Factors Predicting Support Utilization by Older Adults
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Date
2007-09
Authors
Engel, Lindsay
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Abstract
The Canadian population is aging and as it ages, there are concomitant increases
in the numbers of older women with high incidences of disability when compared to
men. Of particular interest for this study are the higher incidences of older women with
Alzheimer’s disease or a related dementia (Lindsay et al., 2002; National Advisory
Council on Aging, 2004). This is because women have a unique interaction with
systems and with the individuals who provide care for them. This uniqueness of
interaction influences their roles and affects their ability to utilize services.
To study this population the Andersen-Newman model of Health Service
Utilization was developed in the 1960s in an attempt to study the health service utilization
patterns of minority groups, like older women. It encompasses three factors: predisposing,
enabling, and need.
Based on the literature surrounding gender, dementia, and their inclusion within
Andersen Newman model, two questions were explored. One, are there gender
differences in the utilization of formal support services, across different age categories
and level of cognitive impairment, while controlling for level of need? Second, what
characteristics predict the utilization of formal supports only, informal supports only, both
informal and formal supports?
Samples for the study were derived from the 2002 General Social Survey (16) on
Social Support and Aging. Multivariate analyses were used to answer both research
questions. Initially, question one results yielded no significant differences between
women and men, across different age categories, or levels of impairment. Further analysis
results indicated significant differences with level of impairment only, and there were no
significant differences across gender or age.
The fact that there were no significant gender differences in question one is
counterintuitive because a higher reliance on formal supports should be seen by women
due to levels of disability, poverty, and willingness to access care. Regarding level of
impairment the fact that those with the lowest level of problems with memory and/or
cognition received the most help leads to two possible conclusions. One hand, formal care
services are being provided preventively at the first sign of impairment. On the other
hand, those women with the greatest need may be not receiving the help they need.
To answer the second research question, three separate stepwise logistic regressions were
performed comparing individuals who receive formal support services to those who
receive none, informal to none, and both to none. The models containing formal and both
significantly predicted of the use of service supports (Above 75%). Predisposing,
enabling, and need factors had significant predictor variables, although need accounted
for the greatest amount of variance.
Results raised concerns about reduced likelihood of formal services among
persons with higher levels of dementia, and the need for greater attention in policy and
practice to recognize and formally support persons with dementia. While gender did not
significantly impact whether individuals utilized support services, the models do provide
a framework for assessment providing information on who is using the system currently
and who should be using the system but has not.
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Keywords
Dementia , Services , Health and hygiene , Medical care , Older women , Canada , Utilization , Health services , Women