Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T15:00:14.521Z Has data issue: false hasContentIssue false

Inhome Service Use by Caregivers and Their Elders: Does Cognitive Status Make a Difference?

Published online by Cambridge University Press:  31 March 2010

Pamela Hawranik*
Affiliation:
University of Manitoba*
*
Requests, etc., Pamela Hawranik, Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, MB R3T 2N2. Email: Pam_hawranik@umanitoba.ca

Abstract

The intent of this study was to examine the effect of cognitive status on the use of inhome services by caregivers and their elders. Data from the screening, clinical and community-caregiver phases of the Manitoba Study on Health and Aging (MSHA-1) were analysed utilizing a modified Andersen-Newman model. The findings indicated that those with dementia were more likely to use personal care services and use two or more inhome services than caregivers and their elders with no cognitive impairment and those with cognitive impairment but no dementia. Functional status of the elder and living arrangement of the caregiver and elder were strongly associated with the use of specific inhome services and with overall use. Policy and research implications of the findings including other significant factors such as caregiver employment, are presented.

Résumé

L'étude visait à examiner la relation entre l'état cognitif et l'utilisation des services en établissement par les soignants et leurs aîné(e)s. À l'aide d'une version modifiée du modèle Andersen-Newman, on a analysé des données reliées à la présélection, à la période clinique et aux soins en milieu communautaire provenant du Manitoba Study on Health and Aging (MSHA-1). Les résultats indiquent que les personnes atteintes de démence ont plus souvent tendance à recourir aux services de soins personnels et à deux ou plusieurs services en établissement que les soignants et leurs aîné(e)s qui n'éprouvent pas de difficultés cognitives ou que ceux qui éprouvent des difficultés cognitives sans être atteints de démence. L'état fonctionnel des aîné(e)s et les conditions de logement des soignants et des aîné(e)s sont fortement reliés à l'utilisation de services en établissement particuliers et à leur utilisation générale. L'étude présente les conséquences sur les politiques et les recherches tirées des résultats des analyses et d'autres importants facteurs, notamment la situation des soignants occupant un emploi.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*The Manitoba Study of Health and Aging (MSHA) was funded in part by Manitoba Health's Healthy Communities Development Fund. Additional funding was provided through the Canadian Study of Health and Aging (CSHA) by the Seniors Independence Research Program of the National Health Research and Development Program of Health Canada (Project No. 6606-3954-MC(S)). The MSHA results and conclusions are those of the author and no official endorsement by Manitoba Health is intended or should be inferred.

References

American Psychiatric Association, Committee on Nomenclature and Statistics. (1987). Diagnostic and statistical manual of mental disorders (rev. 3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
Andersen, R., & Newman, J. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly, 51, 95124.CrossRefGoogle ScholarPubMed
Barberger-Gateau, P., Commenges, D., Gagnon, M., Letenneur, L., Suvel, C., & Dartigues, J.-F. (1992). Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. Journal of American Geriatric Society, 40, 1129–%1134.Google Scholar
Barnes, C., Given, B., & Given, C. (1995). Parent caregivers: A comparison of employed and not employed daughters. Social Work, 40(3), 375381.Google Scholar
Bass, D., Looman, W., & Ehrlich, P. (1992). Predicting the volume of health and social services: Integrating cognitive impairment into the modified Andersen framework. The Gerontologist, 32(1), 3343.CrossRefGoogle ScholarPubMed
Bass, D., & Noelker, L. (1987). The influence of family care-givers on elder's use of inhome services: An expanded conceptual framework. Journal of Health and Social Behavior, 28, 184196.Google Scholar
Beattie, B., Tuokko, H., & Hertzman, C. (1994). Factors affecting continued community living of patients with dementia. Victoria, BC: Centre on Aging, University of Victoria.Google Scholar
Biegel, D., Bass, D., Schulz, R., & Morycz, R. (1993). Predictors of in-home and out-of-home service use by family caregivers of Alzheimer disease patients. Journal of Aging and Health, 5(4), 419438.CrossRefGoogle Scholar
Brody, E., & Schoonover, C. (1986). Patterns of parent-care when adult daughters work and when they do not. The Gerontologist, 26(4), 372381.Google Scholar
Brody, E., Kleban, M., Johnson, P., Hoffman, C., & Schoonover, C. (1987). Work status and parent care: A comparison of four groups of women. The Gerontologist, 27, 201208.Google Scholar
Caserta, M., Lund, D., Wright, S., & Redburn, D. (1987). Caregivers to dementia patients: The utilization of community services. The Gerontologist, 27(2), 209214.CrossRefGoogle Scholar
Chappell, N., & Blandford, A. (1987). Health service utilization by elderly persons. Canadian Journal of Sociology, 12(3), 195215.Google Scholar
Chenoweth, B., & Spencer, B. (1986). Dementia: The experience of caregivers. The Gerontologist, 26, 267272.Google Scholar
Coulton, C., & Frost, A. (1982). Use of social and health services by the elderly. Journal of Health and Social Behavior, 23, 330339.CrossRefGoogle ScholarPubMed
Crowell, S., Rockwood, K., Stolee, P., Buehler, S., James, B., Kozma, A., & Gray, J. (1996). Use of home care services among the elderly in eastern Canada. Canadian Journal on Aging, 15(3), 413426.Google Scholar
CSHA Working Group. (1994). Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899913.Google Scholar
CSHA. (1994). Patterns of caring for people with dementia in Canada. Canadian Journal on Aging, 13(4), 470487.Google Scholar
Dellasega, C., & Stricklin, M. (1993). Cognitive impairment in elderly home health care clients. Home Health Care Services Quarterly, 14(1), 8192.Google Scholar
Duke University Medical Center. (1975). Duke OARS Multidimensional Functional Assessment: The OARS Methodology (1st ed.). Durham, NC: Center for the Study of Aging and Human Development.Google Scholar
Frank, R., German, P., Burns, B., Johnson, W., & Miller, N. (1988). Use of services by cognitively impaired elderly persons residing in the community. Hospital and Community Psychiatry, 39(5), 555557.Google Scholar
Ganguli, M., Seaberg, E., Belle, S., Fischer, L., & Kuller, L. (1993). Cognitive impairment and the use of health services in an elderly rural population: The MOVIES project. Journal of American Geriatrics Society, 41(10), 1065–%1070.Google Scholar
Gill, C., Hinrichsen, G., & DiGiuseppe, R. (1998). Factors associated with formal service use by family members of patients with dementia. Journal of Applied Gerontology, 17(1), 3852.Google Scholar
Ginther, S., Humphers-Ginther, S., Fox, P., & Miller, L. (1993). Why home health services are provided to Alzheimer's disease patients in California's Alzheimer's Disease Program: An exploration. Home Health Care Services Quarterly, 14(2/3), 111125.Google Scholar
Grabbe, L., Demi, A., Whittington, F., Jones, J., Branch, L., & Lambert, R. (1995). Functional status and the use of formal home care in the year before death. Journal of Aging and Health, 7(3), 339364.Google Scholar
Hanley, R., & Wiener, J. (1991). Use of paid home care by the chronically disabled elderly. Research on Aging, 13(3), 310332.Google Scholar
Havens, B. (1995). Canadian health care systems and aging: The Manitoba experience. The Southwest Journal on Aging, 11(2), 6376.Google Scholar
Hawranik, P., & Strain, L. (2000). Health of informal caregivers: Effects of gender, employment and use of home care services. Winnipeg: Centre on Aging, University of Manitoba.Google Scholar
Horowitz, A. (1985). Family caregiving to the frail elderly. Annual Review of Gerontology and Geriatrics, 5, 194246.Google ScholarPubMed
Hosmer, D., & Lemeshow, S. (1989). Applied logistic regression. Toronto, ON: John Wiley & Sons.Google Scholar
Jeans, E., Helmes, E., Mersky, H., Robertson, J., & Rand, K. (1987). Some calculations on the prevalence of dementia in Canada. Canadian Journal of Psychiatry, 32, 8185.Google Scholar
Kiecolt-Glaser, J., Dura, J., Speicher, C., Trask, O., & Glaser, R. (1991). Spousal caregivers of dementia victims: Longitudinal changes in immunity and health. Psychosomatic Medicine, 53(4), 345362.CrossRefGoogle ScholarPubMed
Lewis-Beck, M. (1980). Applied regression: An introduction. Beverly Hills, CA: Sage Publications.Google Scholar
Maletta, G. (1990). The concept of “reversible” dementia: How nonreliable terminology may impair effective treatment. Journal of the American Geriatric Society, 38, 136140.CrossRefGoogle ScholarPubMed
Manitoba Health. (1975). Policy guidelines: Continuing care, Province of Manitoba. Winnipeg, MB: Province of Manitoba.Google Scholar
McCabe, B., Sand, B., Yeaworth, R., & Nieveen, J. (1995). Availability and utilization of services by Alzheimer's disease caregivers. Journal of Gerontological Nursing, 21(1), 1422.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease, Neurology, 34, 939944.Google Scholar
McKinlay, J., Crawford, S., & Tennstedt, S. (1995). The everyday impacts of providing informal care to dependent elders and their consequences for the care recipients. Journal of Aging and Health, 7(4), 497528.Google Scholar
Montgomery, R., Kosloski, K., & Borgatta, E. (19881989). The influence of cognitive impairment on service use and caregiver response. The Journal of Applied Social Sciences, 13, 142169.Google Scholar
Moritz, D., Kasl, S., & Berkman, L. (1989). The health impact of living with a cognitively impaired elderly spouse: Depressive symptoms and social functioning. Journal of Gerontology, 44, S17S27.CrossRefGoogle ScholarPubMed
MSHA Aging Research Group. (1995). Final report. Winnipeg, MB: Centre on Aging, University of Manitoba.Google Scholar
Nahmiash, D. (1995). Informal caregiving: Women's care or work. In Sawyer, E. & Stephenson, M. (Eds.), Continuing the care: The issues and challenges for long-term care (pp. 247268). Ottawa, ON: Canadian Health Association Press.Google Scholar
Ory, M., Williams, T., Emr, M., Lebowitz, B., Rabins, P., Sallo-way, J., Sluss-Radbough, T., Wolff, E., & Zarit, S. (1985). Families, informal supports and Alzheimer's disease. Research on Aging, 7(4), 623643.Google Scholar
Penning, M. (1995). Cognitive impairment, caregiver burden and the utilization of home health services. Journal of Aging and Health, 7(2), 233253.Google Scholar
Plugge, L., Verhey, F., van Everdingen, J., & Jolles, J. (1991). Differential diagnosis of dementia: Intra- and interdiscipline agreement. Journal of Geriatric Psychiatry and Neurology, 4, 9097.CrossRefGoogle ScholarPubMed
Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401.CrossRefGoogle Scholar
Rodin, J., Timko, C., & Harris, S. (1985). The construct of control: Biological and psychosocial correlates. Annual Review of Gerontology and Geriatrics, 5, 355.Google ScholarPubMed
Roth, M., Huppert, F., Tym, E., & Mountjoy, C. (1988). CAMDEX. The Cambridge examination for mental disorders of the elderly. Cambridge, England: Cambridge University Press.Google Scholar
Scharlach, A., Sobel, E., & Roberts, R. (1991). Employment and caregiver strain: An integrative model. The Gerontologist, 31(6), 778787.CrossRefGoogle ScholarPubMed
Shapiro, E. (1986). Patterns and predictors of home care use by the elderly when need is the sole basis of admission. Home Health Care Services Quarterly, 7(1), 2944.Google Scholar
Shapiro, E., & Tate, R. (1997). The use and cost of community care services by elders with unimpaired cognitive function, with cognitive impairment/no dementia and with dementia. Canadian Journal on Aging, 16(4), 665681.Google Scholar
Soldo, B. (1985). In-home services for the dependent elderly. Research on Aging, 7(2), 281304.CrossRefGoogle ScholarPubMed
Solomon, D., Wagner, R., Marenberg, M., Acampora, D., Cooney, L., & Inouye, K. (1993). Predictors of formal home health care use in elderly patients after hospitalization. Journal of the American Geriatrics Society, 41, 961966.Google Scholar
Springer, D., & Brubaker, T. (1984). Family caregivers and dependent elderly: Minimizing stress and maximizing independence. Beverly Hills, CA: Sage Publications.Google Scholar
Starrett, R., Rogers, D., & Walters, G. (1989). Home health care utilization: A causal model. Home Health Care Services Quartely, 9(4), 125140.Google Scholar
Stoller, E. (1982). Patterns of physician utilization by the elderly: A multivariate analysis. Medical Care, 20(11), 10801089.Google Scholar
Stoller, E., & Cutler, S. (1993). Predictors of use of paid help among older people living in the community. The Gerontologist, 33(1), 3140.CrossRefGoogle ScholarPubMed
Strain, L. (1991). The use of health services in later life: The influence of health beliefs. Journal of Gerontology, 46, S143S150.Google Scholar
Tennstedt, S., Cafferata, G., & Sullivan, L. (1992). Depression among caregivers of impaired elders. Journal of Aging and Health, 4(1), 5876.Google Scholar
Tuokko, H., Frerichs, R., Kristjansson, B., & McDowell, I. (2000). Cognitive impairment with no dementia – Yet? The meaning of mild cognitive impairment in older adults. Mature Medicine, July/August, 116118.Google Scholar
Vitaliano, P., Scanlan, J., Krenz, C., Schwartz, R., & Marcovina, S. (1996). Psychological distress, caregiving and metabolic variables. Journals of Gerontology, 51B(5), P290P299.Google Scholar
Wan, T. (1989). The behavioral model of health care utilization by older people. In Ory, M. & Bond, K. (Eds.), Aging and health care: Social science and policy perspectives (pp. 5277). New York, NY: Routledge.Google Scholar
Wan, T., & Arling, G. (1983). Differential use of health services among disabled elderly. Research on Aging, 5(3), 411431.Google Scholar
World Health Organization. (1987). Tenth revision of the International Classifications of Diseases, 1987 draft of chapter V, categories F00-F99, mental, behavioral, and developmental disorders. In Clinical descriptions and diagnostic guidelines. MNH/MEP87. 1 Rev. 1. Geneva: WHO.Google Scholar
Zarit, S. (1982). Predictors of burden and distress for caregiving of senile dementia patients. Unpublished doctoral dissertation, University of Southern California, Los Angeles.Google Scholar
Zarit, S., Reever, K., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20, 649655.Google Scholar
Zarit, S., Todd, P., & Zarit, J. (1986). Subjective burden of husbands and wives as caregivers: A longitudinal study. The Gerontologist, 26, 260266.Google Scholar