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Factors associated with preferences for long-term care settings in old age: evidence from a population-based survey in Germany

BMC Health Services ResearchBMC series – open, inclusive and trusted201717:156

https://doi.org/10.1186/s12913-017-2101-y

Received: 21 December 2016

Accepted: 17 February 2017

Published: 21 February 2017

Abstract

Background

Long-term care is one of the most pressing health policy issues in Germany. It is expected that the need for long-term care will increase markedly in the next decades due to demographic shifts. The purpose of this study was to investigate the factors associated with preferences for long-term care settings in old age individuals in Germany.

Methods

Based on expert interviews and a systematic review, a questionnaire was developed to quantify long-term care preferences. Data were drawn from a population-based survey of the German population aged 65 and over in 2015 (n = 1006).

Results

In multiple logistic regressions, preferences for home care were positively associated with providing care for family/friends [OR: 1.6 (1.0–2.5)], lower self-rated health [OR: 1.3 (1.0–1.6)], and no current need of care [OR: 5.5 (1.2–25.7)]. Preferences for care in relatives’ homes were positively associated with being male [OR: 2.0 (1.4–2.7)], living with partner or spouse [OR: 1.8 (1.3–2.4)], having children [OR: 1.6 (1.0–2.5)], private health insurance [OR: 1.6 (1.1–2.3)], providing care for family/friends [OR: 1.5 (1.1–2.0)], and higher self-rated health [OR: 1.2 (1.0–1.4)]. Preferences for care in assisted living were positively associated with need of care [OR: 1.9 (1.0–3.5)] and higher education [for example, University, OR: 3.5 (1.9–6.5)]. Preferences for care in nursing home/old age home were positively associated with being born in Germany [OR: 1.8 (1.0–3.1)] and lower self-rated health [OR: 1.2 (1.0–1.4)]. Preferences for care in a foreign country were positively associated with lower age [OR: 1.1 (1.0–1.2)] and being born abroad [OR: 5.5 (2.7–11.2)].

Conclusions

Numerous variables used are sporadically significant, underlining the complex nature of long-term care preferences. A better understanding of factors associated with preferences for care settings might contribute to improving long-term care health services.

Keywords

Care settingNeed for carePreferencesLong-term care preferencesOld ageGermany

Background

It is projected that the number and proportion of individuals in old age will increase considerably in the future decades [1]. Because old age is associated with the need for long-term care, it is projected that the number of individuals in need for long-term care will increase substantially [2].

Most often, it is assumed that individuals prefer to life at home as long as possible in order to maintain, e.g., social ties or familiar surroundings. Individuals prefer care settings with a high degree of autonomy [3]. If long-term care is needed, home care is often provided informally by relatives or friends which matches the preferences expressed by care-recipients [3]. Preferences shift toward inpatient care when the need for care grows [47].

Generally, care provided in the community is less costly for the system of social security. Therefore, health policy in Germany, like in many other countries, aims at promoting care provided in the community (§ 3 Social Security Code XI). Nevertheless, informal and formal caregiving in the community is very time-consuming, especially when care-recipients are severely cognitively impaired [8]. Furthermore, it is most likely that (i) the geographical distance of family members, (ii) the employment rates of women and (iii) the proportion of elderly individuals living alone will increase in the next decades [9, 10]. Thus, provision of informal care will most likely become more challenging [11]. Moreover, recent longitudinal studies have found that informal caregiving is associated with various negative outcomes for the caregiver, such as increased depressive symptoms [12, 13]. Furthermore, informal caregiving can eventually result in abusive behavior against the care-recipient. On the other hand, studies have also shown that informal caregiving is associated with several positive outcomes for the caregivers including greater self-esteem or personal growth [14].

For policy-makers as well as for various other stakeholders such as nursing services or informal caregivers, it is important to know which factors are associated with preferences for care settings. This might help to reduce the gap between long-term care preferences and reality which in turn might help to increase satisfaction of individuals in need for care [15, 16].

Yet, little is known about preferences for the various long-term care settings in older individuals in Germany. In particular, studies are missing that examine the various predictors of preferences for care settings comprehensively. Furthermore, only a few studies investigated the predictors of preferences for long-term care abroad [1719]. Thus, by using a large population-based sample of individuals aged 65 and over, the purpose of this study was to investigate which factors are associated with preferences for care settings (1. Home care; 2. Care in relatives’ homes; 3. Care in assisted living; 4. Care in nursing home/old age home; 5. Care in a foreign country) in old age individuals in Germany. We focus on individuals in old age because these individuals are at high risk of needing long-term care [20, 21], and it was shown that they are more knowledgeable regarding different aspects of long-term care [22].

Methods

Sample

In 2015, n = 1006 individuals aged 65 and above living in private households with conventional telephone connection were interviewed by phone [23, 24] (Computer Assisted Telephone Interview, CATI). Fieldwork was carried out by USUMA (Berlin)—a company specialized in market and social research. The interviews lasted for about 25 min. Individuals were randomly selected from all registered private telephone numbers (using the Guidelines for Telephone Surveys from the ADM Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute e.V.), enabling representative sampling. Furthermore, the numbers were computer-generated, allowing for ex-directory households as well. In addition, repeat calls were conducted at different times on different days of the week until an answer was given (if the telephone was not answered at the tenth attempt, the number was dropped). From the gross sample (n = 2346), n = 1006 interviews were realized (42.9%). Main reasons for refusal were lack of time/lack of interest (12.1%) and refusal to take part in telephone surveys (26.5%).

The authors of this study did not have any physical contact with the participants. Furthermore, personally-identifying information from study participants were not collected and responses were anonymized prior to analysis. Based on expert interviews [3] and a systematic review of the literature, a questionnaire was constructed to quantify long-term care preferences.

Dependent variables

Individuals were asked to report their preferences for care settings: “When care is needed, I would like to be cared for …” (from 1 = “totally agree” to 4 = “totally disagree”)
  1. a)

    at own home

     
  2. b)

    in relatives’ homes

     
  3. c)

    in assisted living

     
  4. d)

    in nursing home/old age home

     
  5. e)

    in a foreign country

     

A mid-category (indifferent in the choice question) was not included because we prefer respondents to make a definite choice. The five dependent variables were all dichotomized (0 = “totally disagree” and “rather disagree”; 1 = “totally agree” and “rather agree”) to indicate high preferences versus low preferences.

Independent variables

As explanatory variables in this study, we used socioeconomic factors as follows: age in years, sex (women; men), living situation (living with partner or spouse; others (living alone; living with other family members; living with other individuals), region (West Germany; East Germany), education (without a vocational degree; apprenticeship, full-time vocational school; professional school or trade and technical school for vocational education; University, school of engineering), place of birth (born in Germany; born abroad), having children (yes; no), status of health insurance (statutory health insurance; private health insurance). In addition, it was assessed whether the respondent provided informal care for family or friends (yes; no).

Furthermore, the current need of care was quantified by recording the level of care according to the German long-term care insurance: In order to claim for benefits of the long-term care insurance, individuals must need daily a minimum of 90 min of assistance with basic (instrumental) activities of daily living. Depending on the extent of care required, recipients are categorised into 3 levels after an assessment by a nurse or a physician of the medical service of the German statutory health insurance system. Need of care was dichotomized (0 = no level of care; 1 = level 1 to 3).

Subjective health was measured by using self-rated health, ranging from 1 (“very bad”) to 5 (“very good”). Moreover, the involvement in the issue of need for care (“How much have you thought about the issue of ‘need for care’”) was assessed by using a 5-point Likert scale (from 1 = “very little” to 5 = “very much”).

Statistical analysis

Bivariate comparisons between the two groups (high preferences; low preferences) were done using t-test and chi-square procedures, as appropriate. Multiple logistic regressions were used to examine the relationship between predictors and the five dichotomized outcome measures separately (own home, relatives’ home, assisted living, nursing home/old age home, foreign country). Thus, five multiple logistic regressions were performed. The level of significance was chosen at a p-value of less than .05. Statistical analyses were performed using Stata 14.0 (StataCorp, College Station, Texas).

Results

Sample characteristics and bivariate analysis

Table 1 gives an overview of sample characteristics. For example, most of the individuals were female (56.7%). Mean age was 75.7 years (±6.6 years, ranging from 65 to 96 years). Nearly half of the individuals lived alone in own household (46.2%). 38.0% of the individuals hold an apprenticeship degree/full-time vocational school. 83.6% of the individuals had at least one child. Mean self-rated health was 3.6 (±0.9, ranging from 1 to 5) and 6.0% of the individuals were in need of care (level 1 to 3). Furthermore, Table 1 displays bivariate associations between our outcome measures and independent variables.
Table 1

Bivariate associations between preferences for care settings and independent variables

 

Home care

Care in relatives’ homes

Care in assisted living

Care in nursing home/old age home

Care in a foreign country

 

Low preferences

(n = 127; 12.8%)

High preferences

(n = 866; 87.2%)

p-valuea

Low preferences

(n = 668; 67.7%)

High preferences (n = 319; 32.3%)

p-valuea

Low preferences

(n = 426; 44.4%)

High preferences

(n = 534; 55.6%)

p-valuea

Low preferences

(n = 659; 68.0%)

High preferences (n = 310; 32.0%)

p-valuea

Low preferences (n = 929; 94.5%)

High Preferences

(n = 54; 5.5%)

p-valuea

Age: Mean (SD)

76.5 (7.5)

75.5 (6.4)

p = .11

75.8 (6.7)

75.4 (6.4)

0.43

76.3 (6.7)

75.0 (6.5)

p< .01

75.4 (6.6)

75.8 (6.5)

p = .33

75.9 (6.6)

72.1 (5.6)

p< .001

Sex: N

  

p< .01

  

p< .001

  

p = .83

  

p = .49

  

p < .10

Women

85

475

 

411

147

 

238

302

 

367

180

 

538

24

 

Men

42

391

 

257

172

 

188

232

 

292

130

 

391

30

 

Living situation: N

        

p = .37

  

p = .93

  

p = .98

Living with partner or spouse

35

353

p< .01

216

168

p< .001

161

217

 

257

120

 

363

21

 

Others

92

513

 

452

151

 

265

317

 

402

190

 

566

33

 

Region: N

        

p = .97

  

p = .29

  

p = .21

West Germany

94

648

p = .84

490

244

p = .29

317

398

 

485

238

 

243

10

 

East Germany

33

218

 

178

75

 

109

136

 

174

72

 

686

44

 

Education: N

     

p = .98

  

p< .001

  

p < .10

  

p< .05

Without a vocational degree

10

65

p = .83

52

23

 

45

23

 

44

25

 

67

5

 

Apprenticeship, full-time vocational school;

52

319

 

254

117

 

158

201

 

236

132

 

363

10

 

Professional school or trade and technical school for vocational education;

28

214

 

162

79

 

106

127

 

168

62

 

221

17

 

University, Fachhochschule, school of engineering

37

262

 

200

95

 

114

180

 

208

88

 

274

21

 

Place of birth: N

  

p = .37

  

p< .05

  

p = .27

  

p = .33

  

p< .001

Born in Germany

120

796

 

624

285

 

390

500

 

605

290

 

866

41

 

Born abroad

7

67

 

43

32

 

34

33

 

52

19

 

60

13

 

Having children: N

  

p = .42

  

p< .01

  

p = .96

  

p = .53

  

p = .23

Yes

103

726

 

545

283

 

356

448

 

554

256

 

779

42

 

No

24

139

 

123

35

 

69

86

 

104

54

 

149

12

 

Status of health insurance: N

     

p< .01

  

p = .96

  

p = .65

  

p = .22

Statutory health insurance

111

734

p = .50

586

257

 

360

453

 

558

265

 

793

43

 

Private health insurance

16

128

 

81

60

 

63

80

 

99

43

 

132

11

 

Provided care for family/friends: N

     

p = .97

  

p = .39

  

p = .92

  

p = .57

Yes

67

410

p = .22

346

154

 

215

285

 

341

161

 

444

28

 

No

59

456

 

321

154

 

210

249

 

318

148

 

484

26

 

Level of care: N

  

p > .05

  

p = .62

  

p< .05

  

p = .41

  

p = .48

Yes

2

58

 

39

21

 

33

23

 

43

16

 

57

2

 

No

125

805

 

629

295

 

392

510

 

614

293

 

870

51

 

Self-rated health (from x = ‘very bad’ to y = ‘very good’): Mean (SD)

3.8 (0.8)

3.6 (0.9)

p< .05

3.6 (0.9)

3.7 (0.9)

p< .05

3.6 (1.0)

3.7 (0.9)

p = .19

3.7 (0.9)

3.6 (0.9)

p = .11

3.6 (0.9)

3.6 (1.1)

p = .60

Involvement in the issue of need for care (from x = ‘very little’ to y = ‘very much’): Mean (SD)

3.0 (1.5)

2.9 (1.4)

p = .45

2.9 (1.5)

2.8 (1.4)

p = .16

2.9 (1.5)

2.9 (1.4)

p = .63

2.9 (1.4)

2.9 (1.4)

p = .61

2.9 (1.4)

2.8 (1.6)

p = .58

aComparisons between the two groups were done using t-test and chi-square procedures; Significant findings (p < .05) were highlighted (bold)

Regression analysis

In multiple logistic regressions (Table 2), preferences for home care were positively associated with providing care for family/friends [OR: 1.6 (1.0–2.5)], lower self-rated health [OR: 1.3 (1.0–1.6)], and no need of care [OR: 5.5 (1.2–25.7)]. Preferences for care in relatives’ homes were positively associated with being male [OR: 2.0 (1.4–2.7)], living with partner or spouse [OR: 1.8 (1.3–2.4)], having children [OR: 1.6 (1.0–2.5)], private health insurance [OR: 1.6 (1.1–2.3)], providing care for family/friends [OR: 1.5 (1.1–2.0)], and higher self-rated health [OR: 1.2 (1.0–1.4)]. Preferences for care in assisted living were positively associated with need of care [OR: 1.9 (1.0–3.5)] and higher education [for example, University, OR: 3.5 (1.9–6.5)]. Preferences for care in nursing home/old age home were positively associated with being born in Germany [OR: 1.8 (1.0–3.1)] and lower self-rated health [OR: 1.2 (1.0–1.4)]. Preferences for care in a foreign country were positively associated with lower age [OR: 1.1 (1.0–1.2)] and being born abroad [OR: 5.5 (2.7–11.2)].
Table 2

Predictors of preferences for care settings. Results of logistic regressions (for each outcome measure: 0 = low preferences; 1 = high preferences)

 

(1)

(2)

(3)

(4)

(5)

 

Home care

Care in relatives’homes

Care in assisted living

Care in nursing home/old age home

Care in a foreign country

Age

0.977

1.005

0.981+

1.014

0.902***

 

(0.948–1.007)

(0.983–1.027)

(0.961–1.001)

(0.992–1.036)

(0.854–0.951)

Sex (Ref.: Male)

0.698

0.506***

1.176

0.963

0.650

 

(0.433–1.125)

(0.366–0.700)

(0.864–1.600)

(0.694–1.337)

(0.331–1.275)

Living situation (Ref.: Living with partner or spouse)

0.674+

0.559***

1.016

0.951

1.306

 

(0.432–1.051)

(0.410–0.762)

(0.758–1.364)

(0.697–1.297)

(0.684–2.493)

West and East Germany (Ref.: East Germany)

1.161

0.981

1.025

1.316

1.479

 

(0.690–1.956)

(0.677–1.422)

(0.720–1.459)

(0.897–1.931)

(0.617–3.549)

Apprenticeship, full-time vocational school (Ref.: Without a vocational degree)

0.992

0.806

2.984***

0.962

0.246*

 

(0.476–2.065)

(0.459–1.414)

(1.688–5.275)

(0.552–1.675)

(0.0720–0.841)

Professional school or trade and technical school for vocational education

1.269

0.834

2.666**

0.681

0.822

 

(0.574–2.808)

(0.460–1.511)

(1.465–4.850)

(0.374–1.240)

(0.255–2.647)

University, Fachhochschule, school of engineering

1.062

0.562+

3.494***

0.733

0.858

 

(0.471–2.393)

(0.305–1.036)

(1.892–6.452)

(0.398–1.350)

(0.261–2.820)

German-born (Ref.: No)

0.678

0.703

1.205

1.782*

0.184***

 

(0.291–1.575)

(0.433–1.144)

(0.732–1.983)

(1.014–3.129)

(0.0910–0.374)

Children (Ref.: No children)

1.096

1.610*

1.132

0.872

0.669

 

(0.647–1.854)

(1.047–2.475)

(0.780–1.644)

(0.592–1.285)

(0.322–1.391)

Status of health insurance (Ref.: statutory health insurance)

1.211

1.566*

0.918

0.978

0.849

 

(0.648–2.263)

(1.055–2.324)

(0.627–1.343)

(0.648–1.476)

(0.388–1.858)

Provided care for family/friends (Ref.: No)

1.600*

1.468*

0.915

1.181

0.812

 

(1.043–2.454)

(1.086–1.985)

(0.689–1.217)

(0.874–1.596)

(0.437–1.509)

Level of care (Ref.: No)

0.189*

0.573+

1.900*

1.715+

1.899

 

(0.0406–0.879)

(0.317–1.035)

(1.045–3.453)

(0.903–3.257)

(0.284–12.70)

Self-rated health (from 1 = ‘very bad’ to 5 = ‘very good’)

0.762*

1.192*

1.012

0.850*

0.810

 

(0.601–0.968)

(1.013–1.402)

(0.869–1.180)

(0.723–1.000)

(0.584–1.125)

Involvement in the issue of need for care (from 1 = ‘very little’ to 5 = ‘very much’)

0.894

0.978

1.037

0.980

0.976

 

(0.772–1.036)

(0.881–1.086)

(0.939–1.146)

(0.883–1.089)

(0.786–1.211)

Constant

6647***

1.375

0.330

0.0709*

1188*

 

(75.97–581,578)

(0.110–17.22)

(0.0289–3.761)

(0.00541–0.930)

(2.403–586,850)

Observations

974

968

942

950

964

Pseudo R2

0.043

0.059

0.027

0.017

0.137

Comments: Odd ratios were reported. 95% confidence intervals in parentheses. *** p < 0.001, ** p < 0.01, * p < 0.05, + p < 0.10.

Discussion

By using a large, population-based sample of individuals aged 65 and above in Germany, the aim of this study was to examine which factors are associated with preferences for long-term care settings. We found that preferences for home care were positively associated with providing care for family or friends. This is in accordance with a recent population-based study among individuals aged 45 and above in Germany [25] and might be explained by the fact that individuals who already provided informal care are familiar with home care, so that the situation can be understood. Moreover, feelings of reciprocity (giving with expectation of future reward) might be important. In addition, it might be explained by strong family networks.

Preferences for home care were significantly associated with sex, living situation, need of care and self-rated health. Furthermore, sex, living situation, place of birth, having children and self-rated health were significantly associated with preferences for care in relatives’ homes. In addition, preferences for care in assisted living were significantly associated with age, education and need of care. Moreover, preferences for care in nursing home/old age home were not significantly associated with included independent variables. Age, education and place of birth were significantly associated with preferences for care in a foreign country.

Furthermore, we found that preferences for care in relatives’ homes were positively associated with being male, and living with partner or spouse, which is also in line with previous findings [25, 26]. The former association might be explained by the fact that older women might prefer nursing home facilities when care needs are substantial [27]. Kasper et al. [27] have also shown that their husbands saw in-home family care as the best caregiving arrangement. However, there is also equivocal data suggesting that older men (aged 40–70) preferred care in paid/professional settings, whereas older women more often preferred kin/home care [28]. In total, we assume that the sense of being a burden to relatives might differ markedly between women and men. Nevertheless, only a few studies examined self-perceived feelings of burden to relatives from the perspective of care-recipients [29, 30]. Furthermore, most of these studies are restricted to palliative care settings [31, 32]. Thus, future research is required to clarify this relationship.

The association between preferences for care in relatives’ homes and living with partner or spouse might be explained by the fact that compared to individuals living alone, individuals living with partner/spouse might have more family members or relatives who are willing to give aid or assistance. Thus, the living situation might be associated with the (perceived) availability of informal caregivers [6, 33].

We found that current need of care was significantly associated with long-term care preferences for home care and care in assisted living. This is also supported by several other studies in Germany and America [57, 34]. The current study also found that lower self-rated health was positively associated with preferences for care in nursing home/old age home and preferences for home care. These findings might be explained by the fact that individuals with low self-rated health prefer traditional care settings where they might receive strong support. However, this should be investigated in future studies. The relation between self-rated health and preferences for care in nursing home/old age home supports previous findings [47].

In total, need factors (self-rated health and morbidity) are strongly associated with preferences for care in assisted living as well as preferences for care in nursing home/old age home. This might be explained by the fact that individuals in need for care cannot be cared for outside an institutional setting to meet their basic needs (for example, bathing or using the toilet)—and satisfying the basic needs is of high importance to these individuals [35].

In our study, preferences for care in assisted living were positively associated with higher education. While this is in line with a previous study [6], overall the evidence is mixed [5, 34, 36]. For example, a study among older Korean Americans found that a higher educational level was associated with a lower probability of turning to all formal instead of all informal care settings. These differences might be mainly explained by discrepancies in cultural settings which in turn are related to expectations and family norms [4].

As for long-term care abroad, only a few studies investigated the predictors of preferences for care in a foreign country. We found that these preferences were positively associated with lower age and being born abroad. The former relation might be explained by the fact that individuals in higher age groups might have different values or traits (for example, openness to experience) compared with younger individuals. Moreover, younger individuals might have good knowledge of foreign languages which is important since, for example, many caregivers in Thailand do not speak German at all or speak German poorly [37]. This finding is also in accordance with a population-based survey of the German population aged 14 and above [17]. Furthermore, age is positively associated with knowledge of care [22]. Thus, younger individuals might have unrealistic expectations about his or her functional status in old age. The latter relation (preferences for care abroad and being born abroad) might be explained by the fact that individuals who report being born abroad might be more flexible and are likely to be more open to new experiences [38] since they have left their homeland at least once. Furthermore, this latter relationship might be explained by the fact that these individuals return to their countries of origin in order to be cared for and supported by their relatives. We assume that our findings are in line with a previous study which found that preferences for long-term care abroad was higher in urban population compared with rural population [17]. This might support the idea that country of origin and the degree of urbanization reflect unobserved factors such as openness to experience or flexibility [39].

It should be highlighted that our data were obtained from a large, population-based sample in individuals aged 65 and above. Furthermore, several care settings and numerous predictors were analyzed. Furthermore, this is one of the first studies examining the predictors of preferences for long-term care abroad. Four point (no mid-point) Likert scales were used. Thus, the chance to express a truly neutral position was not offered. However, the use of the four point scales might help to alleviate social desirability bias because it might change the intensity of the preferences [40].

As this is a cross-sectional study, it is difficult to determine whether the statistical association identified reflect causal relations. Thus, longitudinal studies are needed. Longitudinal studies are also needed to guide policy makers. Moreover, we assume that other unobserved factors such as personality traits (e.g. neuroticism, extraversion etc.) might play a role in long-term care preferences [41]. Furthermore, our instruments should be validated in future studies. Individuals were asked to report their preferences for care settings (at own home; in relatives’ homes; in assisted living; in nursing home/old age home; in a foreign country). However, we cannot conclude which care setting is preferred most (without making further assumptions). Thus, due to this fact and due to the cross-sectional nature of our study policy implications are limited.

Conclusions

Numerous variables used are occasionally significant, underlining the complex nature of long-term care preferences. A better understanding of factors which are associated with preferences for care settings might contribute to improving long-term care health services. This might help to improve the satisfaction of care-recipients with long-term care services.

Abbreviations

ADM: 

Arbeitskreis Deutscher Markt- und Sozialforschungsinstitute

CATI: 

Computer Assisted Telephone Interview

OR: 

Odds ratio

USUMA: 

Unabhängige Serviceeinrichtung für Umfragen, Methoden und Analysen

Declarations

Acknowledgements

We want to thank all participants for taking the time and effort to participate in the interviews.

Funding

This publication was funded by the German Federal Ministry of Education and Research (BMBF) (grant: 01EH1101B IIIB). The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Availability of data and materials

All relevant data are within the paper and its Additional file 1.

Authors’ contributions

The conception and design of the study, or acquisition of data or analysis and interpretation of data: AH, TL, AW, SRH, HHK. Drafting the article or revising it critically for important intellectual content: AH, TL, AW, SRH, HHK. Final approval of the version to be submitted: AH, TL, AW, SRH, HHK.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The ethical guidelines of the International Code of Marketing and Social Research Practise by the International Chamber of Commerce and the European Society for Opinion and Marketing Research were followed.

Please note that an ethical statement for this survey was not necessary because criteria for the need of an ethical statement were not met (risk for the respondents, lack of information about the aims of the study, examination of patients). Please see: http://dfg.de/foerderung/faq/geistes_sozialwissenschaften/.

Participants provided their oral informed consent prior to assessment. Oral consent is common in survey research in Germany.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf
(2)
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig

References

  1. Kinsella K, Wan H. An aging world 2008. Washington: U. S. Government Printing Office; 2009.Google Scholar
  2. Matthews Z, Channon A, Van Lerberghe W. Will there be enough people to care? Notes on workforce implications of demographic change 2005–2050. Geneva: World Health Organization; 2006.Google Scholar
  3. Heuchert M, König H-H, Lehnert T. Die Rolle von Präferenzen für Langzeitpflege in der sozialen Pflegeversicherung–Ergebnisse von Experteninterviews. Gesundheitswesen. 2016;1–6. doi:10.1055/s-0041-111839.
  4. McCormick WC, Ohata CY, Uomoto J, Young HM, Graves AB, Kukull W, Teri L, Vitaliano P, Mortimer JA, McCurry SM. Similarities and differences in attitudes toward long‐term care between Japanese Americans and Caucasian Americans. J Am Geriatr Soc. 2002;50(6):1149–55.View ArticlePubMedGoogle Scholar
  5. Min JW. Preference for long-term care arrangement and its correlates for older Korean Americans. J Aging Health. 2005;17(3):363–95.View ArticlePubMedGoogle Scholar
  6. Pinquart M, Sörensen S. Older adults’ preferences for informal, formal, and mixed support for future care needs: a comparison of Germany and the United States. Int J Aging Hum Dev. 2002;54(4):291–314.View ArticlePubMedGoogle Scholar
  7. Pinquart M, Sörensen S, Davey A. National and regional differences in preparation for future care needs: A comparison of the United States and Germany. J Cross Cult Gerontol. 2003;18(1):53–78.View ArticlePubMedGoogle Scholar
  8. Hajek A, Brettschneider C, Ernst A, Posselt T, Wiese B, Prokein J, Weyerer S, Werle J, Fuchs A, Pentzek M. Longitudinal predictors of informal and formal caregiving time in community-dwelling dementia patients. Soc Psychiatry Psychiatr Epidemiol. 2016;51(4):607–16. doi:10.1007/s00127-015-1138-7.View ArticlePubMedGoogle Scholar
  9. Statistisches Bundesamt. Bevölkerung Deutschlands bis 2060–12. koordinierte Bevölkerungsvorausberechnung. Wiesbaden: Statistisches Bundesamt; 2009.Google Scholar
  10. Statistisches Bundesamt. Bevölkerung und Erwerbstätigkeit. Entwicklung der Privathaushalte bis 2030. Ergebnisse der Haushaltsvorausberechnung. Wiesbaden: Statistisches Bundesamt; 2009.Google Scholar
  11. Au C, Sowarka D. Die Vereinbarkeit von Pflege und Erwerbstätigkeit. Informationsdienst Altersfragen. 2007;34(3):2–8.Google Scholar
  12. Hajek A, König H-H. The effect of intra-and intergenerational caregiving on subjective well-being–evidence of a population based longitudinal study among older adults in Germany. PLoS ONE. 2016;11(2):e0148916.View ArticlePubMedPubMed CentralGoogle Scholar
  13. Hajek A, König H-H. Informal caregiving and subjective well-being: evidence of a population-based longitudinal study of older adults in Germany. J Am Med Dir Assoc. 2016;17(4):300–5.View ArticlePubMedGoogle Scholar
  14. Haley WE. Family caregivers of elderly patients with cancer: understanding and minimizing the burden of care. J Support Oncol. 2003;1(4 Suppl 2):25–9.PubMedGoogle Scholar
  15. Cvengros JA, Christensen AJ, Cunningham C, Hillis SL, Kaboli PJ. Patient preference for and reports of provider behavior: impact of symmetry on patient outcomes. Health Psychol. 2009;28(6):660-7.Google Scholar
  16. Parley FF. Person-centred outcomes Are outcomes improved where a person-centred care model is used? J Intellect Disabil. 2001;5(4):299–308.Google Scholar
  17. KONPRESS-Medien eG. Pflege im Ausland – Im Alter ins Exil? 2013.Google Scholar
  18. Ormond M, Toyota M. Confronting economic precariousness through international retirement migration: Japan’s old-age ‘economic refugees’ and Germany’s ‘exported grannies’. In: Rickly J, Hannam K, Mostafanezhad M, editors. Tourism and leisure mobilities: politics, work and play. Abingdon: Routledge; 2016. p. 134–146. Google Scholar
  19. Toyota M. Ageing and transnational householding: Japanese retirees in Southeast Asia. Int Dev Plan Rev. 2006;28(4):515–31.View ArticleGoogle Scholar
  20. Hajek A, Brettschneider C, Ernst A, Posselt T, Mamone S, Wiese B, Weyerer S, Werle W, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Heser K, Kleineidam L, Maier W, Scherer M, Riedel-Heller S, HH K. Einflussfaktoren auf die Pflegebedürftigkeit im Längsschnitt. Gesundheitswesen. 2016;1–6. doi:10.1055/s-0041-111841.
  21. Hajek A, Brettschneider C, Lange C, Posselt T, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Wagner M, Jessen F, Maier W, Scherer M, Riedel-Heller S, König H. Longitudinal predictors of institutionalization in old age. PLoS ONE. 2015;10(12):e0144203. doi:10.1371/journal.pone.0144203.View ArticlePubMedPubMed CentralGoogle Scholar
  22. Kuhlmey A, Suhr R, Blüher S, Dräger D. Das Risiko der Pflegebedürftigkeit. Pflegeerfahrungen und Vorsorgeverhalten bei Frauen und Männern zwischen dem 18. und 79. Lebensjahr. In Böcken J, Braun B, Repschläger Uwe (Eds.): Gesundheitsmonitor 2013. Bürgerorientierung im Gesundheitswesen. Kooperationsprojekt der Bertelsmann Stiftung und der BARMER GEK (S. 11-38). Gütersloh: Bertelsmann Stiftung. 2013.Google Scholar
  23. Hajek A, Lehnert T, Wegener A, Riedel-Heller SG, König H-H. Informelles Pflegepotenzial bei Älteren in Deutschland. Z Gerontol Geriatr. 2017;1–7. doi:10.1007/s00391-017-1181-y.
  24. Hajek A, Lehnert T, Wegener A, Riedel-Heller SG, König H-H. Langzeitpflegepräferenzen der Älteren in Deutschland – Ergebnisse einer bevölkerungsrepräsentativen Umfrage. Gesundheitswesen. in press.Google Scholar
  25. Spangenberg L, Glaesmer H, Brähler E, Strauß B. Use of family resources in future need of care. Care preferences and expected willingness of providing care among relatives: a population-based study. Bundesgesundhbl Gesundheitsforsch Gesundheitsschutz. 2012;55(8):954–60.View ArticleGoogle Scholar
  26. McAuley WJ, Blieszner R. Selection of long-term care arrangements by older community residents. Gerontologist. 1985;25(2):188–93.View ArticlePubMedGoogle Scholar
  27. Kasper J, Shore A, Penninx B. Caregiving arrangements of older disabled women, caregiving preferences, and views on adequacy of care. Aging Clin Exp Res. 2000;12(2):141–53.View ArticleGoogle Scholar
  28. Eckert JK, Morgan LA, Swamy N. Preferences for receipt of care among community-dwelling adults. J Aging Soc Policy. 2004;16(2):49–65.View ArticlePubMedGoogle Scholar
  29. Löfqvist C, Granbom M, Himmelsbach I, Iwarsson S, Oswald F, Haak M. Voices on relocation and aging in place in very old age—a complex and ambivalent matter. Gerontologist. 2013;53(6):919–27.View ArticlePubMedGoogle Scholar
  30. Svidén G, Wikström B-M, Hjortsjö-Norberg M. Elderly persons’ reflections on relocating to living at sheltered housing. Scand J Occup Ther. 2002;9(1):10–6.View ArticleGoogle Scholar
  31. Givens JL, Mitchell SL. Concerns about end-of-life care and support for euthanasia. J Pain Symptom Manage. 2009;38(2):167–73.View ArticlePubMedPubMed CentralGoogle Scholar
  32. Karlsson M, Strang P, Milberg A. Attitudes toward euthanasia among Swedish medical students. Palliat Med. 2007;21(7):615–22.View ArticlePubMedGoogle Scholar
  33. Bradley EH, Curry LA, Mcgraw SA, Webster TR, Kasl SV, Andersen R. Intended use of informal long‐term care: the role of race and ethnicity. Ethn Health. 2004;9(1):37–54.View ArticlePubMedGoogle Scholar
  34. Wolff JL, Kasper JD, Shore AD. Long-term care preferences among older adults: a moving target? J Aging Soc Policy. 2008;20(2):182–200.View ArticlePubMedGoogle Scholar
  35. Harrefors C, Sävenstedt S, Axelsson K. Elderly people’s perceptions of how they want to be cared for: an interview study with healthy elderly couples in Northern Sweden. Scand J Caring Sci. 2009;23(2):353–60.View ArticlePubMedGoogle Scholar
  36. Wielink G, Huijsman R, McDonnell J. Preferences for care a study of the elders living independently in the Netherlands. Res Aging. 1997;19(2):174–98.View ArticleGoogle Scholar
  37. Horn V, Schweppe C. Transnational aging: current insights and future challenges. Abingdon: Routledge; 2016.Google Scholar
  38. Canache D, Hayes M, Mondak JJ, Wals SC. Openness, extraversion and the intention to emigrate. J Res Pers. 2013;47(4):351–5.View ArticleGoogle Scholar
  39. McCann SJH. Emotional health and the Big Five personality factors at the American state level. J Happiness Stud. 2011;12(4):547–60.View ArticleGoogle Scholar
  40. Garland R. The mid-point on a rating scale: Is it desirable. Mark Bull. 1991;2(1):66–70.Google Scholar
  41. Sörensen S, Duberstein PR, Chapman B, Lyness JM, Pinquart M. How are personality traits related to preparation for future care needs in older adults? J Gerontol B Psychol Sci Soc Sci. 2008;63(6):P328–36.View ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© The Author(s). 2017

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