Structural caregiving environments and gendered pathways to hospice at the end of life: evidence from Health and Retirement Study.
Background and Objectives Hospice is designed to support comfort-focused care at the end of life, yet enrollment often depends on whether supportive caregiving infrastructures are in place. Prior studies rely on single indicators such as living arrangements, offering limited insight into the structu...
| Publicado en: | Gerontologist Vol. 66; no. 7; pp. 1 - 12 |
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| Autores principales: | , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Jul2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195281411&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195281411 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00169013 GET jtl: Gerontologist issn: 00169013 maglogo: N pubinfo: dt: Jul2026 vid: 66 iid: 7 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195281411 10.1093/geront/gnag073 ppf: 1 ppct: 11 formats: tig: atl: Structural caregiving environments and gendered pathways to hospice at the end of life: evidence from Health and Retirement Study. aug: au: Dong, Yanjun Wang, Kun Rizzo, Victoria M Zhang, Min Kang, Qing affil: School of Social Welfare, College of Integrated Health Sciences, University at Albany, State University of New York, Albany, New York, United StatesCenter for Healthy Aging, University at Albany, State University of New York, Albany, New York, United States Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States Public Management, Krieger School of Arts and Science, John Hopkins University, Washington, DC, United States Gerontology Personnel Development Committee, China Association of Gerontology and Geriatrics, Beijing, China su: Elder care Health services accessibility Sex distribution Caring Health Retirement Home environment Health facilities Hospice care Old age Medical care use Statistical correlation Secondary analysis T-test (Statistics) Multiple regression analysis Scientific observation Multivariate analysis Descriptive statistics Chi-squared test Odds ratio Research Confidence intervals Data analysis software sug: subj: Elder care Health services accessibility Sex distribution Caring Health Retirement Home environment Health facilities Hospice care Old age Continuing Care Retirement Communities All Other Outpatient Care Centers Nursing Care Facilities (Skilled Nursing Facilities) Home Health Care Services Medical care use Statistical correlation Secondary analysis T-test (Statistics) Multiple regression analysis Scientific observation Multivariate analysis Descriptive statistics Chi-squared test Odds ratio Research Confidence intervals Data analysis software keyword: aged Caregiving environments copyrightHolder:The Gerontological Society of America copyrightYear:2026 end-of-life care erosion Formal care gender Gender differences hospice hrs trial https://dx.doi.org/10.1093/geront/gnag073 Informal care inLanguage:en publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42054580/ terminally ill aged Caregiving environments copyrightHolder:The Gerontological Society of America copyrightYear:2026 end-of-life care erosion Formal care gender Gender differences hospice hrs trial https://dx.doi.org/10.1093/geront/gnag073 Informal care inLanguage:en publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42054580/ terminally ill ab: Background and Objectives Hospice is designed to support comfort-focused care at the end of life, yet enrollment often depends on whether supportive caregiving infrastructures are in place. Prior studies rely on single indicators such as living arrangements, offering limited insight into the structural care environments that shape hospice feasibility. This study conceptualizes end-of-life care environments as graded structural positions: care formalization (how care is organized across household and institutional settings) and care scarcity (the availability of hands-on support) and examines their associations with hospice use among older decedents, including gender differences shaped by gendered life-course trajectories. Research Design and Methods Using nationally representative data from the Health and Retirement Study Harmonized End-of-Life Interview (1994–2021; N = 12,477), we estimated multivariable logistic regression models of hospice use in the last year of life. Results Occupying more formalized structural care positions was associated with greater odds of hospice use (OR = 1.39), whereas greater care scarcity was associated with lower odds (OR = 0.69). Gender moderated both associations: the facilitating effect of formalization was weaker for women (OR = 0.87), while the constraining effect of scarcity was attenuated for women (OR = 1.20), indicating steeper structural gradients among men. Discussion and Implications Hospice use is embedded within structurally patterned caregiving ecologies rather than driven solely by clinical trajectories or preferences. Erosion of support may constrain hospice access, whereas more formalized care settings may enhance referral and coordination. Strengthening caregiving infrastructures and targeting older adults experiencing care scarcity may promote more equitable end-of-life care. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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