title: Early community-based service utilization and its effects on institutionalization in dementia caregiving.
abstract: OBJECTIVE
  The present study attempts to determine whether utilizing community-based long-term-care services early in the dementia caregiving career delays time to nursing home placement (adjusting for severity of dementia).
  
  
  METHODS
  With a reliance on data from 4,761 dementia caregivers recruited from eight catchment areas in the United States and followed over a 3-year period, a Cox proportional hazards model was conducted that considered key components of the stress process (e.g., context of care, primary objective and subjective stressors, and resources), duration, and community-based long-term-care use.
  
  
  RESULTS
  An analysis of interaction terms in the Cox regression model found that those individuals who utilized in-home help services earlier in their dementia caregiving careers were more likely to delay institutionalization.
  
  
  CONCLUSIONS
  The findings suggest the practical importance and cost-effectiveness implications of early community-based service use, and they emphasize the role of timing when one is conceptualizing the proliferation of stress in the dementia caregiving career.
authors.affiliation: Department of Behavioral Science, The University of Kentucky, Lexington, KY, USA. jgaugle@uky.edu
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Gaugler
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: Rosalie A
authors.initials: RA
authors.lastname: Kane
authors.forename: Robert
authors.initials: R
authors.lastname: Newcomer
mesh_terms: D002391:Catchment Area, Health; D003153:Community Health Services / Q000706:statistics & numerical data*; D003704:Dementia / Q000451:nursing*; D005260:Female; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D014481:United States