care. In the past decades, there have been changes in the individual determinants of care use, such as health and social resources, and care provision. This raises the question of whether gender differences in care use have also changed over time. The Longitudinal Aging Study Amsterdam (LASA) involved respondents aged 70–88 in seven waves: 1995/96, 1998/99, 2002/03, 2005/06, 2008/09, 2011/12 and 2015/16 (N = 6,527 observations). Generalised estimating equations (GEE) were used to analyse changes in the impact of gender on the use of informal and formal home care, residential care and private home care, and the non-use of care. Men used more informal care provided by a partner than women, but women used other sources of care more than men. Individual social resources explained the gender gap in informal and formal home care use, and health and social resources explained the gap in residential care. In the non-use of care and, to some extent, in residential care use, the gender gap widened over the years to the disadvantage of men and was not explained by health and social resources. The persistent and even increasing gender gap in the non-use of care over time warrants an exploration of the role of gender in seeking care and access to care, and a closer examination of the role of long-term care policies in maintaining this gap.

The general discourse in health and social care policy purports digital technology as necessary to meet growing demands for long-term care and health care as a result of an ageing population. This needs critical investigation since public policy influences people's health and wellbeing. This study aims to interrogate critically what we call the ‘digital technology solution’ discourse in local Swedish health and social care policies. The main concern of our analysis is the discursive constructions of older people and their informal carers and how the concept of health is constructed. A discourse analysis was conducted of 61 local policy documents using the ‘What's the Problem Represented to Be’ method. Our analysis revealed that so-called ‘e-health strategies’ were rarely concerned with health. Health was often referred to as an activity and seen as a means to achieve independence among older people. The norm advocated independence, with the responsibility placed upon the older person, supported by digital technology. Informal carers were constructed as a resource within an older person's environment and largely taken for granted. We argue that the digital solution discourse ignores older people's agency and capacities as contributors to society, not least with regards to being providers of informal care.