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Dementia Care in Rural Appalachia: Multilevel Analysis of Individual- and County-Level Factors
Suyoung Nah1, Jyoti Savla1,2, Karen A Roberto1,3
1Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA.
The Gerontologist
|April 25, 2024
Summary
Informal support increases access to home and community-based services (HCBS) for dementia caregivers in rural Appalachia. However, travel time and service availability remain barriers to HCBS utilization.
Area of Science:
- Gerontology
- Health Services Research
- Rural Health
Background:
- Home- and community-based services (HCBS) offer significant benefits but are underutilized.
- Dementia caregiving in rural Appalachia presents unique challenges to service access.
- Andersen's behavioral model provides a framework for understanding HCBS utilization.
Purpose of the Study:
- To examine individual- and county-level factors influencing HCBS utilization for dementia care in rural Appalachia.
- To identify barriers and facilitators to HCBS use among family caregivers.
- To inform policy recommendations for improving HCBS access in underserved rural areas.
Main Methods:
- Multilevel analyses of data from 123 dementia family caregivers in rural Appalachian counties.
- Telephone interviews assessed individual-level factors and service use.
- County-level data on service availability and public funding were incorporated.
Main Results:
- Caregiver receipt of informal support was associated with increased use of home-based services.
- Longer travel times to providers correlated with decreased use of community-based services.
- Higher numbers of home health agencies in a county were linked to greater home-based service utilization.
Conclusions:
- Informal support facilitates HCBS use for dementia care in rural settings.
- Geographic accessibility and service availability are critical determinants of HCBS utilization.
- Policy interventions should focus on increasing direct public funding to expand HCBS availability in rural regions.
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