Development and psychometric validation of the measure of alternative care and support (MACS) for community-dwelling older adults

The deeply embedded cultural expectation of filial caregiving in India often creates a nuanced discourse on formal care provisions for older adults ageing outside intergenartional coresidence. The present study aims to develop and validate MACS (Measure of Alternative Care and Support) for older adults outside of intergenerational households. An exploratory sequential design was used for developing and validating MACS, followed by content validation. Data from 291 older adults who were aged alone or solely with a spouse were collected, and the domains of alternative care were identified using Exploratory Factor Analysis (EFA). The item-level CVI ranged between 0.80 and 1.00, while the scale-level CVI was 0.95, the Cronbach’s alpha was 0.72, and test-retest measured an average ICC of 0.769, demonstrating excellent content validity and a good internal consistency. EFA revealed three structural factors: access to health, access to micro and macro systems, as pivotal in deciding the extent of alternative care among empty nesters of Kerala. MACS demonstrated reasonable validity and can be used to measure the extent of alternative care among older adults in migrant households. Geriatricians could use a modified version of the MACS to evaluate unmet care needs and to formulate person-centred care plans for older adults.