# Risk and Protective Factors of Conflicts Between Hospitalized Older Adults and Their Family Members: Structural Equation Modeling (SEM)

## TL;DR

This study explores factors that increase or decrease conflict between hospitalized older adults and their family members, including emotional support, cultural background, and caregiving roles.

## Contribution

The study identifies specific risk and protective factors for family conflict during hospitalization using structural equation modeling.

## Key findings

- Emotional support reduces conflict, while instrumental care and more visitors increase it.
- Being a Former Soviet Union immigrant increases conflict risk, while Israeli Arabs show an indirect effect through caregiving and visitor numbers.
- Depressive symptoms and independence in daily activities influence conflict through emotional and instrumental care.

## Abstract

Family relationships are important for the well-being of older adults, yet these relationships may involve ambivalence and/or conflict, particularly in high-stress scenarios such as hospitalization. This study aimed to identify factors predicting conflict between hospitalized older adults and family members, considering individual, social, and cultural factors. The sample comprised 573 cognitively intact older adults (65+) admitted to internal units in Israeli hospitals. Structural equation modeling (SEM) revealed that emotional support a decrease in conflict (β = −0.105, p = 0.007), while instrumental care (β = 0.146, p = 0.003), number of visitors (β = 0.125, p = 0.011), and the spouse being a primary caregiver (β = 0.159, p < 0.001) was associated with an increase in conflict. On the cultural level, being a Former Soviet Union (FSU) immigrant was a risk factor (β = 0.106, p = 0.016), while being an Israeli Arab had an indirect effect mediated by involvement in instrumental care and larger visitor numbers, which increased the risk for conflict (β = 0.087, p = 0.045). On the individual level, depressive symptoms increased conflict via emotional support (β = 0.01, p = 0.031), and independence in activities of daily living reduced conflict via lower instrumental care (β = −0.002, p = 0.003). These findings highlight the complex interplay of risk and protective factors in predicting conflict and highlight the role of social and cultural factors. Targeted interventions for spouses, caregivers providing instrumental support, and FSU immigrants may help reduce conflict during hospitalization.