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Title:Utilization of healthcare services among older adults: The role of spousal caregiving and psychological well-being
Author(s):Wang, Yang
Director of Research:Tabb Dina, Karen
Doctoral Committee Chair(s):Tabb Dina, Karen
Doctoral Committee Member(s):Zhan, Min; Andrade, Flavia; Hernandez, Rosalba
Department / Program:School of Social Work
Discipline:Social Work
Degree Granting Institution:University of Illinois at Urbana-Champaign
Degree:Ph.D.
Genre:Dissertation
Subject(s):Psychological well-being
Older spousal caregivers
healthcare
Abstract:Older adults often bear the responsibility of taking care of their spouses who have physical or cognitive impairments. While previous studies have suggested various caregiving-related negative experiences are related to older spousal caregivers’ mental health status, the levels of psychological well-being (PSW) among caregivers has not been fully explored. Having a lower level of PSW has not been examined as a potential barrier to healthcare services use, and it is also unclear how similar or different the association is between caregivers and non-caregivers. This study aims to, first, describe and compare the levels (higher or lower) of PSW between older spousal caregivers and non-caregivers. The second purpose of this study is to examine if PSW is associated with the use of healthcare services among older adults who have a spouse/partner. The third purpose is to examine if caregiver status makes a difference in the association between older adults’ healthcare service use and their PSW. The study sample was drawn from wave 2014 and wave 2016 of the Health and Retirement Study (HRS). HRS holds a nationally representative sample of adults older than 50. This sample consists of 3,857 adults who were above 50 and had spouses/partners in 2014. In this sample, 376 of the participants provided care in activities in daily life (ADL) or instrumental activities in daily life (IADL) to their spouses/partners. Three hundred and thirty-one of them had a spouse/partner who needed care, but did not provide the care to their spouse/partner. The majority of participants, 3,150 of them, did not provide care to their spouse/partner, and their spouse/partner also did not need care. Caregiver status was determined by information reported by care recipients. PSW was measured by the Satisfaction with Life Scale, the Purpose in Life Test, and the Positive and Negative Affect Schedule-Expanded Form (for this form, 20 of 25 items were used). Utilization of healthcare services was assessed by two measurements. The first was the number of times respondents had spoken with a healthcare provider about their health issues in the last two years. The second was the total number of types of preventive healthcare services respondents had used during the last two years. Descriptive analysis was used to describe the levels of PSW for caregivers, non-caregivers with need, and non-caregivers without need, by factors related to PSW. Multivariable linear regression was used to analyze the association between PSW and spousal caregiver status. Negative binomial regression and Poisson regression were used to analyze the association between participants’ PSW and their physician visits and their preventive care service use, as well as the moderating effect of caregiver status. Findings indicate that (1) Spousal caregivers and non-caregivers with need had lower levels of PSW, compared to non-caregivers without need. After adjusting for the covariates, the difference was insignificant. (2) Older adults’ physician visits was not associated with any domain of their PSW, while older male adults having a higher level of negative affect and older female adults having a higher level of purpose of life used more types of preventive care services. (3) For non-caregiver with need, their physician visits and the female’s preventive care use were more responsive to PSW. The findings have implications for policy, practice, and research. Policy suggestions are made to promote the training of geriatric mental health social workers, because older spousal caregivers’ PSW could be protected by promoting that population’s enabling resources and health status, and well-trained geriatric mental health social workers can help to achieve it. Practical suggestions regard enhancing caregivers’ healthier behaviors by using family-based intervention projects, couple-oriented intervention projects, and educational programs. Moreover, social workers need to be aware of the role that negative affect and purpose of life play in health behaviors, and inform clients about the possible outcomes of each alternative they choose. Future research should examine the long-term effect of PSW on spousal caregivers’ healthcare service use. They also need to consider the effect of contextual factors. Moreover, non-caregivers with need is a group which needs more research.
Issue Date:2019-07-12
Type:Text
URI:http://hdl.handle.net/2142/105942
Rights Information:Copyright 2019 Yang Wang
Date Available in IDEALS:2019-11-26
Date Deposited:2019-08


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