Intended use of informal long-term care: the role of race and ethnicity

Abstract

Objective: To examine the role of race/ethnicity in the use of informal long-term care among African American and white elders, using an expanded Andersen model of health services use (Bradley et al., Health Services Research, vol. 37, pp. 1221-1242, 2002).

Design: Four hundred respondents (n = 200 African American; n=200 white) aged 65 and older, who had been hospitalized within the last year. Data were collected using a cross-sectional survey analyzed with ordered logistic regression. Independent variables included individuals' predisposing factors, enabling factors, need, and psychosocial factors. Intended use of informal long-term care was defined based on responses to a hypothetical scenario of future use of unpaid services by family members, relatives, friends, or neighbors for help with daily needs.

Results: African American respondents were more likely than white respondents to intend to use informal long-term care. This effect persisted (p < 0.05) after controlling for predisposing, enabling, and need factors. However, race/ethnicity-related differences in intended use were attenuated substantially (14-18%) after controlling for psychosocial differences. Further, in the fully adjusted models, race/ethnicity was no longer significantly associated with intended long-term care use.

Conclusions: Psychosocial factors, particularly social norms concerning family caregiving, mediated the relationship between race/ethnicity and intended use of informal long-term care. A fuller appreciation of the multiple influences on healthcare decision making of older adults has the potential to inform policy efforts to appropriately meet the respective long-term care needs of an ethnically diverse frail older population.