Formal Caregivers Research Articles

Is the Electroconvulsive Therapy Video on YouTube Supportive Information for Patients and Their Primary Caregivers?

Electroconvulsive therapy (ECT) is a significant contemporary medical treatment modality for various mental disorders that have not responded to other treatments. YouTube is a valuable place to get health-related educational content that can have a big impact on patients' and their primary caregivers' behaviors and decisions. The aim of the study is to analyze the content of YouTube videos related to ECT to investigate the quality and reliability of videos as supportive information for patients and their primary caregivers. A total of 250 videos related to ECT that are available on YouTube were analyzed. The Global Quality Scale and the modified DISCERN tool were used to assess the quality and reliability of the videos. Details of the content of the video, caregiver appearance, methods of information presentation, source of the video, and video parameters were analyzed as well. The analysis revealed that the median total score of Global Quality Scale was 3 (interquartile range, 2; min-max, 1-5), which means the video quality was medium. The median total score of the modified DISCERN tool was 3 (interquartile range, 1; min-max, 0-5), which means the videos were highly reliable. Most of the video sources in the included videos were educational (41.2%, n = 103) from formal caregivers, and there was no significant difference between Global Quality Scale scores, video parameters, and modified DISCERN scores. YouTube is considered a supportive source of information related to ECT but needs more encouragement from formal caregivers to disseminate high-quality and reliable healthcare content on YouTube platforms to ensure access to accurate information.

Patient and family engagement interventions for hospitalized patient safety: A scoping review.

To summarize existing studies that focused on improving hospitalized patient safety through patient and family engagement interventions to identify priorities and gaps. A scoping review. Eight databases and citations of important reviews were searched on 30 September 2022. Two researchers independently screened the records. Then, two researchers extracted the data and cross-checked. The results were synthesized narratively, and a comparison was performed for studies from China and those from other countries. Ninety-eight studies were included. The results indicated that patient and family engagement interventions were applied to decrease the incidence of patient safety incidents, and to improve the healthcare providers' and patients' knowledge, attitude or practice of patient safety. Most studies only engaged patients and families at the direct care level, and the engagement strategies at the organization and health system levels were insufficient. For stakeholders, many studies failed to consider patients' perspectives in intervention design and report taking staff training as a supportive strategy. Healthcare providers, especially nurses, were the main implementers of current interventions. Certain differences were observed between studies from China and those from other countries in the above aspects. International interest in engaging patient and family for patient safety is growing. Future studies should enhance the patient and family engagement as a partner in various patient safety at the direct care level, and further explore the engagement at the organization and health system levels. Nurses, as the main formal caregivers for patients, should promote patient and family engagement in patient safety, especially at direct care level. Nurse should also incorporate the perspectives of patients in the design and implementation of interventions. PRISMA-ScR Checklist.

Practice of formal caregivers in medication management of Elderly People, in a home context

Practice of formal caregivers in medication management of Elderly People, in a home context

S.3827 and a Systematic Review of State-Level Multisector Plans for Aging: How Incorporating Volunteer Caregiving Can Mitigate Service Gaps.

Recognizing the growing need to establish and enhance the necessary service infrastructure to better address the diverse needs of a rapidly aging US population, S.3827 (ie, Strategic Plan for Aging Act) seeks to provide federal support for the creation and implementation of Multisector Plans for Aging (MPAs). Passage of S.3827 can motivate states to strategically plan for a growing elder cohort, as only 8 states currently have developed and are implementing their own MPAs. In this policy brief, we detail the benefits of developing and implementing an MPA at the state level as well as the broad benefits of passing S.3827. We also conduct a systematic review of the 8 MPAs which have been developed and are currently being implemented, focusing on areas of significant overlap (eg, support for paid formal caregiving and support for informal family caregivers) and potential gaps. We conclude with a review of the volunteer caregiving movement and a discussion on how incorporating volunteer caregiving into an MPA can address local elder needs and mitigate service gaps, particularly among older adults who lack access to formal paid caregivers or informal family caregivers. Should S.3827 pass, we argue that state legislatures and stakeholders in eldercare should seriously consider incorporating the volunteer caregiving model into their strategic plans for aging.

Do urinary and double incontinence predict changes in living arrangements and mobility in older women after hip fracture? – a 1-year prospective cohort study

BackgroundContinence problems are known to be associated with disability in older adults. Costs of disability and resulting need for more supported living arrangements are high after a hip fracture. The aim was to examine pre-fracture urinary incontinence (UI) and double incontinence (DI, concurrent UI and fecal incontinence) as predictors of changes in mobility and living arrangements in older female hip fracture patients in a 1-year follow-up.MethodsStudy population comprised 1,675 female patients aged ≥ 65 (mean age 82.7 ± 6.8) sustaining their first hip fracture between 2007–2019. Data on self-reported pre-fracture continence status was collected. The outcomes were declined vs. same or improved mobility level and need for more assisted vs same or less assisted living arrangements 1-year post-fracture. Separate cohorts of 1,226 and 1,055 women were generated for the mobility and living arrangements outcomes, respectively. Age- and multivariable-adjusted logistic regression models were used to determine the associations of UI, DI, and other baseline characteristics with the outcomes.ResultsOf the patients, 39% had declined mobility or more assisted living arrangements at 1-year follow-up. Adjusting for age, both pre-fracture UI and DI were associated with changes in mobility and living arrangements. In the multivariable analysis, UI (OR 1.88, 95% CI 1.41–2.51) and DI (1.99, 95% CI 1.21–3.27) were associated with decline in mobility level while only DI (OR 2.40, 95% CI 1.22–4.75) remained associated with the need for more assisted living arrangements.ConclusionsBoth pre-fracture UI and DI in older women are risk factors for declining mobility level, but only DI for more supported living arrangements 1-year post-hip fracture. UI likely develops earlier in life and might not necessarily be strongly associated with the onset or increasing disability in later years. DI may indicate more marked vulnerability and burden to patients as well as to formal and informal caregivers.

Violence towards formal and informal caregivers and its consequences in the home care setting: A systematic mixed studies review

Violence towards formal and informal caregivers and its consequences in the home care setting: A systematic mixed studies review

Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach.

Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from "lesson" to "chapter" and from "suffering from" dementia to "affected by" dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context.

Unmet Needs of Palliative Care Among Iranian Children with Cancer and Their Families: A Qualitative Study

Background: Palliative care is one of the primary rights of children with cancer and their families. Identifying the unmet needs of palliative care for these children is important in providing high-quality care. Objectives: The present study aimed at explaining the perception of formal and informal caregivers about the unmet palliative care needs of children with cancer and their families. Methods: This qualitative study was conducted from October 1, 2020, to May 15, 2021, in one of the children’s hospitals in Rasht (Northern Iran). This study enrolled 25 caregivers (nurses, doctors, grandmothers, sisters, aunts, neighbors, and parents of children with cancer) and 5 children with cancer, who met the inclusion criteria by purposeful sampling to participate in in-depth and semi-structured interviews. The interviews continued until data saturation. A directed content analysis was performed according to the Elo and Kyngas proposed approach and based on the National Consensus Project (NCP) framework. The findings were managed by MAXQDA2020 software. Guba and Lincoln criteria were used to ensure the trustworthiness of the data. Results: The average age of the participants was 32.40 ± 1.4 years, and 1,450 codes were extracted. The extracted theme was “the need for holistic care”, which included 7 main categories such as “the structure and process of care”, “physical aspects of care”, “psychological aspects of care”, “social aspects of care”, “cultural aspects of care”, “care of the patient nearing the end of life”, and “spiritual, religious, and existential aspects of care”, and 23 subcategories. Conclusions: Children with cancer and their families have many physical, psychological, spiritual, and social needs. To meet these needs, it is suggested to provide the necessary infrastructure for palliative care, strive for justice in access to palliative care services for children with cancer and their families, empower caregivers, form an interdisciplinary team, and promote cultural awareness regarding cancer and end-of-life care.

Spiritual well-being levels of formal and informal cancer caregivers in Turkish society and influencing factors: A comparative study

Purpose: This study aimed to compare the spiritualwell-being levels of formal and informal caregiversof cancer patients.Materials and Methods: This study using a crosssectional survey was conducted with formal (n=52)and informal caregivers (n=52), who met theinclusion criteria, were included in the sample. Thedata of the study were collected using web-based andself-reported questionnaires.Results: The scores of spiritual well-being in alldimensions of formal and informal caregivers are ata moderate level. There was a difference between informal and formal caregivers in the belief andpeace sub-dimension scores. Moreover, there was nodifference in total score averages of the spiritualwell-being scale. It was found that there was nostatistically significant difference between themaccording to age groups, gender, marital status,having a child, and income status.Conclusions: This study provides that the careprocess of cancer patients may affect the spiritualwell-being of formal and informal caregivers.Keywords: cancer, formal caregivers, informalcaregivers, spiritual well-being, oncology nursing

The mediating roles of psychological resilience and psychological well-being of caregivers for the older adults.

This study aimed to investigate the mediating effects of psychological resilience and psychological well-being for caregivers at nursing homes on the relationship between insomnia and elder maltreatment. As the world is aging quickly and the number of older individuals cared for by formal caregivers has been increasing, this study's results could help create intervention programs to minimize the occurrence of older people's maltreatment. A total of 431 care workers who met all criteria, from 21 care service centers for older adults in Fukuoka, Japan, completed the Conditions of Maltreatment Scale, Caregivers' Belief in Ideal Care, Insomnia Severity Index, WHO-5 Well-Being Index, and Connor-Davidson Resilience Scale-10. A multivariate analysis of variance revealed that participants with no insomnia had greater resilience, higher psychological well-being, and greater belief in ideal care and to treated older clients less roughly compared to participants with insomnia. Psychological resilience and well-being were significant mediators in the relationship between insomnia, rough care, and beliefs in ideal care. As formal caregivers are in urgent demand, society should take care of them. The most effective and successful intervention for improving their physical and psychological well-being should be initiated at the individual and organizational levels.

Nature and Impact of Family Care in the Life of Elderly People: A Study in Dhaka City

Family care is an important issue that plays a significant role in the life of elderly people since the number of elderly people is increasing and the role of the families is also changing. The family structure reduces the number of caregivers in the family, and it has a crucial implication on the healthy life of older people. The objective of this study is to explore the nature and impact of family care in the life of elderly people in Dhaka city. This study is mainly qualitative in nature and the case study method was followed to understand the in-depth situation of family caregiving. Through a purposive sampling technique, 20 families were selected as cases from the Dhaka South City Corporation area. In-depth interviews were conducted to collect some qualitative data. The study findings indicated that the majority of elderly people get care from spouses and children to perform the basic activities necessary for daily life where women play a vital role. Family members provide both daily living and instrumental support to the elderly people. Moreover, this study found that lack of family attachment, busy urban life, professional stress, involvement of women in the labor market, migration of youth, individualism, limited formal and non-formal caregivers, lack of proper health and disease related information and knowledge, and apathetic attitude are the major challenges for getting adequate and effective elderly care. The findings suggest home-based and community-based care program is needed to support family caregivers and older people to stay in their homes and communities.

Percepção de estresse, síndrome de Burnout e estratégias de enfrentamento em cuidadores de pessoas idosas institucionalizadas: estudo de correlação

Abstract Introduction Acting as a caregiver for institutionalized elderly people has been shown to be susceptible to stress, which in a chronic and adaptive way can lead to Burnout syndrome. In this context, coping strategies can mitigate or delay the negative impact of organizational factors. Objectives To analyze the perception of stress and burnout syndrome in formal caregivers of institutionalized elderly people and to verify their correlation with coping strategies. Method A cross-sectional study conducted with 54 professionals who provide care to elderly people living in three long-term care institutions. A sociodemographic, labor and health characterization questionnaire was used; the Perceived Stress Scale; the Maslach Burnout Inventory - Human Services Survey (MBI-HSS); and the Occupational Coping Scale were also used. The correlation between the values obtained by the instruments was verified using the LOESS statistical method. All ethical precepts were followed. Results There was a predominance of female participants, aged between 36 and 51 years, completed high school, married and with children, with a monthly family income between 1 and 3 minimum wages. Statistical analysis revealed a significant correlation between the perception of stress and burnout, as well as a trend in which higher levels of coping strategies exert a negative correlation on the perception of stress, regardless of the syndrome. Conclusion Screening for stress and burnout syndrome in professionals who provide care to institutionalized elderly people is important to implement preventive actions aimed at this population, and can mitigate physical, emotional, and psychological disorders.

Homens cuidadores informais de idosos dependentes no Brasil

The objective of study was to understand the motivations and implications of care given by men for dependent elderly family members. Qualitative research happened between July and December 2018 in six cities in the five Brazilian regions, interviewing 11 men who perform tasks as informal caregivers. The men assumed this task because the women’s exhaustion and sickness, added to affective and marital reciprocity. Their sons expressed discomfort in taking personal care of their parents, while the spouses had difficulties with domestic activities. Lonely caregivers were tired, in pain, sleep deprived, experiencing depressive symptoms and loneliness. Support provided by family members and formal caregivers proved to be valuable in alleviating the suffering of caregivers who were reluctant to ask for help. Health professionals are called to pay attention to informal care providers for family members.

Educational interventions to prevent urinary infections in institutionalized elderly people. Quasi-experimental Study.

To analyze the effectiveness of an educational intervention among nursing professionals and caregivers to prevent urinary tract infections in institutionalized elderly people. this is a quasi-experimental study carried out with 20 people (7 nurses and 13 formal caregivers). A questionnaire was applied during the pre-intervention stage, then professional training was carried out and finally, the questionnaire was reapplied 6 months after the intervention. The prevalence profile and factors associated with urinary infections in 116 elderly people was evaluated before and after the educational interventions. Statistical analysis was performed using association and correlation tests, logistic regression model comparison and prevalence rates. The average number of correct answers by the nursing professionals and caregivers after the educational intervention increased from the pre to the post-test by 52% regarding signs of urinary infection, 32% regarding its symptoms, 72.5% regarding its treatment, 40% regarding personal/behavioral and morbidity-related risk factors, 59% regarding conditional factors and 43.8% regarding its preventive measures. The team of caregivers showed a greater gain in knowledge compared to the nursing team in almost every question (p<0.05). The length of time working in elderly care showed no positive correlation with any variable (R< p>0.05). The prevalence of urinary tract infection in the pre-intervention period was 33.62%, and 20% in the post-intervention period. The educational intervention was effective in preventing urinary tract infections in the elderly. The increased knowledge acquired by nurses and caregivers was associated with a reduction in the infection rate and an improvement in the most prevalent modifiable factors for the development of this type of pathology.

Ageing well in place: EET as an answer to the need for integrated care and support

Background: Older people prefer to stay as long as possible in their own home and environment. However, as people age, they are typically confronted with age-related declines on different domains; often leading to multidimensional (physical, psychological, social and environmental) frailty, which is associated with an increased vulnerability to adverse health outcomes and a decrease in wellbeing. In order to age well at home, one must shift from the (often) current fragmented, supply-driven support to a more integrated and multidisciplinary demand-driven support that focuses on the wants and needs of older people and their caregivers.&#x0D; The Elder Expertise Team in Tienen (Belgium): Currently, as also mentioned by our stakeholders of informal caregivers, there is insufficient continuity and coherence between the different disciplines involved in the support and care at various echelons. This often leads to non-transparency, not only for older frail people but also for their informal and formal caregivers. As a result, the problems are not recognized, nor treated in time, leading to a threatening of the autonomy, participation in society, health and wellbeing and often leading to an admission into a residential care facility.&#x0D; To address this need, in Tienen, the “Elderly Expertise Team (EET)” was established in 2019 with the objective of enabling frail elderly people to live at home for as long and as qualitatively as possible by offering the most appropriate care and support. The EET has a multidisciplinary, cross-sector and cross-organizational composition, using a network-oriented approach. In order to give an answer to multidimensional frailty, besides healthcare partners also partners from welfare are part of the EET.&#x0D; The EET serves as a “single point of entry” which coordinates care and support across a network of different care and support providers. The EET uses a stepped-care approach: (1) one starts with giving (general) advice by phone, (2) if there is a need for additional case-specific support an assessment and/or screening is done, leading to case-specific tailored advice and a short-term treatment of up to 5 sessions is provided; (3) if necessary, a referral to more specialized care is done. Besides the care for older persons and their caregivers, the EET also provides coaching, trainings and intervisions for formal caregivers. This all results in better and integrated care and support, leading to reduced admissions to residential care and a better wellbeing for the older person and his/her context.&#x0D; Future: Currently, the EET works mainly at the intervention level. However, in the future a more population-based approach using risk-profiles for multidimensional frailty and doing pro-active home visits might also lead to a better casefinding and prevention of frailty. Moreover, as the focus is now on clinical and service integration, the EET recognizes the need for functional integration by means of shared electronic patient records.&#x0D;

The role of Hospice Care at the end of life: perspectives from formal and informal caregivers&amp;nbsp;&amp;nbsp;

Background: Persons nearing the end of life often prefer to die in their familiar surroundings. Dying at home is, however, not always possible, even when the person is supported by a mobile palliative home care team. As the (complex) care needs increase, informal caregivers are required to be available 24 hours a day and take on a significant portion of clinical care. In some cases, no informal caregiver is available or the informal caregiver(s) are overburdened, leading to hospital admission. As it is often not possible to refer these persons to a palliative unit because of the limited number of places available there, forty percent of deaths occur in acute wards in hospitals. These wards are less specialized in palliative care delivery, resulting in an end-of-life care which is not optimally tailored to the needs of the person and his/her caregiver(s). In order to relieve the burden on informal care, to reduce the high mortality rate in acute hospital wards, and to offer better quality palliative care, hospitals and nursing homes started to collaborate in Flanders (Belgium). Two hospices within nursing homes were created: Hospice “Aulighem” and Hospice “De Klaproos”.&#x0D; We studied the experiences of (1) health care professionals and (2) relatives/informal caregivers of persons nearing the end of life who reside in these 2 hospices.&#x0D; Methods: A qualitative study was conducted: (1) two focus groups with a total of 17 care professionals of the respective hospices; and (2) ten individual interviews with relatives of persons who stayed in one of the respective hospices during the past year. Information concerning the experienced hospice care in terms of (1) added value and (2) bottlenecks was gathered.&#x0D; Results: In terms of added value, the following points emerged: the peaceful atmosphere, the "near-home feeling", the continuous proximity of care professionals and/or volunteers, the strong bond of trust between care professionals, residents and loved ones, the interdisciplinarity of the care (psychological, medical, spiritual and social) and the strong focus on the quality of dying and on aftercare.&#x0D; The main bottleneck is that these types of hospices currently are not officially recognized nor subsidized by government. As a result, hospices sometimes face staff shortages and a lack of resources, and their future is uncertain. Moreover, the cost for the resident is higher than in case of hospitalization.&#x0D; Conclusion: This study very clearly shows the added value of hospice care, from the perspective of both formal and informal caregivers. However, structural financing is necessary for the continued existence of these types of hospices, and in order to reduce the cost for residents, to recruit the necessary staff and to provide them with the necessary training.&#x0D; In future research, also the resident’s perspective should be included.

Perceptions of Older Immigrants About Health Care in the Host Countries: A Narrative Review

Older immigrants may have different needs regarding health and care services compared to other age groups. There are suggestions for adapting health services to the elderly and even immigrant elderly in order to provide equal service to everyone. There are studies indicating that with advancing age chronic diseases increase and functional capacity decreases, resulting in poorer physical and psychosocial health in immigrant elderly than in the general elderly population. It is stated that immigrants’ use of health services is lower than that of general population. Cultural and social factors influence health behaviors, opportunities, wishes and barriers for patients to access and use health and care services. Studies stated that elderly immigrants not knowing how to apply for health services, having language problems and being ineffective in communication with healthcare professionals, and experiencing lack of/insufficient social, community and family support, are lead to isolation and inadequate use of health services. In the narrative review, it is aimed to explore the existing research which was conducted on the experiences and perspectives of older immigrants, formal and informal caregivers and healthcare workers regarding health and care services and as well as interventions for better adaptation of health and care services among older immigrants.

Mental Health of Caregivers of Elderly Patients: The Impact of Psychotropic Drugs on Quality of Life, Anxiety, Depression, and Stress

Caregiver burden is a common impairment resulting from coping with the physical dependence and mental incapacity of the care subject. This study aimed to assess the self-perception of formal and informal caregivers of elderly patients regarding burden, quality of life, anxiety and depression, stress, and the impact of psychotropic drugs. The questionnaire was disseminated in nursing homes and caregivers' associations. Statistical analysis was carried out using SPSS V.28, with a significance level of α = 0.05. The questionnaires used were the Sociodemographic Questionnaire, the Depression, Anxiety and Stress Scales, the Zarit Scale, the Satisfaction with Medication Treatment Questionnaire and Quality of Life. The sample consisted mainly of female individuals, with an average age of 52 years, residing in the northern region of the country and mostly married. Around half of the respondents admitted taking some psychotropic drug, namely selective serotonin reuptake inhibitor(s) or benzodiazepines. Caregivers who use medication report being moderately satisfied with it, and global satisfaction was correlated with the convenience and effectiveness of the medication. Caregivers also demonstrate that being a caregiver has a high impact on their quality of life, and informal caregivers are those who report a more severe state of depression, anxiety, and stress. The current study highlights the need to assess mental health status and the impact of pharmacotherapy on the quality of life of caregivers of elderly patients.

Usability and Feasibility Assessment of a Social Assistive Robot for the Older People: Results from the GUARDIAN Project.

In Italy, many people aged over 65 cannot live independently, causing an overall decrease in their quality of life and a need for social and health care. Due to the lack of both formal and informal caregivers, technological solutions become of paramount importance in this scenario. This article describes the user-centered development of the GUARDIAN ecosystem, consisting of a social robot integrated with two mobile applications which aim to monitor, coach, and keep the older user company in order to prolong his/her independence at home. In particular, the advancements from the alpha to the beta prototype of the ecosystem are described, achieved through the feedback collected from 41 end users-older people and their carers-that have tested the system for 6 weeks. By enhancing human-robot interaction, a positive improvement in terms of usability and acceptability of the system was retrieved. However, to increase the perceived usefulness and the impact on older users' lives, it is necessary to make the entire system more customizable, and more capable in providing support for daily activities.

RURAL DISPARITIES IN THE USE OF FAMILY AND FORMAL CAREGIVING FOR OLDER ADULTS WITH DISABILITIES

Abstract As federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, reliance on formal (paid) and family (unpaid) caregivers for support at home nationally has increased in recent years. Yet, it’s unknown if use of formal and family care varies by rurality as a disproportional share of the aging population reside in rural areas. Using the Health and Retirement Study, we describe patterns in receipt of combinations of formal and family home care by rurality among community-dwelling adults aged 65+ with functional limitations from 2004-2016. Compared to older adults in urban areas, older adults in rural areas are more likely to receive any family care than those in urban areas and less likely to receive any formal care (2.4 and -4.4 percentage points respectively, p&amp;lt;0.05). From 2004 to 2016, a growing proportion of older adults in rural areas receive care from family caregivers exclusively while a decreasing proportion receive care from formal caregivers exclusively. When examining older adults in urban areas, we find the opposite trend — a growing proportion of urban adults rely exclusively on formal care and a decreasing proportion rely exclusively on family care. We find that national estimates of sources of caregiving and their trends mask significant heterogeneity in uptake by rurality. Understanding how older adults in rural areas are, or are not, receiving home-based care compared to their urban peers and how these patterns are changing over time is the first step to informing supports for family and formal caregivers.