Social Ties and Community Service Utilization Among Alzheimer's Caregivers

Background and Purpose: Studies on service use by Alzheimer’s caregivers (AC) concluded that there is a high need for service, but low utilization. Despite the positive effects of social ties, not much research has been done on the relationship between social ties and service utilization among AC. What little literature there is on the relationship between AC’s social network and social support and their service utilization yields contradictory findings. While it was found that people with larger social networks may use more community services because they are encouraged by their family and friends to seek care, other studies suggested that individuals with smaller social networks will seek formal services more because they cannot receive assistance from their informal networks. The purpose of this study is to examine the role of social network size and quality of social support in predicting community service utilization among diverse groups of AC.

Methods: The study was conducted using baseline data from the NIH-funded Resources for Enhancing Alzheimer’s Caregivers Health (REACH) II project (n=670) which studied the different risk factors and interventions for AC’s health and well-being. The dependent variable for the study is the level of community service utilization by the AC.  AC’s social ties include size of social network and quality of social support. Size of social network was measured by the number of relatives, friends, and neighbors that AC see or hear, feel close to, and can call on for help.  To address the skewness, two equal-sized groups were created.  Quality of social support was measured in three domains (instrumental, informational, and emotional) and two indicators (frequency and satisfaction). SPSS was used to conduct bivariate and multivariate logistic regression.  All significance tests were two-tailed, p<.05.

Results: Quality of social support and size of social network are both important factors in predicting community service utilization.  Specifically, after controlling social demographic factors, people who receive emotional support "once in a while" are more likely to have higher level of community service utilization than people who receive no emotional support.  People who have larger social networks of relatives, friends, and neighbors are more likely to use community service than people who have smaller social networks. 

Conclusions and Implications: The findings that social ties contribute to the utilization of community services among AC suggest that social policies and programs should aim to target the more under-utilizing groups by strategizing to reach AC’s social networks. Especially, as different social support domains are related to AC’s service use, social work practitioners should identify and explore the diverse sources and degrees of AC’s social support. Further research is needed to explain the complexity of the effects of social ties on service utilization. Such knowledge will help design policies and programs to better meet the needs of AC, who are the backbone of the long term care system.