title: The effects of on- and off-reservation residence on in-home service use among Great Lakes American Indians.
abstract: Community-based, in-home services are a crucial component in the long-term care continuum. Research has shown rural populations to be less likely to use these services. American Indian elders are more likely than their non-American Indian counterparts to reside in non-metropolitan areas, yet little rural research has focused on this subpopulation. The purpose of this article is to explore differences in in-home service use among urban, rural off-reservation, and rural on-reservation older American Indians using data from a statewide needs assessment. The sample includes 206 Great Lakes American Indians aged 55 and older. Predictor variables include the residential classification variable (rural off-reservation, rural on-reservation, and urban) along with sociodemographic, social support, health and functional status, and general knowledge of services. Results of logistic regression analysis indicate that the odds are significantly greater for on-reservation rural American Indian elders use of home services, home health aides, and home visits, than for urban American Indian elders. The off-reservation rural American Indian elder is significantly less likely than the urban American Indian elder to use a home health aid. Health rating, activities of daily living/instrumental activities of daily living (ADL/IADL) impairments, and general knowledge of in-home service availability increase the odds for all groups use of home services and home health aides.
authors.affiliation: Institute of Gerontology, Wayne State University, Detroit, MI 48202, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Chapleski
authors.forename: J W
authors.initials: JW
authors.lastname: Dwyer
mesh_terms: D000368:Aged; D006114:Great Lakes Region / Q000453:epidemiology; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D012111:Residence Characteristics; D012423:Rural Health / Q000706:statistics & numerical data*; D012944:Social Support; D014481:United States / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data