Multiple hands, better care? Examining the moderating role of shared care-giving in the associations among stressors, appraisals and quality of care for older adults with disabilities in China

Despite its significant role in relation to wellbeing among older adults with disabilities, the quality of care from family care-givers is largely understudied. This study aims to (a) investigate the mediating roles of care-giving appraisals in the association between care-giving stressors and quality of care; and (b) examine the moderating role of shared care-giving in the above associations. This study adopted a cross-sectional survey design. Data were collected in Changchun, China using stratified sampling. A total of 416 family care-givers of older adults with disabilities were enrolled. Structural equation modelling, including mediation analysis and multiple-group analysis, was performed to examine the proposed hypotheses. Results showed that low levels of care-giving burden and high levels of positive aspects of care-giving were related to higher quality of care. Older adults’ cognitive impairment had direct negative association with quality of care, while impairment in activities of daily living and instrumental activities of daily living had indirect negative associations with quality of care through care-giving burden. Shared care-giving significantly moderated the association between care-giving burden and quality of care, with the negative association being significant only among sole care-givers. In sum, this study suggested that care-giving stressors and appraisals were important factors associated with quality of care, and shared care-giving could attenuate the negative association between care-giving burden and quality of care. Social services and interventions on both primary care-givers and the family care-giving system should be provided to enhance quality of care for older adults with disabilities.