Caregiving in the Context of Increasing Longevity: Measuring the Involvement of the Italian Population

Caregiving in the Context of Increasing Longevity: Measuring the Involvement of the Italian Population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Caregiving in the Context of Increasing Longevity: Measuring the Involvement of the Italian Population Elisa Cisotto, Cecilia Tomassini, Eleonora Meli This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8406854/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Population aging has become a central demographic and policy concern across Europe, as rising life expectancy and declining fertility expand the share of older adults requiring support while reducing the pool of working-age potential caregivers. In familistic welfare contexts such as Italy, where formal long-term care provision remains limited, unpaid family care plays a crucial role. Yet less is known about how longevity and changing family structures reshape caregiving exposure across life. Building on the Care Life Expectancy (CareLE) framework, this study introduces Care Involvement Life Expectancy (CILE) for Italy, providing the first population-level estimates of years spent in unpaid caregiving. Using nationally representative data from the 1998 and 2016 Italian Family and Social Subjects Survey (FSS; N = 59.050 and 24.753), combined with period life tables, we apply the Sullivan method to estimate gender- and intensity-specific CILE. Results show that gains in life expectancy are accompanied by increasing caregiving exposure, with care-involved life expectancy rising faster than overall life expectancy. In 2016, women aged 25–29 are expected to spend over 17 years in unpaid caregiving (12 in 1998). Gender inequalities persist across adulthood, as women spend a larger share of their lives providing unpaid care, particularly in intensive caregiving, which account for almost 40% of total caregiving at older ages. By expressing care involvement in expected years of life and care intensity, CILE makes inequalities in caregiving exposure across the life course visible and provides a framework for assessing the implications of population ageing in familistic contexts. informal caregiving gender inequalities life expectancy Sullivan method Italy Figures Figure 1 Figure 2 Introduction and Background Population aging represents a central demographic and policy concern across Europe and other high-income regions. As life expectancy rises and fertility declines, the share of the population requiring support, in later life, has grown, while the pool of working-age individuals who typically provide that support is shrinking. In this context, unpaid family care work remains crucial since families remain the primary providers of care for children, older adults, and dependent family members, regardless of the level of formal services available (King et al., 2021 ). This reliance is particularly pronounced in “familistic” countries such as Italy, where formal long-term care services for older adults remain limited and unequally distributed (Kalmijn & Saraceno 2008 ). Extensive research has shown that unpaid caregiving is strongly gendered, with women providing most of the care across the life course. These patterns reflect persistent gender norms and have far-reaching consequences for women’s labour market participation, retirement trajectories, and long-term economic security (Arber & Ginn 1995 ). To capture the cumulative responsibility of unpaid caregiving across adulthood, Ophir and Polos introduce Care Life Expectancy (CareLE; 2022), a demographic measure based on the Sullivan method that estimates the number of years individuals can expected to spend in unpaid caregiving roles. Drawing on mortality schedules and age-specific caregiving rates from the European Social Survey (ESS, 2004–2005), CareLE provides a synthetic measure of caregiving participation over the adult life course and enables comparison across 23 European countries. By conceptualizing care as a role rather than as time-use hours, this approach captures both continuity and variability in caregiving involvement, including differences in intensity. However, due to data limitations, Italy was not included in the original CareLE estimates, despite representing a paradigmatic case of a familistic welfare system with high reliance on informal care. Moreover, the availability of large nationally representative surveys allows caregiving life expectancy to be estimated across 5-year age groups from age 25 onwards, rather than being anchored to a single fixed starting age. Building on this framework, the present study introduces Care Involvement Life Expectancy (CILE) for Italy, providing the first population-level estimates of expected years spent in unpaid caregiving roles for men and women. Using large, nationally representative surveys from the Italian National Institute of Statistics for two time points (1998 and 2016, corresponding to the first and most recent available surveys), we apply the Sullivan method to examine how longer life expectancy relates to the proportion of adult life spent providing care. By distinguishing caregiving by intensity and, where possible, by location (in- and out-of-household), this study offers a dynamic picture of caregiving involvement across the adult life course and over time. Previous studies on unpaid care work consistently show that care is gendered and life-course specific. Women perform most of the unpaid care within families throughout adulthood (Arber & Ginn 1995 , Patterson & Margolis 2019 ). Time use and caregiving studies further highlight that at all life stage women assume a larger share of care responsibilities than men, including hands-on care, housework, and “kin keeping”, reflecting broader gender norms and expectations embedded in family and kinship systems (Addati et al. 2018 ). Gender differences in caregiving also vary across the life course. Research on childcare and grandchild care show that mothers and grandmothers disproportionately shoulder caregiving responsibility and are more likely to provide frequent or intensive care (Albertini & Tosi 2022 ). Similarly, in care for older adults, women are more often involved in intensive support, although some studies point to a partial gender crossover at very old ages (Tomassini & Glaser 2007 ). A further body of work conceptualizes middle-aged adults, particularly women, as belonging to a “sandwich generation”, simultaneously providing care to aging parents and dependent children or grandchildren (Albertini et al. 2021; Grundy & Henretta 2006 ). This perspective underscores how caregiving responsibilities can cluster in midlife, interacting with peak employment years and shaping labour market and retirement trajectories. Unpaid caregiving is closely linked to the core demographic processes of fertility and longevity, that drive population aging. Declining fertility and delayed childbearing change the timing and structure of parenthood and grandparenthood, altering the duration of generational overlap and the life-course timing of care demands. Research on “shared lives” demonstrates that increased longevity has extended the years individuals may spend caring for older family members (Leopold et al. 2014 ), thereby expanding the potential duration of caregiving involvement. Despite this, few studies have analysed the changing patterns of informal care provision in the context of increasing life expectancy, especially in familistic countries where care responsibilities remain strongly family-based and formal services for children and older adults are limited. In these context, overall caregiving rates may be lower, but caregiving tends to be intensive and concentrated among women (Bettio & Plantenga 2004 ; Brandt et al. 2009 ). As longevity continues to increase and women’s labour force participation expands, the distribution and intensity of caregiving may shift, potentially reducing individual caregiving exposure while creating new gaps that formal care systems must address. Additionally, the recognition of unpaid care work as a cumulative social risk, through measures such as care-related leave, pension credits, and respite policies, has gained prominence on the policy agenda, aiming to mitigate the long-term social and financial costs borne disproportionately by women. Data and Method We use data from the 1998 and 2016 Family and Social Subjects (FSS) surveys conducted by the Italian National Institute of Statistics (Istat), combined with Italian life tables for the corresponding years. The FSS surveys are nationally representative of individuals living in private households in Italy (59,050 respondents in 1998 and 24,753 in 2016), excluding the institutionalized population (Meli 2019 ). Care involvement is measured using self-reported unpaid caregiving provided outside the household in both surveys and, for 2016, also within the household. Out-of-household caregivers are identified as respondents who reported providing unpaid support in the four weeks prior to the interview to non-cohabiting individuals, including personal care, health-related assistance, household tasks, companionship, or help with administrative activities. Care intensity was defined according to weekly hours of care provision, with intensive caregivers defined as those providing 20 or more hours per week, in line with previous studies (Brandt et al. 2009 ). For 2016, in-household caregiving is identified when respondents report weekly care to a co-residing individual with limitations due to ageing, chronic illness, or disability. In this year only, in-household and out-of-household caregiving are combined to capture overall care involvement. The analytical sample includes all respondents aged 25 and older with valid information on caregiving status. The final sample comprises 7.689 individuals in 1998 and 7.136 individuals in 2016 (including both in-household and out-of-household caregivers in 2016). Our methodological approach builds on the Care Life Expectancy (CareLE) framework introduced by Ophir and Polos ( 2022 ). We extend this approach by estimating Care Involvement Life Expectancy (CILE) for Italy, where comparable population-level measures were previously unavailable. Using the Sullivan method (Sullivan 1971 ; Imai & Soneji 2007 ), we partition remaining life expectancy at any age into years expected to be spent: (1) providing care to non-cohabiting individuals (1998 and 2016), (2) providing care to non-cohabiting individuals by intensity level (low vs. high, 1998 and 2016), and (3) providing care both in and out of the household (2016 only). The resulting CILE estimates represent period life expectancy as a caregiver, indicating the expected number of years individuals can anticipate spending in caregiving roles at each age. Caregiving prevalences are weighted using normalized ISTAT survey weights. All analyses were performed using Stata 19. Results Table 1 reports age- and sex-specific prevalence rates of caregiving used as empirical inputs for the estimation of Care Involvement Life Expectancy (CILE) using the Sullivan method. The table is intended to document the prevalence patterns underlying the life expectancy estimates rather than analytical outcome measures. For out-of-household caregiving, prevalence rates are reported for both 1998 and 2016, enabling direct comparison over time. For 2016, when survey information allows, prevalence rates also include in-household caregiving and intensive caregiving (defined as providing 20 or more hours of care per week). Total sample sizes by year are reported to document the robustness of the underlying estimates. Descriptively, the age-specific prevalence rates show that caregiving involvement is widespread across the adult life course and increases markedly between 1998 and 2016 for both men and women. In both years, caregiving prevalence peaks in mid-adulthood and declines at older ages, with women generally displaying higher prevalence levels than men at younger and mid-adult ages. In 2016, when in-household caregiving is observed, caregiving remains substantial at older ages, and the prevalence of intensive caregiving increases with age for both genders, indicating that caregiving in later life, when it occurs, is more likely to involve high levels of time commitment. Table 1 Age-specific prevalence of caregiving by gender used to estimate Care Involvement Life Expectancy (CILE) with the Sullivan method. Italy, 1998 and 2016. Weighted data. Source : Family and Social Subjects Survey (FSS). Women Men Age group % Out-of-household caregiving % In- and Out-of-household caregiving (2016) Age group % Out-of-household caregiving % In- and Out-of-household caregiving (2016) 1998 2016 Caregiving Intensive caregiving 1998 2016 Caregiving Intensive caregiving ( n = 4.585) ( n = 3.627) ( n = 4.107) ( n = 1.104) ( n = 3.104) ( n = 2.601) ( n 3.029) ( n = 611) 25–29 16% 25% 26% 4% 25–29 10% 23% 26% 2% 30–34 20% 28% 30% 4% 30–34 14% 21% 23% 3% 35–39 22% 26% 28% 4% 35–39 16% 22% 24% 2% 40–44 24% 37% 40% 7% 40–44 18% 23% 27% 4% 45–49 26% 37% 41% 8% 45–49 19% 24% 29% 5% 50–54 27% 42% 47% 12% 50–54 18% 32% 37% 6% 55–59 28% 43% 47% 12% 55–59 20% 30% 33% 7% 60–64 26% 36% 41% 13% 60–64 18% 30% 34% 6% 65–69 20% 28% 35% 14% 65–69 14% 25% 28% 10% 70–74 16% 23% 31% 12% 70–74 12% 23% 29% 9% 75 + 8% 14% 19% 8% 75 + 9% 12% 20% 9% Figure 1 illustrates age-specific Care Involvement Life Expectancy (CILE) by gender in 1998 and 2016 (Panel A), together with the share of remaining life expectancy spent in caregiving (Panel B). Over time, caregiving involvement increased for both men and women, both in absolute terms (expected years) and relative terms (share of remaining life expectancy), indicating that longer lives have not been accompanied by a proportional reduction in caregiving exposure. Panel A shows that between 1998 and 2016. Care Involvement Life Expectancy (CILE) increased significantly for both men and women across all age groups. Across the life course, CILE is highest in early adulthood and declines progressively with age for both genders, reflecting the mechanical reduction in remaining life expectancy at older ages. For example, at ages 25–29, women are expected to spend more than 17 years in out-of-household caregiving roles over their remaining lifetime (95% CI: 15–19), whereas men are expected to spend approximately 13 years (95% CI: 11–15). In both 1998 and 2016, gender differences in CILE are statistically significant at younger adult ages, with women expected to spend more years of their remaining life providing unpaid care than men. These gender differences narrow at older ages and are no longer statistically significant. Figure 2 focuses on 2016, the only year for which both in-household and out-of-household caregiving can be jointly observed, allowing a more comprehensive assessment of caregiving involvement, particularly at older ages when co-residential care becomes more prevalent. Across the life course, the expected number of years spent in caregiving (CILE) declines with age for both men and women, reflecting the reduction in remaining life expectancy (LE). Among women, CILE decreases from about 20 years at ages 25–29 (approximately 33% of LE at that age) to around 3 years at ages 75 and older (about 19% of LE). Among men, CILE declines from approximately 15 years at younger adult ages to about 2 years at ages 75 and older, corresponding to a reduction from roughly 27% to 20% of remaining life expectancy. At the same time, the composition of caregiving involvement changes markedly with age. While the expected duration of caregiving declines, the relative importance of intensive caregiving (i.e., providing 20 or more hours of care per week) becomes more pronounced at older ages. Among women, the share of remaining life expectancy spent in intensive caregiving remains relatively stable at around 8–10% across the life course. Among men, this share increases with age, rising from about 6% at younger adult ages to above 8% at older ages. As a result, intensive caregiving accounts for an increasing share of total caregiving involvement (ICILE/CILE), reaching approximately 40% at ages 75 and older among women and over 43% among men. For both men and women, these patterns indicate a shift from longer but less intensive caregiving involvement at younger ages to shorter yet more demanding caregiving roles at older ages. Among women, intensive caregiving represents a growing fraction of total caregiving involvement from mid-adulthood onwards. Among men, although overall caregiving involvement remains lower in absolute terms, the relative weight of intensive caregiving increases sharply at older ages, indicating that caregiving in later life, when it occurs, is more likely to take intensive forms. Discussion and Conclusion This study provides the first population-level estimates of Care Involvement Life Expectancy (CILE) for Italy, extending the existing research to a familistic welfare context. By combining nationally representative survey data with period life tables at two time points, this study directly contributes to the debate on whether longer lives imply longer caring lives. In doing so, we provide a synthetic demographic measure that explicitly captures unpaid caregiving across the life course, quantified in terms of both expected number of years spent as a caregiver and the intensity of caregiving involvement. Overall, the findings show that unpaid caregiving involves a substantial share of the population and represents a non-negligible component of adult life. Gains in life expectancy have not been accompanied by a proportional reduction in the expected duration of caregiving. On the contrary, increasing longevity is associated with a longer exposure to caregiving roles, as well as with a redistribution of caregiving involvement across the life course. Importantly, care-involved life expectancy increases at a faster pace than overall life expectancy, indicating that longer lives are not only lived for longer, but are also increasingly spent in caregiving roles, often with higher levels of intensity. Consistent with existing evidence on familistic welfare regimes, the findings reveal marked gender inequalities in caregiving involvement that become particularly salient when examined from a cumulative life-course perspective. Women’s greater involvement in unpaid care does not emerge solely in terms of higher prevalence but, more importantly, in terms of substantially longer expected durations of caregiving across adulthood. Women are expected to spend a significantly larger share of their adult life providing unpaid care than men, especially in intensive caregiving roles. Beyond differences in duration, the results further show that gender inequalities in caregiving also concern the intensity of care and its distribution across the life course. For women, caregiving appears as a structural component of the adult life course: as age increases, women’s caregiving increasingly concentrates in intensive forms of care, a pattern consistent with rising involvement in the care of co-resident family members at older ages. At the same time, the concentration of caregiving in mid-adulthood likely reflects the overlap of multiple intergeneration or intragenerational care roles, which continue to fall disproportionately on women. As a result, a substantial share of women’s caregiving is intensive, reinforcing the unequal distribution of unpaid care responsibilities. Among men, overall caregiving involvement remains lower across adulthood compared to women. However, caregiving intensity tends to increase at older ages, suggesting that men’s caregiving is more often concentrated within a shorter and later phase of the life course, rather than sustained over time. From a policy perspective, these findings suggest that unpaid caregiving should be recognised as a cumulative social risk rather than as an episodic life event. The extended and intensive exposure to caregiving documented in this study, particularly among women, highlights the need for policy frameworks that acknowledge the long-term implications of caregiving for life-course inequalities in employment, income and well-being. In this study, the Care Involvement Life Expectancy (CILE) indicator represents a useful tool for policy-oriented analysis. By expressing caregiving involvement in terms of expected years of life, CILE enables straightforward comparisons over time and across population groups. Importantly, the contribution of this study is primarily measurement and interpretative rather than normative: CILE does not prescribe specific policy solutions but provides a framework through which the long-term implications of population ageing and caregiving arrangements can be systematically assessed and evaluated. In this respect, the indicator is particularly well suited to draw attention to the role of institutional arrangements, such as pension credits for caregivers, care leave schemes, respite services, and forms of partial defamilisation of care, in shaping both the distribution and the intensity of unpaid caregiving across the life course. From a policy perspective, the results suggest that caregiving in a familistic context such as Italy should be conceptualised not as an experience confined to specific life stages, but as a life-course experience that unfolds across different ages. Unpaid caregiving often emerges as a recurrent and intensive form of responsibility that may structure large portions of individuals’ adult lives and for many, particularly women, may intersect with paid employment trajectories in ways that are both demanding and persistent. Framing caregiving as a form of “care career” highlights the importance of recognising its cumulative social and demographic implications and provides an analytical basis for assessing whether and how such trajectories are acknowledged within existing welfare and pension systems. Several limitations of this study should be acknowledged. As with other Sullivan-based indicators, caregiving involvement is measured through prevalence rather than transitions and therefore does not capture movements into and out of caregiving roles over time. The use of cross-sectional data to derive life expectancy estimates may also mask individual-level dynamics and behavioural responses to life events that cannot be observed within a static framework. Moreover, the assumption of a stable population underlying period life tables may limit the ability of the indicator to fully reflect short-term changes in caregiving patterns. These limitations should be borne in mind when interpreting short-term trends. Despite these constraints, from both a demographic and policy perspective the results indicate that, in a familistic context such as Italy, increasing longevity is associated with longer and intensive caregiving trajectories rather than with a reduced care burden. By expressing gendered caregiving patterns in terms of expected years of life spent caring, CILE reveals potential cumulative inequalities that remain largely hidden in age-specific or cross-sectional analyses. Overall, the findings underscore the importance of assessing population ageing not only in terms of exposure to caregiving, but also through a life-course perspective that accounts for its duration and intensity. Declarations Author Contribution The study was conceived by CT. All authors contributed to the study design. Data collection for prevalence computation was performed by EM. Data analysis, including expectancy estimates and decomposition analyses, was conducted by EC. The manuscript was first drafted by CT (Introduction) and EC (Data and Methods, Results, and Discussion). All authors commented on previous versions of the manuscript and approved the final version. Acknowledgement The authors acknowledge funding from Next Generation EU, in the context of the National Recovery and Resilience Plan, Investment PE8 – Project Age-It: “Ageing Well in an Ageing Society” [DM 1557 11.10.2022]. The views and opinions expressed are only those of the authors and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them. This resource was co-financed by the Next Generation EU. Data Availability The data used in this study are from the Family and Social Subjects survey of the Italian National Institute of Statistics (ISTAT) and must be requested using the Institute’s Contact centre (https://contact.istat.it/). See https://www.istat.it/it/archivio/5725 and https://www.istat.it/en/archivio/236643 for more information. References Addati, L., Cattaneo, U., Esquivel, V., & Valarino, I. (2018). Care work and care jobs for the future of decent work . International Labour Organization. Albertini, M., Tur-Sinai, A., & Lewin-Epstein, N. (2022). The older sandwich generation across European welfare regimes: Demographic and social considerations. 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Gender and support of older unmarried people in Italy and Britain. In A. Pinnelli, F. Racioppi, & R. Rettaroli (Eds.), Genders in the life course (Vol. 19, pp. 237–247). Springer. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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09:41:34","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":326007,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8406854/v1/a4e90e770967709c01e24384.jpeg"},{"id":100980033,"identity":"e4eea965-45e5-40f0-b8f0-4722f13737e9","added_by":"auto","created_at":"2026-01-23 12:03:34","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63806,"visible":true,"origin":"","legend":"","description":"","filename":"443863b5f1494c97abdb05e0ed859b5f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8406854/v1/ef20b7032509ecdc3595c51d.xml"},{"id":100980030,"identity":"4e2d670c-7de2-4d5d-ba41-f753fb3f013b","added_by":"auto","created_at":"2026-01-23 12:03:34","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69977,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8406854/v1/121da778c3b7c0b65dbf83d0.html"},{"id":100980025,"identity":"5ff8bc19-6f3c-4834-8a80-f934e4728485","added_by":"auto","created_at":"2026-01-23 12:03:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":162760,"visible":true,"origin":"","legend":"\u003cp\u003eOut-of-household Care Involvement Life Expectancy (CILE, 5-year age groups with 95% CI) by gender (A) and share (%) of remaining life expectancy spent in caregiving (B). Italy, 1998–2016. Weighted estimates.\u003cem\u003e Source\u003c/em\u003e: Family and Social Subjects Survey (FSS).\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8406854/v1/d78ba354973400bfa83fc5dc.png"},{"id":101203385,"identity":"a680b3e9-492b-4cae-a2b7-59c7ceee7f86","added_by":"auto","created_at":"2026-01-27 09:39:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":67556,"visible":true,"origin":"","legend":"\u003cp\u003eIn- and out-of-household Care Involvement Life Expectancy (CILE, years), share of remaining life expectancy (LE) spent in caregiving, and share of intensive caregiving (ICILE) by gender and age. Weighted estimates.\u003cem\u003e \u003c/em\u003eItaly, 2016. \u003cem\u003eSource\u003c/em\u003e: Family and Social Subjects Survey (FSS).\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8406854/v1/f8ad5211afc1c92bd7df8c16.png"},{"id":101207810,"identity":"745883e0-757d-44b4-b94e-866ad107ea92","added_by":"auto","created_at":"2026-01-27 10:07:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":821641,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8406854/v1/9cefb855-3fc3-49f9-adec-47a64c01a616.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Caregiving in the Context of Increasing Longevity: Measuring the Involvement of the Italian Population","fulltext":[{"header":"Introduction and Background","content":"\u003cp\u003ePopulation aging represents a central demographic and policy concern across Europe and other high-income regions. As life expectancy rises and fertility declines, the share of the population requiring support, in later life, has grown, while the pool of working-age individuals who typically provide that support is shrinking. In this context, unpaid family care work remains crucial since families remain the primary providers of care for children, older adults, and dependent family members, regardless of the level of formal services available (King et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This reliance is particularly pronounced in \u0026ldquo;familistic\u0026rdquo; countries such as Italy, where formal long-term care services for older adults remain limited and unequally distributed (Kalmijn \u0026amp; Saraceno \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Extensive research has shown that unpaid caregiving is strongly gendered, with women providing most of the care across the life course. These patterns reflect persistent gender norms and have far-reaching consequences for women\u0026rsquo;s labour market participation, retirement trajectories, and long-term economic security (Arber \u0026amp; Ginn \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1995\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo capture the cumulative responsibility of unpaid caregiving across adulthood, Ophir and Polos introduce Care Life Expectancy (CareLE; 2022), a demographic measure based on the Sullivan method that estimates the number of years individuals can expected to spend in unpaid caregiving roles. Drawing on mortality schedules and age-specific caregiving rates from the European Social Survey (ESS, 2004\u0026ndash;2005), CareLE provides a synthetic measure of caregiving participation over the adult life course and enables comparison across 23 European countries. By conceptualizing care as a \u003cem\u003erole\u003c/em\u003e rather than as time-use hours, this approach captures both continuity and variability in caregiving involvement, including differences in intensity. However, due to data limitations, Italy was not included in the original CareLE estimates, despite representing a paradigmatic case of a familistic welfare system with high reliance on informal care. Moreover, the availability of large nationally representative surveys allows caregiving life expectancy to be estimated across 5-year age groups from age 25 onwards, rather than being anchored to a single fixed starting age.\u003c/p\u003e \u003cp\u003eBuilding on this framework, the present study introduces Care Involvement Life Expectancy (CILE) for Italy, providing the first population-level estimates of expected years spent in unpaid caregiving roles for men and women. Using large, nationally representative surveys from the Italian National Institute of Statistics for two time points (1998 and 2016, corresponding to the first and most recent available surveys), we apply the Sullivan method to examine how longer life expectancy relates to the proportion of adult life spent providing care. By distinguishing caregiving by intensity and, where possible, by location (in- and out-of-household), this study offers a dynamic picture of caregiving involvement across the adult life course and over time.\u003c/p\u003e \u003cp\u003ePrevious studies on unpaid care work consistently show that care is gendered and life-course specific. Women perform most of the unpaid care within families throughout adulthood (Arber \u0026amp; Ginn \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1995\u003c/span\u003e, Patterson \u0026amp; Margolis \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Time use and caregiving studies further highlight that at all life stage women assume a larger share of care responsibilities than men, including hands-on care, housework, and \u0026ldquo;kin keeping\u0026rdquo;, reflecting broader gender norms and expectations embedded in family and kinship systems (Addati et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGender differences in caregiving also vary across the life course. Research on childcare and grandchild care show that mothers and grandmothers disproportionately shoulder caregiving responsibility and are more likely to provide frequent or intensive care (Albertini \u0026amp; Tosi \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Similarly, in care for older adults, women are more often involved in intensive support, although some studies point to a partial gender crossover at very old ages (Tomassini \u0026amp; Glaser \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA further body of work conceptualizes middle-aged adults, particularly women, as belonging to a \u0026ldquo;sandwich generation\u0026rdquo;, simultaneously providing care to aging parents and dependent children or grandchildren (Albertini et al. 2021; Grundy \u0026amp; Henretta \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). This perspective underscores how caregiving responsibilities can cluster in midlife, interacting with peak employment years and shaping labour market and retirement trajectories.\u003c/p\u003e \u003cp\u003eUnpaid caregiving is closely linked to the core demographic processes of fertility and longevity, that drive population aging. Declining fertility and delayed childbearing change the timing and structure of parenthood and grandparenthood, altering the duration of generational overlap and the life-course timing of care demands. Research on \u0026ldquo;shared lives\u0026rdquo; demonstrates that increased longevity has extended the years individuals may spend caring for older family members (Leopold et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2014\u003c/span\u003e), thereby expanding the potential duration of caregiving involvement.\u003c/p\u003e \u003cp\u003eDespite this, few studies have analysed the changing patterns of informal care provision in the context of increasing life expectancy, especially in familistic countries where care responsibilities remain strongly family-based and formal services for children and older adults are limited. In these context, overall caregiving rates may be lower, but caregiving tends to be intensive and concentrated among women (Bettio \u0026amp; Plantenga \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Brandt et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). As longevity continues to increase and women\u0026rsquo;s labour force participation expands, the distribution and intensity of caregiving may shift, potentially reducing individual caregiving exposure while creating new gaps that formal care systems must address. Additionally, the recognition of unpaid care work as a cumulative social risk, through measures such as care-related leave, pension credits, and respite policies, has gained prominence on the policy agenda, aiming to mitigate the long-term social and financial costs borne disproportionately by women.\u003c/p\u003e"},{"header":"Data and Method","content":"\u003cp\u003eWe use data from the 1998 and 2016 \u003cem\u003eFamily and Social Subjects\u003c/em\u003e (FSS) surveys conducted by the Italian National Institute of Statistics (Istat), combined with Italian life tables for the corresponding years. The FSS surveys are nationally representative of individuals living in private households in Italy (59,050 respondents in 1998 and 24,753 in 2016), excluding the institutionalized population (Meli \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCare involvement is measured using self-reported unpaid caregiving provided outside the household in both surveys and, for 2016, also within the household. Out-of-household caregivers are identified as respondents who reported providing unpaid support in the four weeks prior to the interview to non-cohabiting individuals, including personal care, health-related assistance, household tasks, companionship, or help with administrative activities. Care intensity was defined according to weekly hours of care provision, with intensive caregivers defined as those providing 20 or more hours per week, in line with previous studies (Brandt et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFor 2016, in-household caregiving is identified when respondents report weekly care to a co-residing individual with limitations due to ageing, chronic illness, or disability. In this year\u003c/p\u003e \u003cp\u003eonly, in-household and out-of-household caregiving are combined to capture overall care involvement.\u003c/p\u003e \u003cp\u003eThe analytical sample includes all respondents aged 25 and older with valid information on caregiving status. The final sample comprises 7.689 individuals in 1998 and 7.136 individuals in 2016 (including both in-household and out-of-household caregivers in 2016).\u003c/p\u003e \u003cp\u003eOur methodological approach builds on the Care Life Expectancy (CareLE) framework introduced by Ophir and Polos (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). We extend this approach by estimating \u003cem\u003eCare Involvement Life Expectancy\u003c/em\u003e (CILE) for Italy, where comparable population-level measures were previously unavailable. Using the Sullivan method (Sullivan \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1971\u003c/span\u003e; Imai \u0026amp; Soneji \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), we partition remaining life expectancy at any age into years expected to be spent: (1) providing care to non-cohabiting individuals (1998 and 2016), (2) providing care to non-cohabiting individuals by intensity level (low vs. high, 1998 and 2016), and (3) providing care both in and out of the household (2016 only). The resulting CILE estimates represent period life expectancy as a caregiver, indicating the expected number of years individuals can anticipate spending in caregiving roles at each age. Caregiving prevalences are weighted using normalized ISTAT survey weights. All analyses were performed using Stata 19.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e reports age- and sex-specific prevalence rates of caregiving used as empirical inputs for the estimation of Care Involvement Life Expectancy (CILE) using the Sullivan method. The table is intended to document the prevalence patterns underlying the life expectancy estimates rather than analytical outcome measures. For out-of-household caregiving, prevalence rates are reported for both 1998 and 2016, enabling direct comparison over time. For 2016, when survey information allows, prevalence rates also include in-household caregiving and intensive caregiving (defined as providing 20 or more hours of care per week). Total sample sizes by year are reported to document the robustness of the underlying estimates.\u003c/p\u003e \u003cp\u003eDescriptively, the age-specific prevalence rates show that caregiving involvement is widespread across the adult life course and increases markedly between 1998 and 2016 for both men and women. In both years, caregiving prevalence peaks in mid-adulthood and declines at older ages, with women generally displaying higher prevalence levels than men at younger and mid-adult ages. In 2016, when in-household caregiving is observed, caregiving remains substantial at older ages, and the prevalence of intensive caregiving increases with age for both genders, indicating that caregiving in later life, when it occurs, is more likely to involve high levels of time commitment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAge-specific prevalence of caregiving by gender used to estimate Care Involvement Life Expectancy (CILE) with the Sullivan method. Italy, 1998 and 2016. Weighted data.\u003c/p\u003e \u003cdiv class=\"Credit\"\u003e\u003cp\u003e\u003cem\u003eSource\u003c/em\u003e: Family and Social Subjects Survey (FSS).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c13\" namest=\"c8\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e% Out-of-household caregiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e% In- and Out-of-household caregiving (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e% Out-of-household caregiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e \u003cp\u003e% In- and Out-of-household caregiving (2016)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCaregiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntensive caregiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eCaregiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eIntensive caregiving\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.585)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.627)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;4.107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.601)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e3.029)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;611)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e70\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e75 +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates age-specific Care Involvement Life Expectancy (CILE) by gender in 1998 and 2016 (Panel A), together with the share of remaining life expectancy spent in caregiving (Panel B). Over time, caregiving involvement increased for both men and women, both in absolute terms (expected years) and relative terms (share of remaining life expectancy), indicating that longer lives have not been accompanied by a proportional reduction in caregiving exposure.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePanel A shows that between 1998 and 2016. Care Involvement Life Expectancy (CILE) increased significantly for both men and women across all age groups. Across the life course, CILE is highest in early adulthood and declines progressively with age for both genders, reflecting the mechanical reduction in remaining life expectancy at older ages.\u003c/p\u003e \u003cp\u003eFor example, at ages 25\u0026ndash;29, women are expected to spend more than 17 years in out-of-household caregiving roles over their remaining lifetime (95% CI: 15\u0026ndash;19), whereas men are expected to spend approximately 13 years (95% CI: 11\u0026ndash;15). In both 1998 and 2016, gender differences in CILE are statistically significant at younger adult ages, with women expected to spend more years of their remaining life providing unpaid care than men. These gender differences narrow at older ages and are no longer statistically significant.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e focuses on 2016, the only year for which both in-household and out-of-household caregiving can be jointly observed, allowing a more comprehensive assessment of caregiving involvement, particularly at older ages when co-residential care becomes more prevalent. Across the life course, the expected number of years spent in caregiving (CILE) declines with age for both men and women, reflecting the reduction in remaining life expectancy (LE). Among women, CILE decreases from about 20 years at ages 25\u0026ndash;29 (approximately 33% of LE at that age) to around 3 years at ages 75 and older (about 19% of LE). Among men, CILE declines from approximately 15 years at younger adult ages to about 2 years at ages 75 and older, corresponding to a reduction from roughly 27% to 20% of remaining life expectancy.\u003c/p\u003e \u003cp\u003eAt the same time, the composition of caregiving involvement changes markedly with age. While the expected duration of caregiving declines, the relative importance of intensive caregiving (i.e., providing 20 or more hours of care per week) becomes more pronounced at older ages. Among women, the share of remaining life expectancy spent in intensive caregiving remains relatively stable at around 8\u0026ndash;10% across the life course. Among men, this share increases with age, rising from about 6% at younger adult ages to above 8% at older ages. As a result, intensive caregiving accounts for an increasing share of total caregiving involvement (ICILE/CILE), reaching approximately 40% at ages 75 and older among women and over 43% among men.\u003c/p\u003e \u003cp\u003eFor both men and women, these patterns indicate a shift from longer but less intensive caregiving involvement at younger ages to shorter yet more demanding caregiving roles at older ages. Among women, intensive caregiving represents a growing fraction of total caregiving involvement from mid-adulthood onwards. Among men, although overall caregiving involvement remains lower in absolute terms, the relative weight of intensive caregiving increases sharply at older ages, indicating that caregiving in later life, when it occurs, is more likely to take intensive forms.\u003c/p\u003e"},{"header":"Discussion and Conclusion","content":"\u003cp\u003eThis study provides the first population-level estimates of Care Involvement Life Expectancy (CILE) for Italy, extending the existing research to a familistic welfare context. By combining nationally representative survey data with period life tables at two time points, this study directly contributes to the debate on whether longer lives imply longer caring lives. In doing so, we provide a synthetic demographic measure that explicitly captures unpaid caregiving across the life course, quantified in terms of both expected number of years spent as a caregiver and the intensity of caregiving involvement.\u003c/p\u003e \u003cp\u003eOverall, the findings show that unpaid caregiving involves a substantial share of the population and represents a non-negligible component of adult life. Gains in life expectancy have not been accompanied by a proportional reduction in the expected duration of caregiving. On the contrary, increasing longevity is associated with a longer exposure to caregiving roles, as well as with a redistribution of caregiving involvement across the life course. Importantly, care-involved life expectancy increases at a faster pace than overall life expectancy, indicating that longer lives are not only lived for longer, but are also increasingly spent in caregiving roles, often with higher levels of intensity.\u003c/p\u003e \u003cp\u003eConsistent with existing evidence on familistic welfare regimes, the findings reveal marked gender inequalities in caregiving involvement that become particularly salient when examined from a cumulative life-course perspective. Women\u0026rsquo;s greater involvement in unpaid care does not emerge solely in terms of higher prevalence but, more importantly, in terms of substantially longer expected durations of caregiving across adulthood. Women are expected to spend a significantly larger share of their adult life providing unpaid care than men, especially in intensive caregiving roles.\u003c/p\u003e \u003cp\u003eBeyond differences in duration, the results further show that gender inequalities in caregiving also concern the intensity of care and its distribution across the life course. For women, caregiving appears as a structural component of the adult life course: as age increases, women\u0026rsquo;s caregiving increasingly concentrates in intensive forms of care, a pattern consistent with rising involvement in the care of co-resident family members at older ages. At the same time, the concentration of caregiving in mid-adulthood likely reflects the overlap of multiple intergeneration or intragenerational care roles, which continue to fall disproportionately on women. As a result, a substantial share of women\u0026rsquo;s caregiving is intensive, reinforcing the unequal distribution of unpaid care responsibilities.\u003c/p\u003e \u003cp\u003eAmong men, overall caregiving involvement remains lower across adulthood compared to women. However, caregiving intensity tends to increase at older ages, suggesting that men\u0026rsquo;s caregiving is more often concentrated within a shorter and later phase of the life course, rather than sustained over time.\u003c/p\u003e \u003cp\u003eFrom a policy perspective, these findings suggest that unpaid caregiving should be recognised as a cumulative social risk rather than as an episodic life event. The extended and intensive exposure to caregiving documented in this study, particularly among women, highlights the need for policy frameworks that acknowledge the long-term implications of caregiving for life-course inequalities in employment, income and well-being.\u003c/p\u003e \u003cp\u003eIn this study, the Care Involvement Life Expectancy (CILE) indicator represents a useful tool for policy-oriented analysis. By expressing caregiving involvement in terms of expected years of life, CILE enables straightforward comparisons over time and across population groups. Importantly, the contribution of this study is primarily measurement and interpretative rather than normative: CILE does not prescribe specific policy solutions but provides a framework through which the long-term implications of population ageing and caregiving arrangements can be systematically assessed and evaluated. In this respect, the indicator is particularly well suited to draw attention to the role of institutional arrangements, such as pension credits for caregivers, care leave schemes, respite services, and forms of partial defamilisation of care, in shaping both the distribution and the intensity of unpaid caregiving across the life course.\u003c/p\u003e \u003cp\u003eFrom a policy perspective, the results suggest that caregiving in a familistic context such as Italy should be conceptualised not as an experience confined to specific life stages, but as a life-course experience that unfolds across different ages. Unpaid caregiving often emerges as a recurrent and intensive form of responsibility that may structure large portions of individuals\u0026rsquo; adult lives and for many, particularly women, may intersect with paid employment trajectories in ways that are both demanding and persistent. Framing caregiving as a form of \u0026ldquo;care career\u0026rdquo; highlights the importance of recognising its cumulative social and demographic implications and provides an analytical basis for assessing whether and how such trajectories are acknowledged within existing welfare and pension systems.\u003c/p\u003e \u003cp\u003eSeveral limitations of this study should be acknowledged. As with other Sullivan-based indicators, caregiving involvement is measured through prevalence rather than transitions and therefore does not capture movements into and out of caregiving roles over time. The use of cross-sectional data to derive life expectancy estimates may also mask individual-level dynamics and behavioural responses to life events that cannot be observed within a static framework. Moreover, the assumption of a stable population underlying period life tables may limit the ability of the indicator to fully reflect short-term changes in caregiving patterns. These limitations should be borne in mind when interpreting short-term trends.\u003c/p\u003e \u003cp\u003eDespite these constraints, from both a demographic and policy perspective the results indicate that, in a familistic context such as Italy, increasing longevity is associated with longer and intensive caregiving trajectories rather than with a reduced care burden. By expressing gendered caregiving patterns in terms of expected years of life spent caring, CILE reveals potential cumulative inequalities that remain largely hidden in age-specific or cross-sectional analyses. Overall, the findings underscore the importance of assessing population ageing not only in terms of exposure to caregiving, but also through a life-course perspective that accounts for its duration and intensity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe study was conceived by CT. All authors contributed to the study design. Data collection for prevalence computation was performed by EM. Data analysis, including expectancy estimates and decomposition analyses, was conducted by EC. The manuscript was first drafted by CT (Introduction) and EC (Data and Methods, Results, and Discussion). All authors commented on previous versions of the manuscript and approved the final version.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors acknowledge funding from Next Generation EU, in the context of the National Recovery and Resilience Plan, Investment PE8 \u0026ndash; Project Age-It: \u0026ldquo;Ageing Well in an Ageing Society\u0026rdquo; [DM 1557 11.10.2022]. The views and opinions expressed are only those of the authors and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them. This resource was co-financed by the Next Generation EU.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data used in this study are from the Family and Social Subjects survey of the Italian National Institute of Statistics (ISTAT) and must be requested using the Institute\u0026rsquo;s Contact centre (https://contact.istat.it/). See https://www.istat.it/it/archivio/5725 and https://www.istat.it/en/archivio/236643 for more information.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAddati, L., Cattaneo, U., Esquivel, V., \u0026amp; Valarino, I. (2018). \u003cem\u003eCare work and care jobs for the future of decent work\u003c/em\u003e. International Labour Organization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbertini, M., Tur-Sinai, A., \u0026amp; Lewin-Epstein, N. (2022). 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Gender and support of older unmarried people in Italy and Britain. In A. Pinnelli, F. Racioppi, \u0026amp; R. Rettaroli (Eds.), \u003cem\u003eGenders in the life course\u003c/em\u003e (Vol. 19, pp. 237\u0026ndash;247). Springer.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"informal caregiving, gender inequalities, life expectancy, Sullivan method, Italy","lastPublishedDoi":"10.21203/rs.3.rs-8406854/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8406854/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePopulation aging has become a central demographic and policy concern across Europe, as rising life expectancy and declining fertility expand the share of older adults requiring support while reducing the pool of working-age potential caregivers. In familistic welfare contexts such as Italy, where formal long-term care provision remains limited, unpaid family care plays a crucial role. Yet less is known about how longevity and changing family structures reshape caregiving exposure across life.\u003c/p\u003e \u003cp\u003eBuilding on the Care Life Expectancy (CareLE) framework, this study introduces Care Involvement Life Expectancy (CILE) for Italy, providing the first population-level estimates of years spent in unpaid caregiving. Using nationally representative data from the 1998 and 2016 Italian \u003cem\u003eFamily and Social Subjects Survey\u003c/em\u003e (FSS; N\u0026thinsp;=\u0026thinsp;59.050 and 24.753), combined with period life tables, we apply the Sullivan method to estimate gender- and intensity-specific CILE.\u003c/p\u003e \u003cp\u003eResults show that gains in life expectancy are accompanied by increasing caregiving exposure, with care-involved life expectancy rising faster than overall life expectancy. In 2016, women aged 25\u0026ndash;29 are expected to spend over 17 years in unpaid caregiving (12 in 1998). Gender inequalities persist across adulthood, as women spend a larger share of their lives providing unpaid care, particularly in intensive caregiving, which account for almost 40% of total caregiving at older ages. By expressing care involvement in expected years of life and care intensity, CILE makes inequalities in caregiving exposure across the life course visible and provides a framework for assessing the implications of population ageing in familistic contexts.\u003c/p\u003e","manuscriptTitle":"Caregiving in the Context of Increasing Longevity: Measuring the Involvement of the Italian Population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 12:03:17","doi":"10.21203/rs.3.rs-8406854/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fc49c0bc-cde4-42a5-b017-d08bc9a9c589","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T19:38:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 12:03:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8406854","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8406854","identity":"rs-8406854","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}