The purpose of this longitudinal panel study is to describe and explain the use of dementia-oriented services by persons with AD and their families. The descriptive emphasis is on patterns of use over time, and the explanatory emphasis is on identifying both direct and indirect effects of caregiver and care recipient characteristics on service contacts as well as volume and duration of use. Andersen's model of the effects of individual predisposing, enabling, and need characteristics will provide the overall framework for the study. However, substantial reoperationalization of model variables is proposed, focusing on identifying the role of normative health beliefs and caregiver perception of need on service use in this population. It is hypothesized that families will exhibit distinct patterns of service use which will be maintained over time; that certain aspects of perceived need will be strongly related to service use, and that normative health beliefs will exert a strong influence on service use through their effects on perceived need. In combination, these variables are hypothesized to improve the relative contribution of predisposing and enabling characteristics to variation in service use over previously published findings. The sample will consist of over 300 primary caregivers of persons with AD. Information on caregiver and care recipient characteristics will be obtained in cooperation with the ADRC's Clinical Core and Caregiver Core at baseline and at two additional yearly intervals. Information on service use will be collected by project staff using telephone interviews guided by a protocol designed and tested by the PI. Each subject will remain in the study for a 2-year period and subjects will be enrolled over a 2-year period. Preliminary analyses will begin early in year 3, and hypotheses will be tested in analyses performed beginning in year 4. The proposed research addresses a well-documented need for more specific longitudinal data on dementia-oriented service use. Results will contribute to the development of models appropriate for health and social service use beyond the scope of those currently available. Findings will be directly applicable to the development of appropriately targeted programs of service.
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