title: Informal Caregiver Disability and Access to Preventive Care in Care Recipients.
abstract: BACKGROUND
  Many informal caregivers of dependent midlife and older adults suffer from their own functional limitations. The impact of caregiver functional limitations on care recipient receipt of preventive services is unknown. The purpose of this study is to examine the association between caregiver functional limitations and decreased access to recommended preventive services in dependent care recipients.
  
  
  METHODS
  Dependent adults (those receiving assistance with activities of daily living or instrumental activities of daily living) and their primary informal caregiver were identified from pooled alternate years (2000-2008) of the nationally representative Medical Expenditure Panel Survey (data analyzed February-October 2014). The impact of caregiver limitations (cognitive, mobility, sensory, emotional health) on care recipient's receipt of up to seven different preventive services was assessed via survey-weighted linear and logistic regression.
  
  
  RESULTS
  Of the 5-year weighted estimate of 14.2 million caregiver-care recipient dyads, 38.0% of caregivers reported at least one functional limitation. The percentage of recommended preventive services received by care recipients was significantly lower if the caregiver had cognitive, mobility, or emotional health limitations. Each type of caregiver functional limitation was negatively associated with at least four different preventive services.
  
  
  CONCLUSIONS
  Informal caregivers burdened by their own functional impairments may face challenges in facilitating access to preventive care in dependent midlife and older adults. Policies and interventions designed to prevent or mitigate the impact of caregiver functional impairments are critical to the success of community-based models of care for dependent adults.
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System and the Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania; Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania. Electronic address: jmthorpe@pitt.edu.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System and the Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania; Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Division of General Internal Medicine, School of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Courtney H
authors.initials: CH
authors.lastname: Van Houtven
authors.affiliation: Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania.
authors.forename: Loren
authors.initials: L
authors.lastname: Schleiden
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires