Functional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?

TitleFunctional declines, social support, and mental health in the elderly: does living in a state supportive of home and community-based services make a difference?
Publication TypeJournal Article
Year of Publication2010
AuthorsMuramatsu, N, yin, H, Hedeker, D
JournalSoc Sci Med
Volume70
Issue7
Pagination1050-8
Date Published2010 Apr
ISSN Number1873-5347
Call Numbernewpubs20100729_Muramatsu.pdf
KeywordsActivities of Daily Living, Aged, Cognition, Community Health Services, depression, Disabled Persons, Female, Home Care Services, Humans, Logistic Models, Male, Mental Health, Multilevel Analysis, Risk Factors, Social Support, Spouses, State Government, Stress, Psychological, United States
Abstract

<p>This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (>or=70 years old) covering the period 1993-2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.</p>

DOI10.1016/j.socscimed.2009.12.005
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/20117865?dopt=Abstract

Endnote Keywords

Stress/Home Care Services/community-based services/mental Health/depression

Endnote ID

22990

Alternate JournalSoc Sci Med
Citation Key7477
PubMed ID20117865
PubMed Central IDPMC3360961
Grant ListR01 AG021648 / AG / NIA NIH HHS / United States
R01 AG021648-04 / AG / NIA NIH HHS / United States