The investigators' current involvement with a prospective cross-cultural study involving nearly 2000 elderly Japanese Americans affords a unique opportunity to study patterns of long-term care utilization and determinants of nursing home placement in this minority group. The subjects vary considerably in cognitive and physical capacity as well as family and economic support; many subjects are at high risk of nursing home placement.
Aim 1) The frequency of nursing home use (the main outcome of interest) will be ascertained by following subjects longitudinally. Incidence of nursing home placement, length of stay, and whether subjects are placed in an ethnically-oriented Japanese nursing home or other nursing homes will be recorded, as will the magnitude of formal (paid) home care service use.
Aim Aim 2) Using structured interviews, determinants of long-term care use will be obtained at enrollment and updated periodically on all study subjects. These include: cognition, physical function, family support structure, and the preferences and attitudes of subjects regarding use of nursing homes. Hypothesis 1) Although functional and cognitive impairment are expected to be powerful predictors of nursing home placement, other factors, such as elaborate family structure and liberal involvement of family members in care, as well as culturally based preferences and attitudes regarding nursing homes, may also be significant predictors of placement in this population. A higher proportion of subjects is expected to enter a Japanese nursing home than other nursing homes.
Aim 3) When subjects are cognitively or functionally impaired, they will be designated as care receivers. Their caregivers' demography, health, ways of coping, burden, affect, and preferences and attitudes regarding use of nursing homes, as well as subject behaviors (as assessed by caregivers), will be obtained at that time. The Fishbein-Ajzen model of attitude- behavior relationships will be used in analyzing data from the subset of the cohort so designated. Hypothesis 2) Subjective norms (caregivers' perceptions of what other people think they should do) will be more important than the caregivers'own personal attitudes in determining their intention to place care receivers in nursing homes. This is based upon the Japanese cultural emphasis on conforming to a community norm; family is of primary importance. Low perceived psychosocial support, small available social network, and failing health of caregivers are expected to increase intent to place minority elderly in nursing homes.
