title: Intended use of informal long-term care: the role of race and ethnicity.
abstract: OBJECTIVE
  To examine the role of race/ethnicity in the use of informal long-term care among African American and white elders, using an expanded Andersen model of health services use (Bradley et al., Health Services Research, vol. 37, pp. 1221-1242, 2002).
  
  
  METHODS
  Four hundred respondents (n = 200 African American; n=200 white) aged 65 and older, who had been hospitalized within the last year. Data were collected using a cross-sectional survey analyzed with ordered logistic regression. Independent variables included individuals' predisposing factors, enabling factors, need, and psychosocial factors. Intended use of informal long-term care was defined based on responses to a hypothetical scenario of future use of unpaid services by family members, relatives, friends, or neighbors for help with daily needs.
  
  
  RESULTS
  African American respondents were more likely than white respondents to intend to use informal long-term care. This effect persisted (p < 0.05) after controlling for predisposing, enabling, and need factors. However, race/ethnicity-related differences in intended use were attenuated substantially (14-18%) after controlling for psychosocial differences. Further, in the fully adjusted models, race/ethnicity was no longer significantly associated with intended long-term care use.
  
  
  CONCLUSIONS
  Psychosocial factors, particularly social norms concerning family caregiving, mediated the relationship between race/ethnicity and intended use of informal long-term care. A fuller appreciation of the multiple influences on healthcare decision making of older adults has the potential to inform policy efforts to appropriately meet the respective long-term care needs of an ethnically diverse frail older population.
authors.affiliation: Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06520-8034, USA. elizabeth.bradley@yale.edu
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McGraw
authors.forename: Tashonna R
authors.initials: TR
authors.lastname: Webster
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Ronald
authors.initials: R
authors.lastname: Andersen
mesh_terms: D000203:Activities of Daily Living; D001741:Black or African American; D000368:Aged; D017028:Caregivers; D003237:Connecticut; D003430:Cross-Sectional Studies; D003625:Data Collection; D005006:Ethnicity; D005260:Female; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D044465:White People