Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The majority of rural older adults with Alzheimer's disease (AD) live at home and are cared of by family members, relatives, friends or neighbors (Buckwalter, Smith, & Caston, 1994). An increasing number of rural older adults with AD also have used home and community based services (HCBS) provided by social service agencies (Buckwalter, Smith, & Caston, 1994). Considering the challenges in family care and the barriers to HCBS in rural communities, this study is to identify factors that are associated with adequacy of care provided to rural older adults with AD. Methods: This study included 110 primary caregivers in central Illinois. An eligible primary caregiver was an English-speaking adult who was currently providing the greatest amount of unpaid services to an older adult who was 60 years or older, was diagnosed with probable or possible AD, lived at a home located in a rural community defined as having a population of fewer than 5000 residents, and needed assistance with one or more activities of daily living (ADL) (e.g., feeding, dressing, bathing) or instrumental activities of daily living (IADL) (e.g., taking medications, shopping, food preparation). Ordinary least square regression analysis was used to identify the factors that were associated with adequacy of care. Results: The model predicting adequacy of care was statistically significant (F[12, N=110]=4.43, p<.0001) and explained 35.3% of the variance. Factors including caregiver burden, and care recipient's gender, health status, problematic behaviors, and levels of formal assistance were related to adequacy of care. Caregivers who experienced a higher level of burden were likely to report a lower rating on adequacy of care (t=-2.14, p=.03). Compared with their male counterparts, female older adults were more likely to receive a lower rating on adequacy of care (t=-2.19, p=.03). Older adults with better health were likely to receive a higher rating on adequacy of care (t=2.33, p=.02). Older adults with more severe behavioral problems tended to receive a lower rating on adequacy of care (t=-1.66, p=.099). Finally, older adults who received higher levels of formal assistance received a higher rating on adequacy of care (t=2.35, p=.02). Implications for Practice or Policy: To improve adequacy of care provided to rural older adults with AD, programs should be developed or improved to better address the important factors identified in this study. For example, educational programs on the possible causes and triggers of problematic behaviors and management strategies could help informal caregivers and home health aids gain a better understanding of these behaviors and improve their skills handling them (Burgio, Stevens, Guy, Roth, & Haley, 2003). Social workers should also provide information about programs such as respite care, adult day services, support groups, and self-care that may help prevent and/or release caregiver burden. Finally, since the reception of formal services improves adequacy of care, social service providers need to carefully assess older adults' service needs and provide appropriate formal services accordingly.