Social inequalities in the use of formal and informal home care in older women: evidence from a large UK cohort study.

backgroundAt a time when access to publicly funded social care is constrained relative to need, older people with care needs with the least resources may disproportionately rely on informal care.

methodsIn 2020-21, 66,604 participants from the UK Million Women Study were invited to complete an online survey, which included questions on pre-pandemic receipt of home care. Responses were combined with data collected at recruitment in 1998, a 2010 re-survey, and hospital admissions in 2017-19. We used multivariable logistic regression to assess the association between education level and area deprivation quintile with formal or informal care use, with adjustment for pre-disposing characteristics (age), enabling resources (household composition and size) and care need (including self-rated health and co-morbidities).

resultsA total of 44,523 women completed the survey; 43,756 were eligible for analysis (mean age 75.6). A total of 1407 (3.2%) received informal care, 544 received formal care (1.2%) and 255 (0.6%) received both. Compared to those with university degrees, those with no qualifications were more likely to receive informal care (OR: 1.50, 95% CI: 1.23-1.84) and less likely to receive formal care (OR: 0.39, 95% CI: 0.25-0.60). The most deprived were more likely to receive informal care (OR: 1.34, 95% CI: 1.09-1.65) compared to the least deprived, and there was a trend across quintiles (Ptrend = .02).

conclusionThis is the largest UK study to assess variation in social care use by education and deprivation. We found inequities in care that may disadvantage older women in deprived areas and with lower levels of education, and their informal carers.