Subjective Well-Being of Eldercare Recipients and Providers
Subjective well-being refers to how people evaluate their life in general and assess their specific feelings during activities. It covers the emotional dimension of people’s lives beyond material standards of living or traditional measures of physical and cognitive health.
There are three distinct aspects of well-being – evaluative, experienced (or hedonic), and eudemonic (Population Reference Bureau 2015; Steptoe et al. 2015). Evaluative well-being, the most commonly used indicator of subjective well-being, refers to people’s thoughts about the overall quality of their lives. Experienced well-being refers to momentary feelings or moods during everyday activities. Eudemonic well-being focuses on judgments about the meaning and purpose of one’s life.
In recent years, research on subjective well-being has gained increasing attention as governments set improvement of people’s well-being as one of their public policy goals (Dolan et al. 2011; OECD 2013). With population aging globally, subjective well-being of the older people and their caregivers has gradually come to the forefront of population aging research.
People are living longer, but the combination of increasing morbidity with age and an aging population has resulted in a larger number of older people with disabilities or ill health. Older people with functional limitations in physical, mental, or cognitive abilities are a vulnerable group. Their subjective well-being is an important area in population aging research.
On the other hand, the majority of older people with a disability live at home and are cared for by unpaid, informal caregivers, often their spouse or other family members (Ryan et al. 2012; He and Larsen 2014; West et al. 2014; Dukhovnov and Zagheni 2015; National Academies of Sciences 2016). The burden for the family of caregiving to older people is likely to increase with the growth of older population. It is equally important to assess the health and well-being of the eldercare providers.
Subjective well-being research mostly focuses on evaluative well-being, which is often measured by life satisfaction (e.g., Berg et al. 2009). Typically, a survey question for life satisfaction asks the respondents how satisfied they are with their overall life. Surveys may also ask respondents to rate their life on an imaginary ladder of 0 to 10, to obtain degrees of satisfaction (Stone 2012). Experienced well-being, less frequently included in surveys, is measured by asking the respondents how they felt when performing selected specific activities. The range of feelings includes happy, sad, stressed, tired, in pain, angry, depressed, or another feeling (He et al. 2018). Eudemonic well-being, which is largely lacking in survey questions, asks the respondents whether they regard their life in general as purposeful or meaningful (Stone 2012).
Key Research Findings
Much research on subjective well-being has found a U-shaped progression of life satisfaction through one’s life course – life satisfaction is relatively high at childhood/youth, declines until midlife, and rises in older ages (Blanchflower and Oswald 2008). Studies found that after life satisfaction dips in mid-adulthood, it improves starting from ages of late 40s or early 50s. This U-shaped curve for well-being with age has been found in many world regions and countries. Results from several large-scale general social surveys and multinational studies reported the relatively good subjective well-being for older people in the United States, Western and Eastern Europe, Asia, and Latin America (Diener and Suh 1998; Easterlin 2006; Blanchflower and Oswald 2008). However, the U shape is more likely to be found in high-income, English-speaking countries; research has noted declining well-being with age in some former Soviet Union or Eastern European countries and flat progression in some sub-Saharan African countries (Steptoe et al. 2015).
Many factors contribute to the good subjective well-being at older ages (Easterlin 2006; Li et al. 2008; Ng et al. 2017). Socioeconomic status such as education and income showed positive association with people’s well-being (Cho et al. 2015). Demographic determinants such as marital status, living arrangements, or number of children were also found to be correlated with subjective well-being (Grundy et al. 2019). From the life course perspective, by the time adults reach older ages, many of them have entered a phase of life where job or career is established, highest earning potential is being or has been reached, children are grown, and many are retired and have more time to pursue personal hobbies and leisure activities. Some studies found that retirement did not negatively affect the quality of life of the retirees (Freitas et al. 2016).
However, research also found negative well-being among many older people, primarily affected by poor health (Charles et al. 2016; McClintock et al. 2016; Carmel et al. 2017; Freedman et al. 2017; Larsen et al. 2018; Hsieh and Waite 2019). For example, negative feelings or moods were often reported by older people with ill health or functional limitations and in need of care (Heidrich and D’Amico 1993). These eldercare recipients are not only subject to higher levels of physical pain or fatigue but also are more likely to have lower self-efficacy or become socially isolated, all of which could lead to emotional stresses or depressive moods. It is not surprising that at oldest-old ages, life satisfaction declined sharply and distress and depression heightened, especially for those who are terminally ill or near end of life (Palgi et al. 2010; Jivraj et al. 2014; Hoppmann et al. 2017; Neubauer et al. 2017).
Many older people, even oldest-old, are also providers for eldercare (e.g., He et al. 2018). Caregiving, especially to older people in poor health or with a disability, could cause mental and physical burden to the caregivers and negatively affect caregivers’ well-being (Bevans and Sternberg 2012; Adelman et al. 2014; Berg et al. 2014; Moore and Gillespie 2014). Eldercare providers’ subjective well-being can differ depending on the type of care activity they engage in. Eldercare activities as reported by time diaries include a wide range of activities from assisting older people with limitations in daily activities such as eating and bathing, helping to prepare meals, providing physical and medical care and helping with transportation, or providing companionship (Bureau of Labor Statistics 2017).
Research on eldercare providers’ subjective well-being, experienced well-being in particular, is still at an early stage (e.g., Guberman et al. 2012; Freedman et al. 2014; Sun et al. 2015). Data showed that although eldercare providers reported relatively high level of evaluative and experienced well-being, they fared less well than those who did not provide eldercare (He et al. 2018). Some studies found that family caregivers experienced significant deterioration in well-being and quality of life while caring for older patients with dementia or cancer (Bevans and Sternberg 2012; Adelman et al. 2014). Research also showed that older people reported more negative feelings caring for older adults than for children (Zagheni et al. 2015). Differences by gender were also investigated; in general, women or wife reported higher negative feelings of stress, fatigue, or pain than men or husband (Freedman et al. 2014; Chappell et al. 2015).
Future Directions of Research
Research on older people’s subjective well-being often focuses on global levels of well-being such as their general assessment of life satisfaction. Less is known about older people’s feelings or emotions when performing specific activities. Experienced well-being provides a more detailed and complete picture of emotional experience beyond the overall life assessment. More of such research is needed.
While the U-shaped life satisfaction reflecting a better state of well-being for older people has been reported, it is important to explore further the roots and causal relations of this pattern. Cohort and historical effects need to be taken into consideration. Longitudinal data are one of the best tools to disentangle these confounding effects; presently panel surveys on subjective well-being are still in shortage.
In addition, future research on older people’s subjective well-being needs to enhance the understanding that older people are not only eldercare recipients but also providers. Better capturing the well-being of older people who are caregivers has significant implications for institutions and public policies concerned with the informal caregiving, as population aging continues throughout the world.
Lastly, while there have been many international surveys and studies in recent decades that include some aspects of subjective well-being, standardization and comparability among these surveys are essential and should be the next step in older people’s subjective well-being data collection.
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