For persons with ADLs or IADLs, primary groups are better than formal organizations for providing personal services, and this will be reflected in outcomes such as reduced institutionalization in nursing homes or mortality. Primary groups, themselves, may be arrayed on a continuum from marital dyad to friends and neighbors.
1a. Mortality and institutionalization will be greater among those with no help versus those with some help.
1b. Mortality and institutionalization will be greater among those with only paid help versus those with some unpaid help (because the provision of paid help by itself will be shaped by the bureaucratic imperatives of the service agency, unmitigated by the influence and informal oversight of unpaid caregivers).
1c. Mortality and institutionalization will be greater among those receiving unpaid help only from distant relatives (other than spouse or child) or nonrelatives than among those receiving assistance from close relatives (spouse or adult child).
Among persons with ADLs or IADLs, multiple sources of help may imply an optimal caregiving arrangement, including caregiver respite, and should result in better outcomes (i.e., lower rates of mortality and institutionalization). Thus, mortality and institutionalization will be greater among those with only unpaid help versus those with both paid and unpaid help.