Kim Boah, Wister Andrew, Mitchell Barbara, Li Lun, Kadowaki Laura
Department of Gerontology, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada.
Gerontology Research Centre, Department of Gerontology, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada.
BMC Health Serv Res. 2024 Oct 1;24(1):1159. doi: 10.1186/s12913-024-11549-0.
Informal caregivers of older adults play a vital role in improving the degree to which older adults access community and healthcare services in a seamless and timely manner. They are fulfilling important navigation and support roles for their older care recipients. However, there is still little knowledge of the most significant facilitators and barriers to effective and efficient system navigation among caregivers. This paper aims to fill these knowledge gaps through investigation of the key factors (i.e., social capital/cohesion, caregiving supports, and utilization factors) affecting navigation difficulties faced by informal caregivers of older adults.
The Behavioural-Ecological Framework of Healthcare Access and Navigation (BEAN) model is used to frame the study. Using the General Social Survey on Caregiving and Care Receiving 2018, we analyzed 2,733 informal caregivers whose primary care recipients were aged 65 or older. Hierarchical logistic regression was conducted to identify the relationship between system navigation difficulties among informal caregivers and four sequentially ordered blocks of predictors: (1) sociodemographic (2), social capital/cohesion (3), caregiving supports, and (4) healthcare demand.
The fully adjusted model showed that the probability of reporting navigation difficulties was lower for caregivers with social capital/cohesion compared to those without social capital/cohesion. In comparison, the probability of reporting navigation difficulties was higher among caregivers with caregiving support and among caregivers whose care receivers use a higher amount of health service use. Several sociodemographic covariates were also identified.
Our findings support certain aspects of the BEAN model. This study extends our understanding of potential facilitators and barriers that informal caregivers of older adults face while navigating complex community and health systems. There is a need to implement coordinated schemes and health policies especially for older adults with mental/neurological issues to address the challenges of their caregivers given the specific vulnerability identified in this study. The need for further research using different approaches to examine the disproportionate impact of COVID-19 on caregivers' system navigation experience is crucial.
老年人的非正式照料者在提高老年人无缝、及时获得社区和医疗服务的程度方面发挥着至关重要的作用。他们为其老年照料对象履行着重要的引导和支持职责。然而，对于照料者有效且高效地进行系统引导的最重要促进因素和障碍，人们仍然知之甚少。本文旨在通过调查影响老年人非正式照料者引导困难的关键因素（即社会资本/凝聚力、照料支持和利用因素）来填补这些知识空白。
使用医疗服务获取与引导的行为生态框架（BEAN）模型来构建该研究。利用2018年照料与被照料的综合社会调查，我们分析了2733名主要照料对象年龄在65岁及以上的非正式照料者。进行分层逻辑回归以确定非正式照料者的系统引导困难与四个按顺序排列的预测因素组之间的关系：（1）社会人口统计学因素，（2）社会资本/凝聚力，（3）照料支持，以及（4）医疗需求。
完全调整后的模型显示，与没有社会资本/凝聚力的照料者相比，有社会资本/凝聚力的照料者报告引导困难的概率较低。相比之下，有照料支持的照料者以及其照料对象使用较多医疗服务的照料者报告引导困难的概率较高。还确定了几个社会人口统计学协变量。
我们的研究结果支持BEAN模型的某些方面。本研究扩展了我们对老年人非正式照料者在复杂的社区和卫生系统中进行引导时所面临的潜在促进因素和障碍的理解。鉴于本研究中确定的特定脆弱性，尤其需要为患有精神/神经问题的老年人实施协调方案和卫生政策，以应对其照料者面临的挑战。使用不同方法进一步研究COVID-19对照料者系统引导体验的不成比例影响的必要性至关重要。
