Yale University School of Medicine, 333 Cedar Street, SHM I-456, PO Box 208088, New Haven, CT, 06510-8088, USA.
Yale University School of Nursing, 333 Cedar Street, SHM I-456, PO Box 208088, New Haven, CT, 06510-8088, USA.
BMC Geriatr. 2020 Feb 14;20(1):58. doi: 10.1186/s12877-019-1405-7.
Andersen's Expanded Behavioral Model of Health Services Use describes factors associated with the use of long-term services and supports (LTSS). This model, however, has only been tested on the intent to use such services among African-American and White older adults and not the actual use. Given the increasing diversity of older adults in the U.S., the ability to conceptualize factors associated with actual use of LTSS across racial/ethnic groups is critical.
We applied Andersen's Expanded model in the analysis of 2006-2010 qualitative data using multiple methods to understand both the relevancy of factors for older adults who currently use LTSS vs. those who intend to use LTSS (as described in Andersen's original exploration). We additionally explored differences in these factors across racial/ethnic groups and included Hispanic older adults in our analyses.
Four additional constructs linked with actual LTSS use emerged: losses and changes, tangible support, capability to provide informal support, and accessibility of informal support. Racial differences were seen in level of participation in decisions to use nursing home services (Not involved: 45% African-Americans vs. 24% Whites). Reports of LTSS use to avoid burdening one's family were greater among White older adults compared to African-American older adults.
Findings around decision-making and burden along with other constructs enhance our understanding of determinants that influence actual LTSS use and require targeted interventions.
安德森扩展的卫生服务利用行为模型描述了与长期服务和支持（LTSS）使用相关的因素。然而，该模型仅在非裔美国人和白人老年人群体中测试了使用这些服务的意图，而不是实际使用情况。鉴于美国老年人口的多样性不断增加，能够跨种族/族裔群体概念化与 LTSS 实际使用相关的因素至关重要。
我们应用安德森扩展模型对 2006-2010 年的定性数据进行了分析，使用多种方法来理解当前使用 LTSS 的老年人与打算使用 LTSS 的老年人（如安德森最初探索中所述）的因素相关性。我们还探讨了这些因素在不同种族/族裔群体中的差异，并将西班牙裔老年人纳入我们的分析。
出现了与实际 LTSS 使用相关的另外四个构建：损失和变化、有形支持、提供非正式支持的能力和非正式支持的可及性。在参与养老院服务使用决策的程度上存在种族差异（不参与：45%的非裔美国人与 24%的白人）。与非裔美国老年人相比，白人老年人更有可能报告使用 LTSS 是为了避免给家人带来负担。
围绕决策和负担以及其他构建的发现增强了我们对影响实际 LTSS 使用的决定因素的理解，并需要有针对性的干预措施。
