The purpose of this study was to examine the relationship between informal caregiver life satisfaction and receipt of outpatient medical care in persons with dementia. We obtained data from the National Longitudinal Caregiver Survey (NLCS), a survey of 1,269 veterans with dementia and their primary informal caregivers. NLCS data were merged with 12 months of Veteran Administration outpatient claims. Outpatient visits were classified as (a) primary, (b) specialty, or (c) mental health care. Greater levels of caregiver-reported life dissatisfaction were associated with decreased likelihood of care-recipient outpatient visits for both primary and mental health care. In addition, we found that care-recipients with African American caregivers were less likely to receive a mental health visit, and those coresiding with their caregiver were more likely to receive a specialty care visit. Our findings suggest that low caregiver life satisfaction may signal an impending breakdown in care-recipients' access to primary and mental health care.
Aday, L.A., & Andersen, R.M. (1981). Equity of access to medical care: A conceptual and empirical overview. Medical Care, 19(Suppl. 12), 4-27.
3.
Alzheimer's Association. (2005). Alzheimer's disease statistics (2005) [on-line]. Retrieved April 4, 2009, from http://www.alz.org/AboutAD/statistics.asp
4.
American Psychiatric Association. (1997). Practice guideline for the treatment of patients with Alzheimer's disease and other dementias of late life [on-line]. Compendium2006. Retrieved April 4, 2009, from www.psych.org/psych_pract/treatg/pg/AlzheimersPG_05-15-06.pdf
5.
Ashton, C.M., Petersen, N.J., Wray, N.P., & Yu, H.J. (1998). The Veterans Affairs medical care system: Hospital and clinic utilization statistics for 1994. Medical Care, 36, 793-803.
6.
Bass, D.M., & Noelker, L.S. (1987). The influence of family caregivers on elder's use of in-home services: An expanded conceptual framework. Journal of Health and Social Behavior, 28, 184-196.
7.
Beach, S.R., Schulz, R., Williamson, G.M., Miller, L.S., Weiner, M.F., & Lance, C.E. (2005). Risk factors for potentially harmful informal caregiver behavior. Journal of American Geriatrics Society , 53, 255-261.
8.
Beers, M., & Berkow, R. (Eds.). (2000). The Merck manual of geriatrics (3rd ed.). Whitehouse Station, NJ: Merck Research Laboratories.
9.
Belle, S.H., Burgio, L., Burns, R., Coon, D., Czaja, S.J., Gallagher-Thompson, D., et al. (2006). Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Annals of Internal Medicine, 145, 727-738.
10.
Bonnie, R.J., & Wallace, R.B. (2003). Elder mistreatment: Abuse, neglect, and exploitation in an aging America. Washington, DC: National Academies Press.
11.
Boustani, M., Sachs, G., & Callahan, C.M. (2007). Can primary care meet the biopsychosocial needs of older adults with dementia? Journal of General Internal Medicine, 22, 1625-1627.
12.
Bradburn, N. (1969). The structure of psychological well-being. Chicago: Aldine.
13.
Buhr, G.T., Kuchibhatla, M., & Clipp, E.C. (2006). Caregivers' reasons for nursing home placement: Clues for improving discussions with families prior to the transition. Gerontologist, 46(1), 52-61.
14.
Callahan, C.M., Boustani, M.A., Unverzagt, F.W., Austrom, M.G., Damush, T.M., Perkins, A.J., et al. (2006). Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: A randomized controlled trial. Journal of the American Medical Association, 295, 2148-2157.
15.
Cravens, D.D., Mehr, D.R., Campbell, J.D., Armer, J., Kruse, R.L., & Rubenstein, L.Z. (2005). Home-based comprehensive assessment of rural elderly persons: The CARE project. Journal of Rural Health, 21, 322-328.
16.
Cummings, J.L., Frank, J.C., Cherry, D., Kohatsu, N.D., Kemp, B., Hewett, L., et al. (2002a). Guidelines for managing Alzheimer's disease: PartI. Assessment. American Family Physician, 65, 2263-2272.
17.
Cummings, J.L., Frank, J.C., Cherry, D., Kohatsu, N.D., Kemp, B., Hewett, L., et al. (2002b). Guidelines for managing Alzheimer's disease: Part II. Treatment. American Family Physician, 65, 2525-2534.
18.
D'Hoore, W., Bouckaert, A., & Tilquin, C. (1996). Practical considerations on the use of the Charlson comorbidity index with administrative data bases. Journal of Clinical Epidemiology, 49, 1429-1433.
19.
de Leval, N. (1995). Scales of depression, ill-being and the quality of life-Is there any difference? An assay in taxonomy. Quality of Life Research, 4, 259-269.
20.
Dejong, G., Palsbo, S.E., Beatty, P.W., Jones, G.C., Knoll, T., & Neri, M.T. (2002). The organization and financing of health services for persons with disabilities. Milbank Quarterly, 80, 261-301.
21.
DiMatteo, M.R., Lepper, H.S., & Croghan, T.W. (2000). Depression is a risk factor for non-compliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101-2107.
22.
Fillenbaum, G.G. (1988). Multidimensional functional assessment of older adults. Hillsdale, NJ: Lawrence Erlbaum.
23.
Fiscella, K., Franks, P., Doescher, M.P., & Saver, B.G. (2002). Disparities in health care by race, ethnicity, and language among the insured: Findings from a national sample. Medical Care, 40(1), 52-59.
24.
Fortney, J.C., Steffick, D.E., Burgess, J.F., Jr., Maciejewski, M.L., & Petersen, L.A. (2005). Are primary care services a substitute or complement for specialty and inpatient services? Health Services Research, 40, 1422-1442.
25.
Greenberger, H., & Litwin, H. (2003). Can burdened caregivers be effective facilitators of elder care-recipient health care? Journal of Advanced Nursing , 41, 332-341.
26.
Hassing, L.B., Hofer, S.M., Nilsson, S.E., Berg, S., Pedersen, N.L., McClearn, G., et al. (2004). Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: Evidence from a longitudinal study. Age Ageing, 33, 355-361.
27.
Headey, B., Kelley, J., & Wearing, A. (1993). Dimensions of mental health: Life satisfaction, positive affect, anxiety and depression. Social Indicators Research, 29, 63-82.
28.
Hebert, L.E., Scherr, P.A., Bienias, J.L., Bennett, D.A., & Evans, D.A. (2003). Alzheimer disease in the US population: Prevalence estimates using the 2000 census. Archives of Neurology, 60, 1119-1122.
29.
Hinton, L., Franz, C.E., Reddy, G., Flores, Y., Kravitz, R.L., & Barker, J.C. (2007). Practice constraints, behavioral problems, and dementia care: Primary care physicians' perspectives. Journal of General Internal Medicine, 22, 1487-1492.
30.
Kohout, F.J., Berkman, L.F., Evans, D.A., & Cornoni-Huntley, J. (1993). Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. Journal of Aging and Health, 5, 179-193.
31.
Koivumaa-Honkanen, H.T., Viinamaki, H., Honkanen, R., Tanskanen, A., Antikainen, R., Niskanen, L., et al. (1996). Correlates of life satisfaction among psychiatric patients. Acta Psychiatrica Scandinavica, 94, 372-378.
32.
Landerman, R., George, L.K., Campbell, R.T., & Blazer, D.G. (1989). Alternative models of the stress buffering hypothesis . American Journal of Community Psychology, 17, 625-642.
33.
Langner, T.S. (1962). A twenty-two item screening score of psychiatric symptoms indicating impairment. Journal of Health and Human Behavior, 3, 269-276.
34.
Lee, H.B., & Lyketsos, C.G. (2003). Depression in Alzheimer's disease: Heterogeneity and related issues. Biological Psychiatry , 54, 353-362.
35.
Maciejewski, M.L., Perkins, M., Li, Y.F., Chapko, M., Fortney, J.C., & Liu, C.F. (2007). Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: An observational cohort study. BMC Health Services Research, 7, 56.
36.
Moore, M.J., Zhu, C.W., & Clipp, E.C. (2001). Informal costs of dementia care: Estimates from the National Longitudinal Caregiver Study. Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 56, S219-S228.
37.
Pfeiffer, E. (1979). A short psychiatric evaluation schedule. Paper presented at the Bayer Symposium VII: Brain Function in Old Age, Berlin, Germany.
38.
Posner, H.B., Tang, M.X., Luchsinger, J., Lantigua, R., Stern, Y., & Mayeux, R. (2002). The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology , 58, 1175-1181.
39.
Shrive, F.M., Stuart, H., Quan, H., & Ghali, W.A. (2006). Dealing with missing data in a multi-question depression scale: A comparison of imputation methods. BMC Medical Research Methodology, 6, 57.
40.
Sleath, B., Thorpe, J., Landerman, L.R., Doyle, M., & Clipp, E. (2005). African-American and White caregivers of older adults with dementia: Differences in depressive symptomatology and psychotropic drug use. Journal of American Geriatrics Society, 53, 397-404.
41.
Sloane, P.D., Zimmerman, S., Suchindran, C., Reed, P., Wang, L., Boustani, M., et al. (2002). The public health impact of Alzheimer's disease, 2000-2050: Potential implication of treatment advances. Annual Review of Public Health, 23, 213-231.
42.
Strine, T.W., Chapman, D.P., Kobau, R., Balluz, L., & Mokdad, A.H. (2004). Depression, anxiety, and physical impairments and quality of life in the U.S. noninstitutionalized population. Psychiatric Services, 55, 1408-1413.
43.
Szilagyi, P.G., Bordley, C., Vann, J.C., Chelminski, A., Kraus, R.M., Margolis, P.A., et al. (2000). Effect of patient reminder/recall interventions on immunization rates: A review. Journal of the American Medical Association, 284, 1820-1827.
44.
Tariot, P.N., Mack, J.L., Patterson, M.B., Edland, S.D., Weiner, M.F., Fillenbaum, G., et al. (1995). The Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer's Disease. The Behavioral Pathology Committee of the Consortium to Establish a Registry for Alzheimer's Disease. American Journal of Psychiatry, 152, 1349-1357.
45.
Thorpe, J.M., Kalinowski, C.T., Patterson, M.E., & Sleath, B.L. (2006). Psychological distress as a barrier to preventive care in community-dwelling elderly in the United States. Medical Care, 44, 187-191.
46.
Thorpe, J.M., Sleath, B.L., Thorpe, C.T., Van Houtven, C.H., Blalock, S.J., Landerman, L.R., et al. (2006). Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia. Medical Care, 44, 713-721.
47.
Toseland, R.W., McCallion, P., Gerber, T., & Banks, S. (2002). Predictors of health and human services use by persons with dementia and their family caregivers. Social Science & Medicine, 55, 1255-1266.
48.
Toseland, R.W., McCallion, P., Gerber, T., Dawson, C., Gieryic, S., & Guilamo-Ramos, V. (1999). Use of health and human services by community-residing people with dementia. Social Work, 44, 535-548.
49.
Vickrey, B.G., Mittman, B.S., Connor, K.I., Pearson, M.L., Della Penna, R.D., Ganiats, T.G., et al. (2006). The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Annals of Internal Medicine, 145, 713-726.
