Dementia Family Caregivers Research Articles

Profiles of psychological flexibility and caregiving experience in dementia family caregivers: A latent profile analysis.

To explore the profiles of psychological flexibility among dementia family caregivers and examine their associations with psychological well-being and caregiving factors. Participants were 521 dementia family caregivers in Japan. Latent profile analysis was conducted to explore the profiles of psychological flexibility. The analyses examined differences in depression, anxiety, life satisfaction, and work-family conflict/enrichment between the profiles, and whether sociodemographic variables and caregiving stressors predict the profile. Four distinct profiles were identified: high psychological flexibility (14.2%), moderate psychological flexibility with high commitment (24.7%), moderate psychological flexibility with low commitment (48.0%), and low psychological flexibility (13.1%). The low psychological flexibility profile exhibited the highest scores of depression, anxiety and work-family conflict, followed by the moderate psychological flexibility with low/high commitment profiles, and the high psychological flexibility profile. The high psychological flexibility and moderate psychological flexibility with high commitment profiles exhibited higher life satisfaction than the moderate psychological flexibility with low commitment profile. Caregiving stressors, marital status, and caregiver status predicted the profile. Enhancing defusion and acceptance, rather than increasing commitment to personal values, may be beneficial in supporting distressed caregivers. Having more caregiving stressors, being single/divorced/bereaved, and being a primary caregiver may be useful indicators of decreased psychological flexibility among dementia family caregivers.

Longitudinal effects of ambivalent and guilt feelings on dementia family caregivers' depressive symptoms.

The world prevalence of people with dementia is increasing. Most of the care received by people with dementia is provided by family caregivers, and this prolonged activity has a significant impact on caregivers' levels of depression. Stressors and frequency of leisure are known predictors of caregivers' depressive levels. The longitudinal impact of caregivers' ambivalent and guilt feelings is unknown. Participants were 177 family caregivers of relatives with dementia who were assessed three times during a 2-year period. In addition to demographic variables, psychological symptoms of the dementias, and frequency of leisure activities, caregivers' ambivalent feelings, guilt, and depressive symptoms were measured. The longitudinal association of changes in these variables with changes in caregivers' depressive symptoms over time was assessed using mixed linear models. Changes over time in the assessed variables predicted 48.05% of variance of changes over time in depressive symptoms. Even when variables strongly associated with increased depressive symptoms were controlled (lower caregivers' age and educational level, higher reaction to BPSD, and lower leisure activities), increases in ambivalence and guilt contributed to an increase of 9.22% of the variance of changes depressive symptoms over a 2-year period. The effects of ambivalent feelings on depression are indirect, mediated by guilt feelings. Cessation of caregiving do not seem to alter these findings. Caregivers' ambivalent and guilt feelings are significant predictors of caregivers' mental health. Caregivers may significantly benefit from early detection of ambivalent and guilt feelings and preventive strategies targeting triggers associated with ambivalent and guilt symptoms.

Services for Latino Family Dementia Caregivers: Is the Workforce Prepared?

The American healthcare system is ill-fitted to meet the needs of the growing population with Alzheimer's and Related Dementias (ADRD) and their caregivers, which disproportionately affects Latinos. This paper describes the caregiving process for Latino patients with ADRD from the perspective of caregivers and service providers to reveal service areas in need of improvement. Ten providers and 24 Latino caregivers were interviewed through the Miami-Dade County Aging Network. Interviews were analyzed using a grounded theory approach. Five themes emerged: lack of social service connectivity, case management challenges, unmet mental health needs, language barriers, and the need for alternative service models. Our analysis indicates insufficient training and the need to improve dementia competencies, support strategies, and understanding of cultural nuances among service providers. These findings can help inform the development of a required ADRD provider education curriculum that incorporates cultural competency training to improve the quality and effectiveness of care.

Using Digital Inequality Framework to Evaluate a Technology-Delivered Intervention for Caregivers: Age, Education, and Computer Proficiency.

Objectives: Using "digital inequality" as a conceptual framework, this study evaluates the feasibility and usability of a technology-delivered intervention (an "app") for Alzheimer's and related dementia family caregivers. Time for Living and Caring (TLC) is an on-line intervention that provides virtual coaching and self-administered education and resources. Methods: A sample of family caregivers (n = 163) used the tool for 16 weeks, which included completing the Computer Proficiency Questionnaire (CPQ-12) at baseline. Analyses investigate the relationship between age, CPQ scores, intervention use, appraisal, and caregiver outcomes. Results: Age was inversely associated with CPQ; however, CPQ scores did not have a significant relationship with participant's self-perceived benefits or intervention appraisal. Computer Proficiency Questionnaire scores provided insight regarding research feasibility, with lower scores associated with greater odds of discontinuing engagement. Discussion: CPQ-12 scores can be used as a screening tool to identify those who may need additional support to engage with and benefit from technology-delivered interventions.

Family dementia caregivers with suicidal ideation improve with mentalizing imagery therapy: Results from a pilot study

BackgroundFamily caregivers of persons living with dementia often experience increased depression and suicidal ideation (SI). However, the feasibility and impact of therapies on caregiver SI has remained largely unexplored. Mentalizing imagery therapy (MIT) helps reduce psychological symptoms through mindfulness and guided imagery. This pilot study examined the feasibility of participation by caregivers with SI in a randomized controlled trial (RCT) of MIT versus a psychosocial support group (SG), and the respective impact of group on SI, depression, and secondary outcomes. MethodsA secondary analysis of data from an RCT of 4-week MIT or SG for caregivers (n = 46) was performed, identifying SI (n = 23) and non-SI (n = 23) cohorts. Group attendance and home practice were compared between cohorts. In the SI cohort (total n = 23, MIT n = 11, SG n = 12), group differences in SI, depression, and secondary outcomes were evaluated post-group and at 4-month follow-up. ResultsAttendance in both groups and home practice in MIT were similar between SI and non-SI cohorts. In the SI cohort, MIT evinced greater improvements relative to SG in SI (p=.02) and depression (p=.02) post-group, and other secondary outcomes at follow-up. LimitationsLimitations include small sample size and single-item assessments of SI from validated depression rating scales. ConclusionsParticipation in an RCT was feasible for caregivers with SI. MIT resulted in important benefits for SI and depression, while SG showed no acute SI benefit. The role of MIT in improving SI should be confirmed with adequately powered trials, as effective therapies to address caregiver SI are critical.

Affiliate Stigma among family caregivers of individuals with dementia in China: a cross-sectional study.

Affiliate stigma experienced by family caregivers of individuals with dementia may seriously affect home care and prognosis of these patients. This study aimed to explore the levels of perceived affiliate stigma and its influencing factors among family caregivers of patients with dementia in mainland China, which remains a relatively unexplored topic. In this cross-sectional study, purposive sampling was used to recruit dementia family caregivers from an online communication group between April and May 2022. A total of 727 eligible caregivers were included and asked to complete the demographic questionnaire, the affiliate stigma scale, and the caregiver burden inventory. Descriptive statistics, independent sample t-test, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression were used to explore the factors that influence perceived affiliate stigma among dementia family caregivers. The mean score for affiliate stigma of dementia family caregivers was 48.09 ± 16.38 (range: 22-86). Whether there were regular breaks during patient care, time-dependent burden, developmental burden, physical burden, and social burden were significant factors influencing the affiliate stigma of dementia family caregivers. Dementia family caregivers showed a moderate to high level of affiliate stigma. Those who had regular breaks during patient care, higher time-dependent burden, developmental burden, and physical burden and lower social burden exhibited higher levels of affiliate stigma.

The Effects of Neuropsychiatric Symptom Clusters in People with Dementia on Family Caregiver Burden.

Neuropsychiatric symptoms are a robust risk factor for caregiver burden in family dementia caregivers. By grouping these symptoms, clinical interpretations regarding neuropsychiatric symptoms may facilitated because different groups of symptoms may require a different approach for intervention, thereby reducing caregiver burden. As clustering of neuropsychiatric symptoms could be clinically relevant, we aimed to explore the effects of these clusters on burden in family dementia caregivers. 152 family dementia caregivers were included. Caregiver burden was measured using the Ervaren Druk door Informele Zorg (EDIZ)/Self-Perceived Pressure from Informal Care, a Dutch questionnaire. Caregivers also reported the neuropsychiatric symptoms and functional impairments in daily activities of the people with dementia they cared for. Multiple regression analyses were used in this cross-sectional study. Adjusted for functional impairments and sociodemographic variables, neuropsychiatric symptoms were associated with more caregiver burden (p < 0.001). However, this association did not differ between the three neuropsychiatric symptom clusters (p = 0.745). Neuropsychiatric symptoms were associated with more family caregiver burden, but no conclusive evidence was found that this association differed for the three clusters. Clustering of neuropsychiatric symptoms is, however, worth exploring further in future studies with more participants. If specific links are found, these could be targeted in clinical practice in order to prevent, reduce and/or postpone caregiver burden.

Supplemental Material for Efficacy of the Residential Care Transition Module: A Telehealth Intervention for Dementia Family Caregivers of Relatives Living in Residential Long-Term Care Settings

Supplemental Material for Efficacy of the Residential Care Transition Module: A Telehealth Intervention for Dementia Family Caregivers of Relatives Living in Residential Long-Term Care Settings

Profiles of Dementia Caregivers according to Psychosocial and Resource Variables. Importance of Kinship.

The present study aims to analyze the existence of different profiles in family caregivers of people with dementia according to psychosocial and resource variables. In addition, it aims to study whether there is a greater representation of each kinship group in each of the profiles and if there are differences in emotional distress among such profiles considering the kinship with the care-recipient. Participants were 288 family dementia caregivers, divided into four kinship groups (wives, husbands, sons and daughters). Psychosocial (familism, dysfunctional thoughts and experiential avoidance), resource (leisure activities and social support) and outcomes (depressive, anxious and guilt symptomatology) variables were collected. A hierarchical cluster analysis using Ward's method, an exploratory factor analysis of two fixed factors and contingency tables were performed. Five clusters were obtained: Low psychosocial vulnerability-High resources, Low psychosocial vulnerability-Low resources, Mixed, High psychosocial vulnerability-High resources, and High psychosocial vulnerability-Low resources. Results suggested that clusters associated with lower distress were the Low psychosocial vulnerability-High resources and the High psychosocial vulnerability-High resources. Clusters associated with higher distress were the Low psychosocial vulnerability-Low resources and Mixed. High levels of dysfunctional thoughts, familism and experiential avoidance do not always have a maladaptive function. This could depend on sociocultural and resource variables such as the kinship with the caregiver or perceived social support. The identification of profiles of family caregivers potentially needing protection and vulnerable to psychological distress could help to increase the effectiveness of interventions aimed at this population.

SELF-COMPASSION, DAILY STRESS APPRAISALS, AND ODDS OF ELDER ABUSE AND NEGLECT IN DEMENTIA FAMILY CAREGIVING

Abstract Stress related to behavioral symptoms is often found to be a risk factor for elder abuse and neglect in dementia family caregiving. The stress-process model suggests that stressful events alone do not determine caregiving outcomes, rather, they are impacted by personal factors which influence the response to stress. Self-compassion represents how one responds to themselves in moments of distress, with compassionate self-responding consisting of treating oneself with self-kindness (vs. judgement), feelings of common humanity (vs. isolation), and mindful awareness (vs. overidentification). Self-compassion is a modifiable intervention target with efficacious interventions available. We hypothesize that self-compassion can buffer the effects of daily stress on a caregiver’s likelihood of using abusive and neglectful behaviors. To test this hypothesis, a generalized linear mixed model with days (n=9513) nested in dementia family caregivers (N=453) was used. Self-compassion was measured at baseline with the Self-Compassion Scale – Short Form, and daily stress appraisal of behavioral symptoms and occurrences of elder abuse and neglect were measured on 21 sequential daily diary surveys. Having higher self-compassion reduced the likelihood of a caregiver using abusive and neglectful behaviors on a given day by 40% (p=0.001, CI 0.45-0.80). Daily stress appraisal of behavioral symptoms significantly increased the odds of abuse and neglect (OR 1.05, CI 1.02-1.09, p=0.002), while the interaction term showed self-compassion significantly lowered the effect of daily stress (OR 1.01, CI 1-1.02, p=0.029). Given the large effect size, self-compassion should be a priority area for future interventions to reduce elder abuse and neglect in dementia family caregiving.

GENDER DIFFERENCES IN PSYCHOLOGICAL OUTCOMES OF DEMENTIA CAREGIVERS

Abstract Substantial research has been conducted on the high prevalence of anxiety and depression among dementia family caregivers. Stressors, such as financial hardships related to costs of care and feelings of role captivity, can exacerbate adverse mental health outcomes. However, there is limited literature focused specifically on gender differences in the caregiving stress process. Using data from a mixed-methods study of 46 dementia family caregivers between the ages of 23-96, the purpose of this study was to examine gender differences in self-reported caregiving stressors (e.g., cost of care, care intensity) and psychosocial outcomes including depression and anxiety. Results showed that compared to females, male caregivers reported greater costs of care, greater feelings of role captivity, higher frequency of assistance with medical/nursing tasks (p=.01) and activities of daily living (ps range from .01-.04). Male caregivers also reported significantly greater distress related to care tasks (p=.04), as well as higher levels of depression (p=.02) and anxiety (p=.05). These findings provide insight into how the informal caregiving experience can vary by caregiver gender and potential factors contributing to these differential outcomes. The data establishes the importance of considering demographic characteristics in providing needed resources to dementia family caregivers.

SUPPORTING CHINESE FAMILY CAREGIVERS OF RELATIVES WITH DEMENTIA——A PILOT INTERVENTION STUDY IN SHANGHAI

Abstract Background Effective interventions are urgently needed to assist dementia family caregivers in China, where limited formal support and services are available. This pilot study aims to test a psychoeducational program that consists of information, skills training, and the use of binaural sound through the Processing Inner Strength toward Actualization Therapy (PISTA) device to alleviate caregiver burden and improve mental health outcomes. Methods Single subject design approach was used. Eight dementia family caregivers in Shanghai, China, were recruited and received a two-stage intervention over 12 weeks: Stage 1 (S1, Six 90-minute weekly sessions: Psychosocial education programs +PISTA) and Stage 2 (S2, Six 90-minute weekly sessions: Psychosocial education only). Caregiver outcomes, including caregiving burden, anxiety, depression, and positive aspects of caregiving (PAC), were assessed through established scales. Paired t-tests and visual analyses were used to compare outcome levels and trends between stages. Results Seven participants completed the entire study, and 1 participant dropped out during S2. Participants showed a decrease in caregiver burden, anxiety, and depression and an increase in PAC during S1. A similar trend was observed during S2 on burden, anxiety, and PAC outcomes, except for depression. Furthermore, the decrease in burden and anxiety scores and the increase in PAC scores were less salient during S2 than during S1, suggesting more effects were observed in S1 with PISTA. Conclusion Evidence is promising that psychoeducational programs combined with PISTA can lead to better psychological outcomes for dementia family caregivers. Findings need to be affirmed in future investigations using an experimental design.

LONG-TERM CARE CONCERNS AMONG CHILDLESS OR SINGLE CAREGIVERS TO PEOPLE LIVING WITH DEMENTIA

Abstract It is estimated that 77% of people living with dementia receive help with self-care and household activities from informal caregivers (typically family members), meaning there is a significant proportion of the population not receiving informal support. In this qualitative study, we aimed to explore similarities and differences in family caregivers’ concerns about organizing their own care should they develop dementia in the future between those who were childless and/or single and those who had a current partner and children. We interviewed 12 British current and former dementia family caregivers, 5 of whom were childless and/or single, 9 were women and 3 were men, with a mean age of 61. All 5 childless and/or single participants were women. Participants perceived a caregiver as vital for ensuring the person with dementia received the care they needed from services. Caregivers who were childless and/or single expressed concern that by not having someone to be their caregiver should they develop dementia in the future, they would be vulnerable to receiving poor care. In these cases, childless and/or single caregivers described the possibility of exploring options for suicide or euthanasia should they be diagnosed with dementia in the future. Similar sentiments were not expressed by caregivers with current partners and children. While this study uses a small sample size, these findings highlight persons without children and/or a partner have serious concerns about their future care, should they develop dementia. More research is needed to understand how to better support people with dementia without caregivers.

SECONDARY ROLE STRAIN AND GRIEF OF DEMENTIA FAMILY CAREGIVING AS PREDICTORS OF BURDEN

Abstract Services often aim to improve caregiver experiences for dementia family caregivers by addressing challenges in daily care activities and enhancing care quality for care-recipients. Supporting caregivers should not exclusively focus on supporting activities related to direct care provision (e.g., primary stressors), but should also include services that holistically support the caregiver’s well-being. Identifying an individual’s unique needs beyond their caregiving role is crucial; the growing phenomenon of caregiver burnout, burden, and psychosocial struggle includes experiencing a loss of identity, increased desire to escape, and intense role captivity. While some services are more individualized, such as one-on-one therapy, there is an overall gap in caregiver support in secondary domains. The current study examined whether primary stressors (e.g., activities of daily living and everyday care tasks) or secondary stressors (e.g., strain on other relationships and responsibilities) were more predictive of burden in a sample of 46 participants who completed a mixed-method study examining the heterogenous experiences and unmet needs of dementia family caregivers. Analysis shows that interference of the care role with responsibilities to other family (i.e., secondary role strain) and feeling pre-loss grief over their loved one’s illness were significant predictors of greater burden compared to primary stressors. Results indicate the importance of addressing secondary stressors such as pre-loss grief and deterioration of one’s microenvironment (including social support, familial relationships, and identity) in intervention efforts to better enhance quality of life and well-being in dementia care.

THE RELATIONSHIP BETWEEN ROLE CAPTIVITY, COPING STRATEGIE,S AND DEMENTIA FAMILY CAREGIVER MENTAL HEALTH

Abstract Informal caregivers of individuals living with dementia have an increased risk for experiencing depressive and anxiety symptoms. The stress-process model posits that situational stressors and stress moderators, such as role captivity and coping strategies, predict worse mental health outcomes; however, relatively little is known about the relationship between role captivity and specific coping strategies dementia caregivers use to manage caregiving-related stress. The purpose of this study was to examine relationships between role captivity, coping strategies, and depressive and anxiety symptoms. A preliminary analysis was conducted on a sample of community-dwelling family caregivers (N=30) from an ongoing national study on daily caregiving experiences. Data were analyzed using regression analysis. Dementia family caregivers reported moderate anxiety symptoms, measured by the GAD-7 (M= 11.86, SD= 4.39) and moderate depressive symptoms, measured by the CESD, (M=19.59, SD= 12.67). The sample’s mean age was 54.7 years old and 76.7% female. Role captivity was positively associated with depression (β=2.98, t(28) = 3.94, p&amp;lt; 0.001) and anxiety (β= 0.92, t(28) = 3.31, p&amp;lt; 0.01) among dementia caregivers. Avoidant coping was positively associated role captivity (β=0.31, t(28) = 4.27, p&amp;lt; 0.001). The results of this study suggest role captivity is associated with an increase in depression and anxiety among dementia caregivers. Further, avoidant coping is associated with an increase in role captivity reported by caregivers. The findings from this study support the benefit of interventions that help dementia family caregivers in their role and promote the use of positive coping strategies.

RELATIONSHIPS BETWEEN DEMENTIA CAREGIVER PERSONALITY, OUTCOMES, AND MANAGEMENT AND COPING STRATEGIES

Abstract Family caregivers of people living with dementia are at higher risk for negative outcomes such as depression and burden. However, the experiences of family caregivers are widely variable due to individual differences. Five-factor model personality traits have previously been connected to depression and burden. The current study seeks to expand this area by investigating the links between personality, caregiver management and coping, and outcomes (burden and depression). The sample consisted of 100 dementia family caregivers ranging from 20-90 years old (X̅=63.7, SD=16.1) who participated in the STYLE study on caregiving. Sample demographics consisted of 76% females, 80% White, 12% Black, 6% other, and 2% declined to report. Multiple regression models revealed significant relationships while controlling for caregiver age, gender, hours of care provided per week, months of providing care, and relationship to care receiver, though burden did not reveal any significant relationships. Higher conscientiousness (β=.226, p=.014) and higher neuroticism (β=.446, p&amp;lt;.001) were associated with higher depression. Higher agreeableness (β=-.367, p&amp;lt;.001) was associated with lower use of criticism-based management strategies, while higher neuroticism (β=.211, p=.023) was associated with higher use of criticism-based management strategies. High openness (β=.230, p=.020) was associated with higher problem-focused coping. Higher agreeableness (β=.201, p=.048) was associated with higher acceptance-focused coping, while higher neuroticism (β=-.254, p=.013) was associated with lower use of acceptance-focused coping. Higher neuroticism (β=.247, p=.020) was associated with higher emotion-focused coping. These analyses demonstrate links between dementia family caregiver personality, the management and coping strategies they use, and caregiver mental health.

RESULTS OF AN ONLINE CAREGIVING DURING CRISIS COURSE

Abstract Caregiving during Crisis (CDC) is an online, asynchronous, self-paced course for dementia family caregivers. The course was developed to enhance caregivers’ sense of mastery for their role as systems navigator with the secondary effects of improving their own and their person’s quality of life. CDC was drafted by subject matter experts and finalized by family caregivers. The final version focused on three main topics: Safe Home; Navigating the Healthcare System; and Managing the Day divided into 54 short interactive segments. One hundred caregivers were enrolled in a randomized waitlist control group design, with measures of mastery and quality of life at three timepoints over 16 weeks. We employed multi-level mixed effects models (MLM) with random (participant) and fixed (group) effects to test linear (or possibly non-linear) trajectories of change for the immediate and waitlist groups and model group X time and group*time interactions. Of 100 consented participants (50 in immediate and 50 in waitlisted group), 76 completed the midpoint study activities (38 in each group). For the immediate group, there was an increase in mastery such that by the midpoint at 2 months, the caregivers in the immediate group had significantly higher mastery scores (p=.039) than those in the waitlist group, with a moderate effect size (d=0.501) difference. Fourteen course participants completed semi-structured interviews. Their responses to the course were very positive, noting it was well organized, logical, and not too technical. They also indicated a need to include guidance for interactions with legal, regulatory, social service, and financial systems.

RE-IMAGINING DEMENTIA FAMILY CAREGIVER ENGAGEMENT FOR POST–ACUTE CARE TRANSITIONS: LESSONS LEARNED FROM COVID-19

Abstract Family caregivers of persons with dementia (PwD) experience three-times more post-acute care transitions (PACT) to skilled nursing facilities than other caregivers. During Covid-19, visitation policies drastically changed, limiting family caregiver engagement in the skilled nursing facility. This was a widespread experience; yet, few studies have examined dementia family caregivers’ perceptions of PACT engagement during Covid-19 restrictions. This qualitative study focused on the findings and lessons learned about the meaning of engagement, barriers, facilitators, and support needs during Covid-19 using an interpretive descriptive approach. Participants (n=15) were mostly female (n=13), adult children (n=8), and the majority (n=9) had a PACT experience during the Covid-19 pandemic. Family caregivers reported improved engagement with the PwD and healthcare team in the acute care setting, because hospital policies on Covid-19 allowed one visitor which gave family caregivers the option to be physically present and advocate for the PwD. However, after the PACT, only essential workers were allowed at the skilled nursing facility making it impossible for family caregivers to visit the PwD and communicate with professional caregivers. Lack of perceived support negatively affected family caregivers’ ability to communicate, share knowledge, advocate, and participate in critical decision making. These Covid-19 challenges highlight the importance of being physically present as a necessary component to engagement which was a form of communication compensation that improves outcomes for the PwD. Future practice policies should view family caregivers as essential to the healthcare team and develop innovative solutions to connect family caregivers to the PwD during Covid-19 or future pandemics.

SOCIAL NETWORK AND CAREGIVING EXPERIENCE AMONG SPOUSE AND ADULT-CHILD DEMENTIA CAREGIVERS: A MEDIATION ANALYSIS

Abstract Evidence on differences in social network and their roles in associations between types of family caregivers and caregiving experience is limited. Based on the stress process model (SPM), we aimed to explore the different levels and interactions of social network and caregiving experience among spouses and adult-child caregivers. A questionnaire-based survey was conducted on a total of 146 dementia family caregivers (78 adult-child, and 68 spouses) in China. Data collection comprised four sections: (a) care-related stressors, (b) caregivers’ context, (c) social network using Lubben social network scale, and caregiving experience using short-form Zarit burden interview, and nine-item positive aspects of caregiving (PAC) scale. Linear regression, mediation model analysis, and interactive analysis were performed to explore associations between variables. Spouses experienced lower social network (β= -0.294, P=0.008) and higher PAC (β= 0.234, P=0.003) than adult-child caregivers, whereas no significant difference was found in caregiver burden between two groups. Mediation analysis suggested that associations between caregiver type and caregiver burden were indirect-only mediation effects by social network(β=0.140, 95%CI=0.066 to 0.228). The mediation effect of social network on caregiver type and PAC was the suppressing effect, and the interaction effect was significant (P for interaction =0.025). A higher social network was associated with higher positive aspects of caregiving among the spouse subgroup (β= 0.341, P=0.003). Social networks mediate responses to caregiving experiences among different care provider types and are vital intervention targets, especially for spousal caregivers. Our results can serve as references for identifying caregivers for clinical intervention.

INDIVIDUAL AND COUNTY-LEVEL FACTORS OF SERVICE USE BY DEMENTIA FAMILY CAREGIVERS IN RURAL APPALACHIA

Abstract Formal services have been shown to provide health benefits for care recipients and family caregivers. Despite prior efforts, it is still unclear which factors play a role in the decisions to use formal services by family caregivers living in under-resourced rural regions. Drawing upon the Andersen model of health service use, this study examined individual and county-level factors’ associations with the utilization of support services (e.g., homemaker, respite) and personal services (e.g., home health nurse, personal care aide) by dementia family caregivers residing in rural Appalachia (N = 163). Results of multilevel models revealed that caregivers with higher income and care recipients with more limitations in activities of daily living tended to use more support and personal services. Greater informal support from family or friends was associated with less utilization of support services, but not personal services. Caregivers residing in counties with higher poverty and lower public spending on support services for older adults were more likely to use support services. Conversely, caregivers living in counties with more home health agencies were more likely to utilize personal services. These findings suggest that caregivers living in rural regions may depend more on informal support for meeting basic care needs of their relative living with dementia. However, if the care recipient requires more specialized care, living in resource-rich counties increases their chances of receiving appropriate care. Discussion will focus on strategies to allocate funds and resources to expand care coverage to vulnerable individuals such as people living with dementia in rural regions.