This study examined reasons for not using nine community-based services and characteristics associated with these reasons among a sample of 293 older person–caregiver dyads in a Canadian province. The most frequent reasons were that the older person's health did not necessitate use, family/friends provided assistance, and the caregiver was unaware of the service. Cognitive impairment was associated with not using homemaker and/or cleaning services, in-home nursing services, and home-delivered meals as family/friends provided assistance; higher caregiver burden also emerged as significant for these services and personal care services. Male caregivers and caregivers with less education were more likely to be unaware of the availability of day centers, day hospitals, and formal respite services. Implications for future research and practice are highlighted.
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References
1.
American Psychiatric Association
. (1987). Diagnostic and statistical manual of mental disorders(Rev. 3rd ed.). Washington, DC: American Psychiatric Association.
2.
Andersen, R. M.
(1968). A behavioral model of families'use of health services(Research series 25, Center for Health Administration Studies). Chicago: University of Chicago Press.
3.
Andersen, R. M.
(1995). Revisiting the behavioral model and access to medical care: Does it matter?Journal of Health and Social Behavior, 36, 1-10.
4.
Andersen. R.
,& Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly Journal, 51, 95-124.
5.
Baker, D. I.
,& Pallett-Hehn, P. (1995). Care or control: Barriers to service use by elderly people. Journal of Applied Gerontology, 14, 261-274.
6.
Bass, D. M.
, & Noelker, L. S. (1987). The influence of family caregivers on elder's use of inhome services: An expanded conceptual framework. Journal of Health and Social Behavior, 28,184-196.
7.
Canadian Study of Health and Aging Working Group
. (1994a). Canadian Study of Health and Aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899-913.
8.
Canadian Study of Health and Aging Working Group
. (1994b). Patterns of caring for people with dementia in Canada. Canadian Journal on Aging, 13, 470-487.
9.
Caserta, M. S.
, Lund, D. A., Wright, S. D., & Redburn, D. E. (1987). Caregivers to dementia patients: The utilization of community services. The Gerontologist, 27, 209-214.
10.
Chappell, N. L.
(1991). Living arrangements and sources of caregiving. Journal of Gerontology: Social Sciences, 46, S1-S8.
11.
Crets, S.
(1996). Determinants of the use of ambulant social care by the elderly. Social Science and Medicine, 43, 1709-1720.
12.
Gill, C. E.
, Hinrichsen, G. A., & DiGiuseppe, R. (1998). Factors associated with formal service use by family members of patients with dementia. Journal of Applied Gerontology, 17, 38-52.
13.
Hamilton, E. M.
, Braun, J. W.,Kerber, P., Thurlow, C.,& Schwieterman, I. (1996). Factors associated with family caregivers' choice not to use services. American Journal of Alzheimer's Disease, 11(4), 29-38.
14.
Johnson, R. J.
, & Wolinsky, F. D. (1996). Use of community-based long-term care services by older adults. Journal of Aging and Health, 8, 512-537.
15.
Lawton, M. P.
, Brody, E. M., & Saperstein, A. R. (1991). Respite for caregivers of Alzheimer patients: Research and practice. New York: Springer.
16.
Malone Beach, E. E.
, Zarit, S. H., & Spore, D. L. (1992). Caregivers' perceptions of case management and community-based services: Barriers to service use. Journal of Applied Gerontology, 11, 146-159.
17.
McCabe, B. W.
,Sand, B. J., Yeaworth, R. C.,& Nieveen, J. L. (1995). Availability and utilization of services by Alzheimer's disease caregivers. Journal of Gerontological Nursing, 21, 14-22.
18.
McCaslin, R.
(1988). Reframing research on service use among the elderly: An analysis of recent findings. The Gerontologist, 28, 592-599.
19.
McKhann, G.
, Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (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, 939-944.
20.
Miller, B.
,& McFall, S. (1991). The effect of caregiver's burden on change in frail older persons' use of formal helpers. Journal of Health and Social Behavior, 32, 165-179.
21.
Miller, B.
, & Mukherjee, S. (1999). Service use, caregiving mastery, and attitudes toward community services. Journal of Applied Gerontology, 18, 162-176.
22.
MSHA Research Group
. (1995). Manitoba Study of Health and Aging Final Report: Technical section. Winnipeg, Manitoba, Canada: Centre on Aging, University of Manitoba.
23.
MSHA–2 Research Group
. (1998). Follow-up to the Manitoba Study of Health and Aging: Methodology. Winnipeg, Manitoba, Canada: Centre on Aging, University of Manitoba.
24.
Mullan, J. T.
(1993). Barriers to the use of formal services among Alzheimer's caregivers. In S. H. Zarit, L. I. Pearlin, K. W.Schaie (Eds.), Caregiving systems: Formal and informal helpers(pp. 241-259). Hillsdale, NJ: Lawrence Erlbaum.
25.
Penning, M. J.
(1995a). Cognitive impairment, caregiver burden, and the utilization of home health services. Journal of Aging and Health, 7, 233-253.
26.
Penning, M. J.
(1995b). Health, social support, and the utilization of health services among older adults. Journal of Gerontology: Social Sciences, 50B, S330-S339
27.
Stephens, M. P.
(1993). Understanding barriers to caregivers' use of formal services: The caregiver's perspective. In S. H. Zarit, L. I. Pearlin, & K. W. Schaie (Eds.), Caregiving systems: Formal and informal helpers(pp. 261-272). Hillsdale, NJ: Lawrence Erlbaum.
28.
Teng, E. L.
, & Chui, H. C. (1987). The Modified Mini-Mental State (3MS) Examination. Journal of Clinical Psychiatry, 48(8), 314-318.
29.
Tennstedt, S. L.
, Crawford, S.,& McKinlay, J. B. (1993). Determining the pattern of community care: Is co-residence more important than caregiver relationship?Journal of Gerontology: Social Sciences, 48(2), S74-S83.
30.
Zarit, S. H.
, Gaugler, J. E.,& Jarrott, S. E. (1999). Useful services for families: Research findings and directions. International Journal of Geriatric Psychiatry, 14(3), 165-181.
31.
Zarit, S. H.
, Reever, K. E.,& Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, 20, 649-655.
