Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use

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dc.contributor.authorSavla, Jyoti S.en
dc.contributor.authorRoberto, Karen A.en
dc.contributor.authorBlieszner, Rosemaryen
dc.contributor.authorKnight, Aubrey L.en
dc.date.accessioned2022-08-30T14:23:58Zen
dc.date.available2022-08-30T14:23:58Zen
dc.date.issued2022-01-01en
dc.description.abstractBackground and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. 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, underresourced 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.en
dc.description.notesThis research was supported by Award No. 17-2 from the Commonwealth of Virginia's Alzheimer's and Related Diseases Research Award Fund and the National Institute on Aging at the National Institutes of Health (R21AG054682).en
dc.description.sponsorshipCommonwealth of Virginia's Alzheimer's and Related Diseases Research Award Fund [17-2]; [R21AG054682]en
dc.description.versionPublished versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.1093/geroni/igab055en
dc.identifier.eissn2399-5300en
dc.identifier.issue1en
dc.identifier.otherigab055en
dc.identifier.pmid35146130en
dc.identifier.urihttp://hdl.handle.net/10919/111667en
dc.identifier.volume6en
dc.language.isoenen
dc.publisherOxford University Pressen
dc.rightsCreative Commons Attribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/en
dc.subjectCultural identityen
dc.subjectHome and community-based servicesen
dc.subjectService utilizationen
dc.titleFamily Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Useen
dc.title.serialInnovation in Agingen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten

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