Examining Rural vs. Urban Disparities in Community-Based Helper Support and Residential Care Transitions among Medicare Beneficiaries with Dementia and Functional Limitations Public Deposited

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  • March 19, 2019
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  • Hilliard, Tandrea
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Strategies to afford elders with dementia the opportunity to remain in their homes or other community dwelling places are often desirable among various stakeholders. Informal care in the community has been shown to delay nursing home entry. Rural elders in general are particularly vulnerable for institutionalization due to reduced access to adequate community-based support. Less is known regarding geographic disparities in community-based helper support networks over time for people with dementia and functional difficulties and the direct impact of such support on residential care transitions from community dwellings to nursing facilities (i.e., skilled nursing facilities (SNFs), nursing homes, and assisted living facilities). Using a retrospective cohort of community-dwelling Medicare beneficiaries in the Medicare Current Beneficiary Survey (MCBS), this study aimed to examine the presence, magnitude, and sources of community-based helper support over time for Medicare beneficiaries age 65 and older with dementia and ADL/IADL limitations living in rural and urban residences, as well as to determine whether and how such support impacts residential care transitions. Gaps in support for functional limitations (i.e., the absence of reported help for a reported functional difficulty) were found among the full sample; however, the presence of the support gaps for functional limitations did not statistically differ across geographic areas. Compared to persons living in an urban area, persons with dementia and functional limitations who lived in a rural area adjacent to a metropolitan or micropolitan area were, on average, less likely to transition to both short- and long-term care nursing facilities. Rural-urban residence and community-based support were not associated with time-to-transition. Age and number of co-morbidities were significantly associated with time-to-first nursing facility transition. In conclusion, this study did not find evidence of geographic disparities in residential care transitions. However, differences in the composition of support networks of older persons in the community with dementia who are managing functional limitations across rural and urban communities were found. Widespread access to well-supported community living for persons with dementia or their family members who desire this option should remain a policy priority given the perpetual impact of this disease.
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  • In Copyright
Advisor
  • Dilworth-Anderson, Peggye
  • Silberman, Pam
  • Edwards, Lloyd
  • Van Houtven, Courtney
  • Domino, Marisa
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
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  • Chapel Hill, NC
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