Attitudes about care

Attitudes about care

LASA filenames:
LASA032 (Choices for care and housing, only in wave B)
LASA112 (Attitudes about care)
LASA175 (Attitudes towards nursing home care)

Contact: Marjolein Broese van Groenou

Background
In LASA, questions have been asked about the preference for source of care, for example informal or formal care. Care has often been studied within the framework of Andersen and Newman that specifies individual and societal determinants of care use [1]. From past studies we know older adults’ care use is, amongst others, related to their predispositions to receive care, such as, norms, attitudes and preferences [2-4]. The questions of attitudes (LASA112) about care have been derived from studies by de Klerk & Huijsman and Steverink [5,6].

Furthermore, community-dwelling respondents were asked during wave B (LASAB032) that when they need help at a particular moment, from who they would like to receive help and, concerning housing, where they would like to move to. Next, the older adults not living independently were asked that when they would have to make a housing choice again, where they would prefer to live.

After the reform of long term care in 2015, the allocation of residential care became more restricted: residential care homes (verzorgingshuizen) were abolished and nursing care homes were only available for those needing 24/7 care. As a result, only the very frail and/or very old could move into a nursing home. In line with this, general attitudes toward nursing homes may have become more negative. At the LASA J-and K-wave we included nine items on care in nursing homes in order to examine the general attitudes towards nursing homes. These items were developed in consultation with members of the research group on Care of the Netherlands Institute on Social Research (SCP).

Measurement instruments in LASA

1) Attitudes about care (LASA112)
The respondents were asked to indicate on a 5-point scale, ranging from completely disagree to completely agree, whether they agreed to the following statements:

  1. It’s annoying to be dependent on professional agencies for help
  2. If you need temporary help, you should be able to ask your children, family or neighbours
  3. Older adults should not have to pay for the help they need
  4. Help from your children or family goes at the expense of your independence
  5. By living with children or family you give them too much burden
  6. If older adults need help for their personal care, they should be able to count on children, family or neighbours
  7. Help from professional agencies goes at the expense of your independence
  8. You need to wait too long before you get help from professional institutions
  9. I need to ask too often my children, family or neighbours for help

At wave LASA-B, LASA-2B and LASA-F, statements 1 to 8 were asked. At wave LASA-G, -H, -3B, -MB, -I, -J and -K statements 1, 2, 4, 6, 7 and 9 were asked. These statements are categorized in the variables qaid1 to qaid9 (in LASA-MB: maid1 to maid9).

2) Choices regarding to care (LASAB032)
Questions concerning choices for care and housing were asked. Six statements were only asked at respondents living independently:

  1. When I need help at a particular moment I would want:
    a. Organize: self
    b. Organize: family doctor
  2. When I have to move because of my health, I would prefer:
    a. Move: to family
    b. Move: to residential home
  3. When I need help at a particular moment I would want
    a. Organize: family doctor
    b. Organize: children
  4. When I have to move because of my health, I would prefer for moving to
    a. Move: residential home
    b. Move: old peoples home (with service)
  5. When I need help at a particular moment:
    a. Organize: self
    b. Organize: children
  6. When I have to move because of my health, I would prefer:
    a. Move: to family
    b. Move: old peoples home (with services)

Another six statements were only asked at respondents not living independently:

  1. When I would have to make a housing choice again, I would prefer to:
    a. Choice: home
    b. Choice: residential home
  2. When I would have to make a housing choice again, I would prefer to:
    a. Choice: home
    b. Choice: family
  3. When I would have to make a housing choice again, I would prefer to:
    a. Choice: nursing home
    b. Choice: home (independently)
  4. When I would have to make a housing choice again, I would prefer to:
    a. Choice: family
    b. Choice: nursing home
  5. When I would have to make a housing choice again, I would prefer to:
    a. Choice: residential home
    b. Choice: nursing home
  6. When I would have to make a housing choice again, I would prefer to:
    a. Choice: residential home
    b. Choice: family

These 12 statements are categorized in the variables prefe01 to prefe12.

3) Attitude towards nursing home care (LASAJ175, LASAK175)
At LASA-J and LASA-K, a new element regarding nursing home was added, asking respondents about their view on nursing home care in the Netherlands. Using a 5-point scale ranging from completely disagree to completely agree, respondents could indicate whether or not they agreed to the following 9 statements:

  1. The quality of nursing home care in the Netherlands can undoubtedly be considered to be good.
  2. In a nursing home residents have sufficient privacy
  3. Residents of a nursing home barely go outside.
  4. Being together with other residents in a nursing home creates a cosy  and social ambience.
  5. In a nursing home it is the residents decision if and when to go to the bathroom.
  6. Residents in a nursing home barely get visitors.
  7. In a nursing home the personnel treats you with respect.
  8. In a nursing home you can decide for yourself at what time you want to get out of bed.
  9. I can have a good conversation with other residents of a nursing home.

These 9 statements are categorized in the variables nh01 to nh09. Items 3 and 6 need to be reversed. A sum or mean of all nine scores can be calculated to derive at a scale ranging from negative to positive attitudes on nursing homes. Used in a sample of independent living older adults from the J-wave the scalability of the nine items appeared good (N = 1229, Cronbach’s alpha = 0.73, Hoekerswever, 2023).

Questionnaires
LASAB032 (main interview, in Dutch);
LASAB112 / LAS2B112 / LASAF112 / LASAG112 / LASAH112 / LAS3B112 / LASAI112 / LASAJ112 / LASAK112 (self-administered questionnaire, in Dutch) / LASMB112 (medical interview, in Dutch);
LASAJ175 / LASAK175 (medical interview, in Dutch)

Variable information
LASAB032
(pdf);
LASAB112 / LAS2B112 / LASAF112 / LASAG112 / LASAH112 / LAS3B112 / LASMB112 / LASAI112 / LASAJ112 / LASAK112
(pdf);
LASAJ175 / LASAK175
(pdf)

Availability of information per wave ¹

BCDE
2B*		FGH

3B*		MB*IJK
Attitudes (about
care)
LASA112		 Sa---SaSaSaSaSaMeSaSaSa
Help & Housing
choice
LASA032		Ma----


--------
Attitudes
towards Nursing
Home Care
LASA175		-----------MeMe

¹ More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort

Ma=data collected in main interview;
Me=data collected in medical interview;
Sa=data collected in self-administered questionnaire

Previous use in LASA
The attitudes about care and choices regarding care can be used in various ways. In general, the items are used to indicate a preference for informal care versus a preference for formal care. This can be indicated by using a single item or multiple items. Yet, preliminary analyses with the items ‘Attitudes about care’ have shown that many respondents prefer both informal and formal care, and do not consider this two sides of one dimension. As a result, the scalability of the six or nine items is very low. It is recommended to use the items 1, 3, 7 and 9 to calculate an index for ‘preference for professional care’, and to use the items 2, 4, 5, 6 and 8 to calculate an index for ‘preference for informal care’.

A single item, preference for organizing care by GP or by children, was used in a study on income inequality in the use of professional home care by older adults and the impact of health, social context, care preference and personality [1].

Indicators of ‘preference for professional care’ and ‘preference for informal care’ were used in a study on trends in volunteering, informal care and social support giving [VWS report 1 and 2], in studies on care network types [2-4] and in a study on care networks types and well-being [5]. The scale ‘attitudes towards nursing homes’ has been used in a thesis for the master Sociology (Hoekerswever, 2023).

Publications in peer-reviewed journals

  1. Schuijt-Lucassen, N.Y., & Broese van Groenou, M.I. (2006). Verschillen in zorggebruik door ouderen naar inkomen: De rol van gezondheid, sociale context, voorkeur en persoonlijkheid [Income inequality in the use of professional home care by older adults: The impact of health, social context, care preference and personality]. Tijdschrift voor Gezondheidswetenschappen, 84, 4-11.
  2. Broese van Groenou, M.I., Jacobs, M.T., Zwart-Olde, I., Deeg, D.J.H. (2016). Mixed care networks of community-dwelling older adults with physical health impairments in the Netherlands. Health & Social Care in the Community, 24, 1, 95-104.
  3. Jacobs, M. T., van Tilburg, T. G., Groenewegen, P., & Broese Van Groenou, M. I. (2016). Linkages between informal and formal caregivers in home-care networks of frail older adults. Ageing and Society, 36(8), 1604-1624.
  4. Jacobs, M.T., Aartsen, M.J., Deeg, D.J.H. & Broese Van Groenou, M.I. (2016). Diversity in older adults’ care networks: the added value of individual beliefs and social network proximity. Journals of Gerontology. Series B: Psychological Sciences and Social Sciences. doi: 10.1093/geronb/gbw012
  5. Broese van Groenou, M.I. (2020). Associations between care network types and psychological well-being among Dutch older adults. International Journal on Care and Caring, 1, online first.


Reports for the Ministry of Health, Welfare and Sports (Beleidsrapporten VWS, in Dutch)

  1. Broese van Groenou, M.I. and N. Tolkacheva (2014). Zijn ouderen nu meer of minder sociaal actief dan voorheen? Trends in vrijwilligerswerk, mantelzorg en het geven van steun door 64-75-jarigen in 2005, 2008 en 2012. [Trends in volunteering, informal care and social support giving]. Rapport voor het ministerie van VWS. Amsterdam: VU/LASA.
  2. Broese van Groenou, M.I. and Bijnsdorp, F. (2017). Zorgnetwerk, kwaliteit van zorg en kwaliteit van leven. [Care network, quality of care and quality of life]. Rapport voor het ministerie van VWS. Amsterdam: VU/LASA.

 

Master thesis

Hoekerswever, K.A. (2023). Het beeld dat zelfstandig wonende ouderen hebben van verpleeghuizen en de invloed op formeel zorggebruik. Master thesis Sociologie. Amsterdam: Vrije Universiteit.

 

References

  1. Andersen, R & Newman, F. (2005). Societal and Individual Determinants of Medical Care Utilization in the United States. Milbank Quarterly, 83(4). doi: 10.1111/j.1468-0009.2005.00428.x.
  2. Wielink G., Huijsman R. & McDonnell J. (1997). Preferences for care: a study of the elders living independently in the Netherlands. Research on Aging, 19 (2), 174–198
  3. Pinquart M. & Sorensen S. (2002). Older adults’ preferences for informal, formal, and mixed support for future care needs: a comparison of Germany and the United States. The International Journal of Aging and Human Development, 54 (4), 291–321.
  4. Larsson K. & Silverstein M. (2004). The effects of marital and parental status on informal support and service utilization: a study of older Swedes living alone. Journal of Aging Studies, 18 (2), 231–244.
  5. De Klerk, M.M.Y, & Huijsman, R. (1992). Preferenties van ouderen [Preferences of older persons]. Erasmus University Rotterdam, The Netherlands: Institute for Medical Technology Assessment.
  6. Steverink, N. (1996). Zo lang mogelijk zelfstandig: naar een verklaring van verschillen in oriëntatie ten aanzien van opname in een verzorgingstehuis onder fysiek kwetsbare ouderen. [Independent for as long as possible]. Dissertation, ICS, University of Groningen. Amsterdam: Thesis Publishers.
  7. Schuijt-Lucassen, N.Y., & Broese van Groenou, M.I. (2006). Verschillen in zorggebruik door ouderen naar inkomen: De rol van gezondheid, sociale context, voorkeur en persoonlijkheid [Income inequality in the use of professional home care by older adults: The impact of health, social context, care preference and personality]. Tijdschrift voor Gezondheidswetenschappen, 84, 4-11.
  8. Broese van Groenou, M.I. and N. Tolkacheva (2014). Zijn ouderen nu meer of minder sociaal actief dan voorheen? Trends in vrijwilligerswerk, mantelzorg en het geven van steun door 64-75-jarigen in 2005, 2008 en 2012. [Trends in volunteering, informal care and social support giving]. Rapport voor het ministerie van VWS. Amsterdam: VU/LASA.
  9. Jacobs, M.T., Broese van Groenou, M.I., Aartsen, M.J., & Deeg, D.J.H. (2015). Diversity in care networks: the added value of psychosocial factors and social network proximity. Unpublished manuscript.


Date of last update: Februari 22, 2024