Advancing Health Equity Among Older Adults Without Care Partners: Evidence to Support Culturally Tailored Intervention Development

Abstract

Our demographically aging society includes a rising number of individuals aging into and with disability. These individuals rely on care partners to assist with self-care, mobility, and activities of daily living needs. However, demographic shifts in the U.S. are resulting in a growing number of older adults who lack spouses, children, extended kin, or other network members able and willing to provide this vital care. In the U.S. context these older adults are in a precarious position with limited access to both care partner and publicly provided supports. This precarity is amplified for individuals with marginalized positionalities who are both more likely to need care, and less likely to have access to it. By centering care access, this dissertation aligns with critical gerontology and critical disability studies, which interrogate how the marginalization of aging and disabled bodies and minds in dominant society shapes both who needs care and who can access it. These fields reveal how ageism and ableism, operating within a political and economic system that prioritizes individual responsibility over collective care, render care both devalued and precarious. This mixed-method dissertation aims to address this gap in access to care by 1) uncovering the key risks and outcomes older adults without care partners experience, as documented in peer-reviewed literature; 2) testing how these identified risk factors predict institutionalization over time using nationally-representative longitudinal data; and 3) analyzing an existing intervention to identify opportunities for further cultural tailoring and intervention refinement for older adults without care partners. In combination, these studies help lay the groundwork for developing targeted, culturally tailored, and efficacious interventions for this growing and underserved group.