(see Poster Gallery) Persons Living with Dementia and the Mediating Role of Mobility on Home Health Service Utilization

Background/Purpose: In addition to a prevalence of behavioral symptoms, Persons Living with Dementia (PLWD) often require assistance with Instrumental Activities of Daily Living (IADLs), as well as Activities of Daily Living (ADLs). As such, family care partners of PLWD often shoulder these responsibilities and provide a greater number of hours delivering assistance to their care recipients compared to non-dementia care partners. Yet the utilization of respite services such as home health services remains low among dementia dyads. This study aimed to understand the role mobility may have in home health service utilization and applied a mobility theoretical framework involving six determinants: 1) financial, 2) psychosocial, 3) environmental, 4) physical, 5) cognitive, and 6) biographical influences. The guiding research question for this analysis was: Is the association between levels of assistance required for ADLs and service utilization with home health services as reported by proxy’s of PLWD mediated by the number of months using a device for mobility?

Methods: The sample examined represents Medicare recipients surveyed in the 2020 (round 10) National Health and Aging Trends Survey (NHATS). Cases were restricted to proxy responses provided on the behalf of PLWD (N=257). Controls included dichotomous variables, older age and Medicaid insurance, as well as dementia severity which was a sum score of questions related to behavioral disturbances occurring in the past year. Number of months using a mobility device (i.e., cane, walker, wheelchair) was a continuous variable. The independent variable ADLs represented a sum score of questions pertaining to PLWD requiring assistance with bathing, dressing, toileting, and eating. The dependent variable home health service utilization was measured by the number of months receiving hom health services since the last round of interview. Multivariate analyses were analyzed to test the mediating effects that months using mobility devices had on the relationship between ADLs and home health service utilization using PROCESS in SPSS.

Results: Model 1 (path c) showed a significantly positive relationship between ADLs and home health service utilization (b=2.14, p <.001) after controlling for older age, dementia severity, and having Medicaid insurance. Model 2 (path a) reflected a significant and positive association between ADLs and using a mobility device (b =1.65, p <.001). Model 3 (path b and c’) showed a positive and significant relationship between using a mobility device and home health service utilization (path b) (b =.399, p <.001). However, the mediating effect (path c’) through the number of months using a mobility device was observed to weaken the positive relationship between ADLs and home health service utilization (b =1.48, p<.001) compared to the original path c (b=2.14, p <.001). The indirect effect using a mobility device had on home health service utilization with ADLs was also significant (b =.657, LL=.350, UL=1.06).

Conclusions: This analysis indicates that dementia dyads may utilize home health service utilization less frequently depending on the number of months PLWD utilize mobility assistive devices. Further examination is required to understand this relationship and should consider the influence of mobility regarding home health service utilization.