title: Understanding factors that influence success of home- and community-based services in keeping older adults in community settings.
abstract: OBJECTIVE
  To understand factors that influence success of home- and community-based services in keeping older adults in community settings, we examined the causal relationships among older adults' personal factors, older adults' home- and community-based services use, and older adults' remaining in communities.
  
  
  METHODS
  Structural equation modeling was employed to test a home- and community-based services model based on Andersen's Health Behavioral Model. Data from 5,294 elders in a nationally representative dataset, the Second Longitudinal Study of Aging, were included for analysis.
  
  
  RESULTS
  Two significant supportive factors for older adults to remain in communities were use of paid instrumental activities of daily living (IADL) personal care services and awareness of unmet needs.
  
  
  CONCLUSIONS
  Our findings suggest the importance of encouraging older adults to acknowledge their unmet needs and to seek community-based support services early, rather than wait until they have developed more serious needs, such as difficulties in activities of daily living (ADL).
authors.affiliation: University of Washington, Seattle, WA 98195, USA. yameic@u.washington.edu
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Chen
authors.forename: Elaine Adams
authors.initials: EA
authors.lastname: Thompson
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D016009:Chi-Square Distribution; D003153:Community Health Services; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006301:Health Services Needs and Demand; D006699:Home Care Services; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D009735:Nursing Homes; D012111:Residence Characteristics; D012944:Social Support; D013223:Statistics as Topic