Health Serv Res. 2026 Jun;61(3):e70130. doi: 10.1111/1475-6773.70130.
ABSTRACT
OBJECTIVE: To examine whether different caregiving arrangements influence hospitalization risk and frequency among older adults with functional limitations.
STUDY SETTING AND DESIGN: This longitudinal study used linear probability and Poisson regression models with individual and wave fixed effects, lagged predictors, and household-clustered standard errors to assess associations between different caregiving arrangements and hospitalization outcomes among community-dwelling older adults in the United States. Caregiving was categorized as no help, family help, formal help, or combined help. Outcomes included any hospitalization and the number of hospital stays over a two-year period.
DATA SOURCES AND ANALYTIC SAMPLE: Data came from eight waves of the Health and Retirement Study (2004-2018). The samples included adults aged 65 and older who reported difficulty with at least one activity of daily living and participated in at least two survey waves. The final analytic sample comprised 2926 individuals contributing 5595 person-wave observations.
PRINCIPAL FINDINGS: While the overall hospitalization risk did not differ significantly by caregiving type, receiving combined support was associated with a reduced number of hospital stays among those hospitalized (IRR = 0.712, p < 0.01), compared to receiving no support. Cognitive functioning modified these relationships, with formal help linked to fewer hospitalizations among those with impairment but more among those without. Differences also emerged across racial and ethnic groups, where formal help was linked to lower hospitalization rates for Black individuals, and combined help was associated with increased hospitalizations among Hispanic older adults.
CONCLUSIONS: Policies that expand access to both formal and family caregiving support may help reduce hospitalizations among older adults with functional limitations, particularly when tailored to care recipient characteristics.
PMID:42137944 | DOI:10.1111/1475-6773.70130
