The purpose of this study was to determine if caregiver-related characteristics affect the utilization of community based long- term care services by caregivers and care recipients. More specifically the study examined the caregiver-related need variables as predictors of service use. Caregiver-related need variables of interest included caregiving demands, caregiver health and perceived sense of control, or mastery. More caregiving assistance, more restriction in personal and social activities due to caregiving responsibilities, greater depressive symptoms, and lower mastery have a significantly positive effect on the use of formal services. Interventions aimed at addressing the characteristics that lead to an increase in service use, such as depression, may lower the financial strain on institutions providing formal assistance to caregivers who otherwise may be physically able to carry out their caregiving activities.

Background: One of the strongest demographic predictors of the utilization of community-based formal care services is age. Many elderly people rely on a family member to provide informal care. An elderly spouse is most likely to be the caregiver for an impaired, community-dwelling older adult. Disabled elders and their elderly spouse caregivers can be viewed as joint users of formal care services. The purpose of this study was to determine if caregiver-related characteristics affect the utilization of community based long-term care services among such caregiver/care recipient couples. More specifically, the study examined the caregiver-related need variables as predictors of service use. Caregiver-related need variables of interest included caregiving demands, caregiver health, and mastery. Mastery is defined as the extent to which one believes that their life experiences are under one's control.

Methods: The sample consisted of 186 adults age 65 years or older who were caring for a disabled spouse. Caregiving demands included two variables- amount of caregiving assistance provided and restriction in personal and social activities due to caregiving responsibilities. The two indicators of the caregiver's health included depressive symptoms and overall health. Caregivers indicated whether they provided their spouse with assistance on each activity with which difficulty was experienced. Scores were summed with higher scores indicating the provision of greater assistance. Caregiver restriction in personal and social activities was measured by indicating the extent to which 11 types of activity (eg. self care, care of others, eating habits, sleeping habits, visiting friends, etc.) were restricted. Depressive symptoms were indicated by caregiver responses to survey statements. Caregiver's sense of mastery was measured using a similar method. Predisposing, enabling, and care recipient need variables, known predictors of service use, were controlled for. Formal service utilization was measured as the number of community and home-care services used by caregivers for their spouse/and or themselves.

Findings: An increase in provision of caregiving assistance, more restrictions in personal and social activities, greater depressive symptoms, and lower mastery had a significantly positive effect on the use of more formal services.

Conclusions: This study contributes to our understanding of the factors related to the use of formal services by older adults. In particular, the findings provide new insights on the role of caregiver need variables in the use of long-term care services by older adults, looking beyond sociodemographic and background variables of the caregiver, which have been the focus of past studies. The relationship between caregiver depressive symptoms and formal service use, for example, indicates the need for investments in intervention strategies to relieve these symptoms. Interventions aimed at addressing the characteristics that lead to an increase in service use may lower the financial strain on institutions providing formal assistance to caregivers who otherwise may be physically able to carry out their caregiving activities.

Reference: Bookwala J, Zdaniuk B, Burton L, Lind B. Jackson S, Schulz R. "Concurrent and Long- Term Predictors of Older Adults' Use of Community-Based Long-Term Care Services: The Caregiver Health Effects Study". Journal of Aging and Health, 2004; 16(1): 88-115.

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