Where You Age Matters: Individual- and County-Level Predictors of Formal and Informal Care in Rural Appalachia

Abstract

Objective: Despite overall improvements in the U.S. health care, older adults living in rural counties, such as Appalachian Virginia, continue to be underserved.

Method: Multinomial regression models, including both individual and county data from 503 older adults aged 65+, were used to examine factors associated with informal and formal care use.

Results: Older adults with stronger filial beliefs and less positive attitudes toward community services preferred informal help. If the county had more formal care services, however, older adults were more likely to use them, regardless of their filial beliefs. Disparities based on gender were observed, in that women who lived in counties with a higher percentage of older adults below the poverty line were more likely to receive no help than men.

Discussion: Developing effective service promotion tactics, destigmatizing community services, and targeting services and support, especially to women, could decrease health disparities in rural Appalachia and similar geographic areas.

Keywords: care-mix; formal care; health disparities; informal care; rural.

Figure 1.

A heuristic model depicting interactions among contexts to predict care-mix.