Changes in Formal-Informal Caregiving in Elderly Stroke Survivors

CHANGES IN FORMAL-INFORMAL CAREGIVING IN ELDERLY STROKE SURVIVORS Holly Anne Beard Old Dominion University, 2007 Director: Dr. James Alan Neff The purpose of this study is to determine the extent to which the Andersen and Aday Model of Health Services Use to predict cross-sectional and longitudinal differences in the caregiving source among stroke survivors (0=477) over a six-year period. This study involves a secondary analysis o f a longitudinal panel study focusing upon three waves of interview data from the HRS/AHEAD study spanning 1998 through 2002. Multinomial logistic regression was utilized to examine caregiving source crosssectionally at each wave. Clustered multinomial logistic regression was used to examine relationships between predictor variables in the model and caregiving source across waves while holding time constant. The results o f this study indicate that crosssectionally and longitudinally the need domain accounted for the largest proportion o f the explained variance. Within the need domain the most consistent predictors of caregiving were the number o f activities o f daily living and instrumental activities o f daily living impairments. The predisposing domain became less significant once enabling and need variables were entered in the cross-sectional models. In the longitudinal models, all of the domains in the Andersen-Aday Model were significantly related to caregiving type. These findings provide information about the caregiving situation post stroke, but also Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. post rehabilitation, which is often the last contact with formal care services. The results o f this study have two health policy implications for survivors of stroke. First, the limited number of transitions between different types of caregiving services indicates that there is likely be a fairly large length of commitment for informal caregivers. Second, discharge planning in the hospital or acute rehabilitation provides a ‘teachable’ moment or the key moment for intervention where realistic options for long-term care could be discussed and planned knowing that whatever is chosen will be the arrangement for the caregiver and care receiver for a considerable amount of time. Beyond individual and provider implications these findings pose serious questions and opportunities for national and state long-term care policy. Understanding the dynamic process o f caregiving will inform federal and state policymakers on the type and amount o f care desired by older Americans. Ultimately the question is not what type of care is used, but how will the cost o f care be distributed and in the long run how can the federal government in partnership with the states and individuals plan for this type o f care while creating a sustainable system. Studies about the continuum of care, like this one, provide details about long-term care such as the use of formal and informal caregiving that can be utilized by policymakers to design systems to enhance both formal and informal caregiving. Co-Directors of Advisory Committee: Dr. Stacey B. Plichta Dr. Karen Karlowicz Dr. Bonnie K. Lind Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.