This competitive renewal application builds upon instrument development and findings from current research on """"""""settled"""""""" (4.5 years average) family caregivers of patients with; the physical impairments. Alzheimer's Disease, and Cancer in order to achieve the following two goals. First, to identify and inception cohort of 750 family members who are NEW to caregiving and to follow them over 18 months and compare those who persist with those who cease caregiving. Second, to describe and compare the dispositions of patients whose caregivers persist and cease (institutionalization in pursing homes and acute care settings, death, cared for by another family member or paid caregiver, recovery). Achieving these two goals will serve the following policy and theoretical ends. For policy, comparing the courses of patients whose caregivers cease with those who persist, controlling for difference in functional status and technology, will indicate how the loss of a caregiver impacts the costs and utilization of formal services; the potential to intervene early in the course of home care to maintain the family caregiver; and to describe how assumption of care by a NEW caregiver following receipt of skilled home care impacts the patient and that family member over time. For theory, this approach permits calculation of true rates of attrition, not just attrition among caregivers who have already survived to varying points in time, as most studies reported, and then to described which caregivers persists and compare their characteristics with those who cease using an event history technique. Finally, structural equation modeling will be used to arrange causal patterns of process and outcome variables for patients and caregivers over the 18 month observation period. In conclusion, this proposed work is a logical extension of current research and will allow this term to pursue and complete a comprehensive understanding of the trajectories of family caregivers.
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