scholarly journals Family Caregivers in Rural Appalachia Caring for Older Relatives with Dementia: Predictors of Service Use

2021 ◽  
Author(s):  
Jyoti Savla ◽  
Karen A Roberto ◽  
Rosemary Blieszner ◽  
Aubrey L Knight
Keyword(s):  
Family Caregivers ◽  
Support Services ◽  
Structural Equation ◽  
Service Use ◽  
Structural Equation Models ◽  
Behavioral Model ◽  
Community Dwelling ◽  
Personal Services ◽  
Formal Services ◽  
Rural Appalachia

Abstract Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the U.S. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, under-resourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally-relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.

scholarly journals COMBATTING LONELINESS: SERVICE USE AMONG RURAL FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S888-S888
Author(s):  
Emily K Hoyt ◽  
Karen A Roberto ◽  
Jyoti Savla
Keyword(s):  
Family Caregivers ◽  
Service Use ◽  
Well Being ◽  
Personal Care ◽  
Rural Caregivers ◽  
Rural Family ◽  
Emotional Loneliness ◽  
Formal Services ◽  
Rural Appalachia ◽  
Social Loneliness

Abstract According to a 2018 AARP study, 42% of unpaid caregivers experience loneliness. While findings across multiple studies suggest that caregivers experience loneliness either because they lack intimacy in close relationships (i.e., emotional loneliness) or they feel disconnected from their social network (i.e., social loneliness), little is known about how aspects of dementia caregiving influence loneliness, particularly among rural caregivers. The purpose of this study was to examine the association between in-home service use and caregivers experience with both types of loneliness. Eighty-eight co-residing dementia caregivers in rural Appalachia (Mean Age = 68 years; 91% White; 58% Spouses) completed telephone interviews that included questions about their use of formal services and perceptions of emotional and social loneliness. More than half (58%) of the caregivers accessed 1 to 4 formal services. Regression models revealed that caregivers who experienced greater social loneliness were more likely to access personal care services (p=0.013) and respite services (p=0.004) compared to caregivers who experienced less social loneliness. Further, caregivers who experienced greater emotional loneliness were also more likely to access personal care (p=0.028) and respite (p=0.039) services compared to caregivers who experienced lower emotional loneliness. These associations remained robust even after controlling for relationship to the PwD (spouse vs. non-spouse). Findings suggest that beyond assisting with the care of the PwD, the use of formal services may help family caregivers manage loneliness and relieve social isolation. Discussion will focus on the importance of service accessibility and use for the health and psychological well-being of rural family caregivers.

scholarly journals When the Day Goes Awry: Families Caring for Persons With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 638-639
Author(s):  
Karen Roberto ◽  
Jyoti Savla ◽  
Steven Zarit
Keyword(s):  
Family Caregivers ◽  
Rural Areas ◽  
Service Use ◽  
Management Strategies ◽  
Care Quality ◽  
Future Research ◽  
Full Time ◽  
Daily Lives ◽  
Formal Service ◽  
Formal Services

Abstract The daily lives of family caregivers of persons with dementia (PwD) often require that they manage multiple competing demands in a context of unpredictability. Memory and behavior changes associated with dementia can cause PwD to act in random and irrational ways that create stress and influence all aspects of caregivers’ everyday life. Supportive others, including informal helpers and formal service professionals, should provide relief to primary caregivers; however, help may not alleviate caregiver stress and can sometimes compound the burden of care. This symposium draws on daily diary surveys and face-to-face interviews to focus on four aspects of managing everyday care of PwD among family caregivers in rural areas. Brandy Renee McCann explores how caregivers’ vigilance on behalf of PwD care quality interacts with service use. Karen Roberto examines the ways in which caregivers manage PwD resistance to help, including their use of forceful care strategies. Rosemary Blieszner focuses on competing caregiver roles and demands that may contribute to or alleviate caregiver stress. Tina Savla addresses the unexpected, and often hidden, challenges involved in using formal services. Collectively, the four presentations provide in-depth insight into the complicated daily lives of families coping with dementia and the ways in which they meet the demands of full-time caregiving under often difficult and challenging circumstances. Discussant Steve Zarit considers the efficacy of these management strategies for various aspects of everyday care and offers suggestions for future research and person-centered programs and interventions to reduce health disparities among caregivers in rural areas.

Older Adults in Rural Appalachia

2017 ◽  
Vol 86 (4) ◽  
pp. 364-381 ◽  
Author(s):  
Raven H. Weaver ◽  
Karen A. Roberto ◽  
Rosemary Blieszner
Keyword(s):  
Older Adults ◽  
Mixed Method ◽  
Structural Equation ◽  
Community Services ◽  
Equation Modeling ◽  
Care Needs ◽  
Formal Services ◽  
Future Care ◽  
Rural Appalachia ◽  
Informal Help

Little is known about how rural-dwelling older adults anticipate and plan for future care needs. Using a mixed-method explanatory design, structural equation modeling ( n = 535) revealed significant associations between concerns about using services on preference for type of help; preference was associated with likelihood of using future services. Content analysis of interview data from 19 older adults who needed but were not receiving help revealed how they conceptualize their need for assistance and anticipated future care arrangements. Nine older adults were not thinking about future care needs. While most older adults articulated preferences for informal help, they indicated some openness to formal assistance. Preferences did not always align with expectations for the future. Rather, concerns about burdening family and friends outweighed concerns about community services and influenced expectations of using formal services. Understanding rural older adults’ expectations for future care arrangements is necessary for advancing policy and implementing successful services options.

scholarly journals Why Are Adolescent Mothers More iikely to Have Stunted and Underweight Children Than Adult Mothers? A Path Analysis Using Data from 30,000 Bangladeshi Mothers, 1996–2014

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1463-1463
Author(s):  
Phuong Nguyen ◽  
Samuel Scott ◽  
Long Khuong ◽  
Priyanjana Pramanik ◽  
Akhter Ahmed ◽  
...  
Keyword(s):  
Adolescent Pregnancy ◽  
Adolescent Mothers ◽  
Structural Equation ◽  
Service Use ◽  
Structural Equation Models ◽  
Complementary Feeding ◽  
Feeding Practices ◽  
Age At First Birth ◽  
Child Feeding ◽  
Poor Growth

Abstract Objectives Adolescent pregnancy is a major global concern due to its adverse effects on maternal and child health and wellbeing. Bangladesh has one of the highest rates of adolescent pregnancy globally. We sought to examine trends in adolescent pregnancy and associated factors in Bangladesh in the last two decades, and to understand why children of adolescent mothers are at high risk of poor growth. Methods Data were from 6 rounds of Bangladesh Demographic and Health Survey (1996–2014). Women aged 15–49 years who gave birth in the 5 years preceding each survey (n = 30,331) were classified based on age at first birth: ≤19 years (adolescence), 20–24 years (young adulthood), and ≥25 years (adulthood). Trend analysis was used to assess the progress over time. Multivariable regression and structural equation models were used to understand how adolescent pregnancy is linked to child undernutrition through maternal nutritional status, education and bargaining power, health service use, child feeding and living conditions. Results Adolescent pregnancy has declined slowly, from 84% in 1996 to 73% in 2014. Children born to adolescent mothers had lower z-scores for height-for-age (mean difference: −0·64 SD), weight-for-age (−0·45 SD), and higher prevalence of stunting (18 percentage points [pp]) and underweight (12pp) than children born to adult mothers. Compared to adult mothers, adolescent mothers were shorter (−0·8 cm), lighter (−6.9 kg), more likely to be underweight (+14pp), had lower education (−4·3 years), less decision-making power (−9pp), and lived in poorer households (−0·79 SD) with poorer sanitation (−23pp) (all P < 0.05). Adolescent mothers were less likely to access ANC (−20pp), institutional delivery (−42pp), postnatal care services (−24pp) and had poorer complementary feeding practices (−15pp). In path analyses, these intermediate factors explained 66% of the association between adolescent pregnancy and child anthropometry, with the strongest links being through women's weight, education, socioeconomic status and complementary feeding practices. Conclusions Adolescent pregnancy is still the norm in Bangladesh. Policies and programs to address poverty and improve women's education can help to improve women's health, reduce early childbearing and break the intergenerational cycle of poverty and undernutrition. Funding Sources A4NH at IFPRI.

“There isn't an easy way of finding the help that's available.” Barriers and facilitators of service use among dementia family caregivers: a qualitative study

2017 ◽  
Vol 29 (5) ◽  
pp. 765-776 ◽  
Author(s):  
Ashley Macleod ◽  
Gemma Tatangelo ◽  
Marita McCabe ◽  
Emily You
Keyword(s):  
Family Caregivers ◽  
Service Use ◽  
Care Service ◽  
Aged Care ◽  
Community Dwelling ◽  
Barriers And Facilitators ◽  
Care Recipient ◽  
Structured Interviews ◽  
Good Communication ◽  
People With Dementia

ABSTRACTBackground:Family caregivers of people with dementia have significant unmet needs in regard to their caregiving role. Despite this, they are reluctant to utilize services to reduce their burden. The aim of this study was to examine the barriers and facilitators of service use among family caregivers of people with dementia.Method:Semi-structured interviews were conducted with 24 family caregivers of community-dwelling people with dementia. Of these, 12 were partner caregivers (4 men, 8 women) and 12 were offspring caregivers (2 men, 10 women). The interviews were transcribed and analyzed using thematic analysis.Results:Six main barriers and three facilitators were identified. These barriers and facilitators were relevant across many types of services and supports. The barriers were: the inability to find information about relevant services or support, the poor quality or mistrust of the services, the inflexibility of services, caregivers’ beliefs about their obligations to the caregiving role and resistance by the care recipient. Key facilitators were: having good communication with the care recipient, having an “expert” point of contact, and having beliefs about the caregiving role that enabled the use of services.Conclusion:Given the significant changes in the aged care service-system, it is important to discuss the barriers faced by family caregivers of people with dementia. This will inform the development of targeted strategies to address the lack of service use among these family caregivers.

scholarly journals Support service use and interest in support services among distressed family caregivers of lung cancer patients

2012 ◽  
Vol 22 (7) ◽  
pp. 1549-1556 ◽  
Author(s):  
Catherine E. Mosher ◽  
Victoria L. Champion ◽  
Nasser Hanna ◽  
Shadia I. Jalal ◽  
Achilles J. Fakiris ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Support Services ◽  
Service Use ◽  
Support Service ◽  
Lung Cancer Patients

scholarly journals Home and Community Based Service Use Among Veterans With Dementia Living in Rural Virginia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 108-109
Author(s):  
Jyoti Savla ◽  
Mamta Sapra ◽  
Lauren Hagemann ◽  
Katherine Luci
Keyword(s):  
Family Caregivers ◽  
Support Groups ◽  
Service Use ◽  
Behavioral Model ◽  
Community Services ◽  
Health Care Facilities ◽  
Caregiver Support ◽  
Home Based ◽  
Adult Day Centers ◽  
Using Data

Abstract Despite the overall expansion of rural Veteran health care facilities, older Veterans in these areas are still underserved and face challenges and barriers to access services. Using data from 60 family caregivers of persons with dementia (PwD; Mean Age = 67 years, Range = 39-84; 92% White; 71% Spouse) we examined the types of home-based and community services they utilized. We also examined reasons that family caregivers provided for not using these services. Next, we applied Andersen's Behavioral Model of Health Services to examine how predisposing factors such as demographics, available resources, and PwD’s needs were associated with the use of services. We found that Veterans living in rural counties had lower access to caregiver support groups, homemaker services, adult day centers, and home-based respite services. The top three reasons for not using services were that the family caregiver chose to do it themselves, the PwD did not want the service or the service provider to help, or it was too far from the caregiver’s home. Regression analysis further showed that caregivers caring for PwDs with greater ADL challenges and memory and behavior problems were more likely to need and utilize paid services. Disparities based on gender, age, and race were also explored. Findings suggest the need to develop effective service promotion strategies and destigmatizing the use of paid services among Veteran families to reduce health disparities in rural regions.

Does marital status and marital status change predict physical health in older adults?

2006 ◽  
Vol 36 (9) ◽  
pp. 1313-1320 ◽  
Author(s):  
KATE M. BENNETT
Keyword(s):  
Physical Health ◽  
Marital Status ◽  
Structural Equation ◽  
Service Use ◽  
Structural Equation Models ◽  
Status Change ◽  
Age And Gender ◽  
Time Courses ◽  
And Gender ◽  
The Impact

Background. Evidence for the effects of marital status and marital status change on physical health is equivocal.Method. Structural equation models examined whether marital status predicted physical health. Six groups were examined simultaneously: married (M); widowed (W); divorced (D); never married (NM); newly widowed (NW); and newly divorced (ND). There were four annual measures (T1–T4). Both NW and ND were married at T1, but had lost their partners by T2. Four physical health variables were examined: Problems, Limitations, Service use, and Self-rated health (SRH). Age and gender were included.Results. Previous health predicted future for all measures and for all groups. However, the specific strengths and time-courses varied between marital status groups and between health measures. The most marked patterns were associated with marital status change. Service use was influenced most strongly by NW, whilst Limitations was influenced by ND. Problems distinguished NW and ND from stable marital status groups but also from each other. SRH was influenced by W and not by recent marital status change. The effects of age and gender were modest and restricted to specific health variables and specific marital statuses.Conclusions. The results demonstrate that marital status and marital status change, in particular, influence health longitudinally. The impact of a change to divorced or to widowed status is not the same. No two health variables responded in the same way, suggesting that marital status has a differential effect on health.

Factors associated with participating in formal support services among family caregivers of older adults with poor-prognosis cancers.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 21-21
Author(s):  
J Nicholas Dionne-Odom ◽  
Allison Applebaum ◽  
Katherine Ornstein ◽  
Andres Azuero ◽  
Paula Warren ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Support Services ◽  
Service Use ◽  
High Stress ◽  
Mail Survey ◽  
Stage Iv ◽  
Support Service ◽  
Cross Sectional ◽  
Formal Support ◽  
Stress Burden

21 Background: Family caregivers of persons with cancer are at high risk for distress and may benefit from formal support services. The purpose of this study was to describe cancer family caregiver’s use of and desire for formal support services. Methods: Cross-sectional mail survey conducted in communities of eight cancer centers in Tennessee, Alabama, and Florida. Family caregivers of Medicare beneficiaries with pancreatic, lung, brain, ovarian, head and neck, hematologic, and stage IV cancers reported support service use and completed validated measures of depression, anxiety, burden, preparedness, and health. Results: Caregivers(n = 294) were on average age 65.5 years and mostly female (72.8%), white (91.2%), and care recipients’ spouse/partner (60.2%). Patients averaged 75.3 years and were mostly male (54.4%). Formal support services were used by 32.0% (n = 94) of all caregivers; 4.4% used therapy or counseling, 19.7% received education and training; and 11.2% received assistance from local, state, or national organizations. Twenty-eight percent of all caregivers were “mostly or “extremely” interested in receiving support services; of those, 44% had high depressive symptoms, 52.3% had high anxiety symptoms, and 36.4% in the lowest quartile of preparedness. In multivariate analyses, participation in services was significantly associated with lower objective burden, higher preparedness, not working, and not being the patient’s spouse. Being “mostly” or “extremely” interested in support services was significantly associated with being a minority, shorter durations of caregiving, and with higher stress burden. Conclusions: While distressed and underprepared family caregivers reported strong interest in formal support services, only a small proportion accessed these services. Strategies to increase service use may include targeting those caregivers who are still early in their caregiving experience and who report high stress burden.

scholarly journals SERVICE USE AND BARRIERS TO SERVICE ACCESS AMONG FAMILY CAREGIVERS IN RURAL APPALACHIA

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 868-868
Author(s):  
A S Vipperman ◽  
J Savla ◽  
Karen A Roberto ◽  
A Harris ◽  
E Hoyt ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Service Use ◽  
Service Access ◽  
Barriers To Service ◽  
Rural Appalachia
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