Expanding Caregiver Coping Strategies: The Relationship between Stress Management Behaviors and Service Utilization

Purpose. Coping mechanism has been long studied to explain large variations in the health status of informal caregivers caring for frail older adults. Many studies have identified various coping strategies and their co-occurrence. Nevertheless, few studies address interrelations between these coping strategies and there is no consensus on which strategy is more efficient to improve health status. Therefore, this study aims to conceptualize coping patterns, identify their interrelations, determine predictors related to these coping patterns, and examine coping efficacy on health status.

Methods. Using data from the 2004 National Long-Term Care and Informal Caregiver Survey (N=1908), Latent Class Analysis (LCA) classified homogeneous subgroups based on stress management behaviors (spending time alone, eating, drinking alcohol, meditation, talking with friends/relatives, exercising/hobbies, smoking, watching TV, reading, medications, and counseling) and formal service utilizations (day care/senior center, house modification, assistive devices, financial information, support group, respite service, personal/nursing care, housework service, meal delivery, and transportation). As guided by the Stress and Coping model (Lazarus & Folkman, 1984), multinomial logistic regressions identified predictors of coping patterns and examined the effects of coping patterns on health status.

Results. LCA classified stress management behavior (SMB) and formal service use (FSU) patterns. For SMB, four coping groups were classified: 3% unconstructive engagement copers; 43% constructive selection copers; 33% unconstructive selection copers; and 21% constructive disengagement copers. FSU composed three subgroups: 23% multiple service users; 36% selected service users; and 41% light service users. Constructive selection copers and constructive disengagement copers were less likely to use formal services. Stressors more significantly influenced FSU than SMB patterns. While more capable caregivers were consistently less engaged in two coping patterns, those with higher informal support were less engaged in SMB but more selected formal services. The effects of negative appraisals on coping patterns were larger than those of positive appraisals. While unconstructive selection copers had lower probability of reporting good health, multiple service users had higher probability of reporting good health. Higher unmet needs after service use were associated with worse health.

Implications. By structuring interrelations between coping strategies, typologies of various coping strategies may contribute to differentiation and targeting of services, effectively distributing program resources, and better meeting caregivers' needs. This typology process may also be beneficial to identify certain risky population who needs emergent caregiver support system. Understanding which coping strategies predict positive caregiving outcome is an important clue that could support family service providers to target and develop strategies for supporting caregivers. In light of coping strategies, the efficacy of coping strategies on health status should be further assessed with longitudinal data.